222 replies to this topic

[invalidusername]

First I would like to say how grateful I am that people are actively helping people with this medication. I could not believe there was a whole site dedicated to this purpose!

 

So, I started switching from Citalopram (taken for 13 years) to Duloxetine as follows;

 

 

Week 1        20mg Cit / 30mg Dulox

Weeks 2-3   10mg / 60mg

Weeks 4-5   5mg / 60mg

Weeks 6-11 10mg / 60mg

Weeks 12    10mg / 30mg

 

I moved the Citalopram back up as I thought it was that which was causing the physical symptoms, but they have since remained. I reduced the Dulox last week as I thought I was at risk of serotonin syndrome. 

 

I had bad anxiety week 3, which is normal for dropping citalopram, but then weeks 6, 8, 10 and 12, I have had repeated symptoms of dizziness, fatigue and nausea. They don't let up or reduce in severity. I can understand that week 12 was expected from the drop to 30mg, but this was also due to the onset of chronic diarrhea/stomach cramps, which has lasted for over 3 weeks now. I sent a sample to the hospital for analysis, but they appeared to have lost it, so I am waiting under orders for it to turn up. Not helping my mental wellbeing.

 

Is this the Duloxetine disagreeing with me? Should I cross-taper back to Citalopram? 

 

I am really worried about my stomach problems and thinking it could be colitis or something sinister. I cannot judge whether Dulox is better for me mentally as the reoccurring physical symptoms just set my depression/anxiety off each time. I feel trapped in a very viscous circle.

 

Any help would be very gratefully received. Bless you all.

[fishinghat]

Welcome invalidusername

Several things come to mind. It could be from Citalopram withdrawal BUT you have been on Cymbalta long enough for it to fully kick in and that should take care of the withdrawal symptoms.

It could be a side effect of the Cymbalta but that would be hard to prove.

Although unlikely, it could be mild symptoms of Serotonin Syndrome. Any fever, especially just before bed or 2 hours after taking the Cymbalta? Do you take the Citalopram and the Cymbalta at the same time?

[invalidusername]

Hi fishinghat. I have been reading your posts avidly over the last few days - you certainly have helped so many, and so please to have found this site.

 

I completely agree with you about the withdrawal symptoms. I just don't understand where they came from at 11 weeks. I could understand if the episodes became further apart, or the severity lifted, but no. Each episode was similar to the last.

 

I do indeed take them both at the same time when I wake up (at the same time as making a beeline for the can). I do not have any fever. I had flushes and the sweats for the first 3-4 weeks, but these passed, thus I assumed were side effects, and they behaved as side effects should. This is why I feel there is something more sinister behind what I now have. Week 10's episode saw the worst case of restlessness I have known, along with another influx of bad anxiety. This lasted a week before it settled, but each of those days saw a respite of symptoms in the last 4-5 hours of my day... when the "Ccrap" (i'm getting the lingo!) had reached its half-life. You will know better if there is anything to be read into this. This was the same week when the diarrhea started.

 

Maybe the combination of the both are causing this? But do I really want to stay on Dulox on the off-chance this hypothesis is right... all the while knowing the nightmare awaiting me when I come off them? I at least know that Citalopram does not make me ill in any way shape or form. 13 years on them is proof enough.

 

Again, my thanks. I will continually report back so this may help others in the future. 

[invalidusername]

16 days reduced from 60mg to 30mg and this morning I woke feeling suicidal. Worst in at least 3 months or so.

 

So I took 60mg along with my 10mg citalopram around 3 hours ago. I don't know if I should have done that, I didn't really care at the time.

 

Am feeling agitated, more nausea and still suicidal... plus my usual toilet trips. No idea what I am doing or what is going on with me.

 

Please someone tell me if this is what I should expect after 2 weeks of halving the dose? Should I stick it out despite the depression, or did I do the right thing in getting back to 60mg??

[fishinghat]

"Maybe the combination of the both are causing this?"

Possible. If it is then dividing the dose will help some. One antidepressant in the morning and one in the evening.

After 12 weeks the Cymbalta should be fully kicked in so any withdrawal symptoms should not be present. My thoughts are this is either a mild case of serotonin syndrome (dividing the doses should help) or a side effect of the Cymbalta. If dividing the doses helps then you will need to start kicking back on the citalopram. If that does not help I think it is time to get the drs opinion. By the way I do know you shouldn't raise and lower doses on one given antidepressant to much as it will bring on withdrawal symptoms. Each time you bump up to 60 and then follow by going down to 30 you risk repeating the withdrawal. If the suicidal thoughts are significant then I would suggest you go see your shrink. If you don't trust your current one. This is your life and accepting a second rate dr is not going to help any.

[invalidusername]

I'm glad you agree that withdrawal should be done by now. It is one thing to rule out. The advise on splitting the doses was just what I needed - it makes sense - and it is moving forward. My depression has be bought on by nothing other than the physical symptoms of the last 5 days and the fact that I cannot get help.

 

Unfortunately here in the UK, the system doesn't work like the US. We do not automatically get a shrink. First you must be referred to the NHS mental health team by your GP (unless you have gone to hospital yourself). The wait is then typically 8-10 weeks for an assessment. At the assessment, if they feel you meet the criteria, you will be admitted to the service which will allow you access to the crisis team (an emergency 24/7 speaking or home visiting service) and a shrink if deemed a requirement. If you are found to need a shrink, there is a wait of around 6 months. I am currently waiting a second assessment, having been told I didn't meet the criteria the first time. 

 

Therefore, I am at the mercy of my GP, Google and yourselves. No-one should consider withdrawing or switching without the guidance of a professional, as you - and others here - have rightly said, but what more can I do? 

 

This is why I am so grateful for your help. I will remain on my 30mg/10mg - expect a response as a result of taking the 60mg - and split this dose morning/evening and go from there. God bless you.

[fishinghat]

What a nightmare. Can you see a shrink directly if you pay for it yourself?

Anyway, we will help the best we can.

[invalidusername]

Yes this is an option, but the costs are too high. Initial sessions are around £300, with weekly follow up at £150. So it is almost the same as renting a second apartment!

 

However, I did pay for one back in March and he told me that I was doing everything right and that the amount of stress I had at the time was the direct cause and that I needed to wait for the stresses to ease. He told me that "chopping and changing" meds is something he never advises because of the ever-present risks. I believed him. But then the other lot told me Citalopram was "too old" and I needed to be on a newer drug - enter duloxetine.

 

I feel like I might as well flip a coin sometimes. But I just don't have the sort of capital to pay for someone to supervise

[fishinghat]

I understand.  There is n o pattern to which antidepressant will work for people. It is simply trial and error. There are some who can be on a specific antidepressant for 30 years and it still be effective. Others, same antidepressant, will have it stop working after a few months and still others where it would not work at all.

 

I am interested to see what you feel like after a couple 3 days of splitting up the doses.

[invalidusername]

Absolutely. I honestly think it is my best way forward and furthermore, that between us, we are potentially helping others who are unfortunate to come across a similar mess. 

 

Having foolishly taking the 60mg this morning, I am reluctant to start the evening Citalopram this evening, so will begin with the Dulox 30mg in the morning, and Citalopram 12 hours after.

 

I really want to get information out there, so I will "diary" my progress.

 

Back soon

[fishinghat]

Fantastic!!

[gail]

Hi invalidusername,

Just a few words here, do not upper the dulox. And if you could get back on citalopram, it would be a good move.

I almost lost my mind on Cymbalta, while on it for four months and while withdrawing. I'm not often on the forum, but your story caught my attention.

[invalidusername]

Hi Gail - great to hear from you, and I am so sorry that you also went through what I am currently going through. It is so tough, so very tough.

 

But I am comforted to know that someone else had a bunch of side effects that wouldn't subside. Is one normal bowel movement in a month too much to ask

 

I will do what I can to also help - in fact I have just posted a little research I did earlier this evening about staggering meds while switching. If it helps one person, I will consider it a success. Fishinghat suggested it to potentially diagnose my present issue.

 

Anyway, I will continue to report back to let you all know how it goes.

 

Thanks again Gail....

[invalidusername]

So day 1, I took the Dulox 30mg in the morning - no Citalopram (last dose 24 hours ago). Similar day as before, but felt very tired after about 3 hours and had to rest for an hour. Mood picked up at bit mid afternoon, then had an hour of unexplained anxiety, which I put down to Citalopram withdrawal. Then had another wash of fatigue early evening for a couple of hours, but was working so couldn't do much.

 

Took 10mg Citalopram early evening and within the hour felt far less tired and mood was better - but it usually is in the evening so difficult to measure. When it came to sleep, body was very tired, but brain was quite wired so took a while to get off to sleep...

[fishinghat]

It will take 3 days for blood levels of Cymbalta to stabilize and a little longer for Citalopram so time will tell.

[invalidusername]

Day 2 say a slightly better mood in the morning, but still far from normal. This is going to be tough as I have not had a "good" day for a week now. Something that has not happened since this all started last year. I am still very easily influence by the smallest thing which can bring my mood down very quickly. But I didn't have the wall of anxiety that I had on day 1. Just a feeling of being so very fragile. 

 

I know this is largely a reaction to the length of bad days, so naturally I am going to be anxious about this continuing, I'd just like the smallest glimpse of good so I can gain some confidence. Seems that instead of doing the occasional sprint, with periods of rest, I am running a marathon where it is impossible to stop... if people understand what I mean.

[fishinghat]

"Seems that instead of doing the occasional sprint, with periods of rest, I am running a marathon where it is impossible to stop"

Exactly but it does eventually stop. Time and patience.

[invalidusername]

Day 3 - Still no change in the stomach department, but mood is just not working. I feel I will get worse. With every passing day that I spend without a glimmer of hope, it only brings me further down. I have woken this morning with the usual dread, but more potent. The thoughts of yesterdays mood are there and pulling me further down. 

 

I am doing everything by the book - working, facing any potential anxious moment, living life as if I didn't have depression, but it is always there - the dog on my back as Churchill said. I cannot loose it at all. Before last week, getting on with life would aid the depression, and at the very latest, late afternoon would see a better mood. But yesterday, it just didn't change at all. At least with the physical effects (headache, dizziness etc) I can be sure being the pills, but the depression can be something I am creating with my mood, rather than the pills decreasing the serotonin. Particularly as my physical side effects have diminished, so if depression was a side effect too, then sure this should have diminished, but it just doesn't. And this is only adding to my state.

 

Can anyone confirm this is normal behaviour of withdrawal?

 

3 weeks on 30mg Dulox and 10mg Cital. As I am only occasionally tired, and no other side effects now, I think I need to drop to 20mg of Dulox and go on 20mg of Cital. Any thoughts?

 

How long would you suggest I continue the split dose (morning/evening)? Should I have the stronger dose in the morning?

 

Again my sincere thanks for help...

[fishinghat]

Can anyone confirm this is normal behaviour of withdrawal?

Absolutely. Cymbalta focuses on controlling the serotonin and the norepinephrine in the amygdala and the hippocampus. These are the centers for fear, worry, paranoia, anxiety and even depression. Until your body heals you will experience wild swings in these emotions. There is no use in fighting it, exercising, working hard, etc. All that just stresses the body more. This is a time to take it easy rest, baby yourself. Pushing yourself only makes the symptoms worse. Time and patience.

[invalidusername]

This makes complete sense. Knowing that this is something that is "normal" and that cannot be controlled for the time being, whilst difficult, does help as it means that it is nothing that I am doing, per se, that has caused it.

 

On the plus side, day 4, I am pleased to announce, turned out much better after the first couple of hours! Still fragile, but it gave me the glimmer of hope that I needed yesterday, knowing that I could indeed feel "normal" and that I would therefore see it again. Bit dramatic again, but you all know how these feelings go. I also moved dose to 20/20 yesterday, but I think from here, it needs to be a slow taper down from 20mg. I have 38 duloxetine left, but these are 60mg, so I will have more that enough of those little balls. If need be I can get some acid-resistant capsules and build my own 15mg, 10mg etc.

 

As you have all said, I will need to listen to my body from here on....

[invalidusername]

Some good news!!!

 

Day 5 saw my diarrhea improve significantly! And again this morning! So likely an interaction of the two meds, or possibly the dose drop from 30mg to 20mg, or combination of the both. Would have been easier if I didn't lower my dose, but I don't want to lengthen the process any more than I have to.

 

True enough, if it was the interaction causing this, it doesn't mean the other side effects occurring every 10-12 days would have stopped, and I really do not want to risk that. And of course, seeing the potential of what more duloxetine can do, it would just cause me to worry more.

 

So day 3 now of 20/20 of both. Dizziness, headache already set it, so its already starting for round 2, but just bring it on. Lets get this poison out...!!

 

Again, my thanks to FishingHat for encouragement in getting me to this point...

[fishinghat]

You are the one doing all the hard work IUN. Give yourself some credit. Hang in there.

[invalidusername]

Thank you fishinghat. Yesterday was another good day, again without any stomach issues!!

 

Not such a good day in terms of the flu-type symptoms having dropped 30 to 20. Maybe I should have given myself a few days before pressing on. It is so easy to get impatient isn't it!!

 

Was very dizzy and fatigued, but this led to a nice sleep last night. Mood is a bit uneasy this morning, but I at least know what to expect as a result from dropping doses. What I need to remember is that it isn't a case that if 60 to 30 was a drop of 30, then 30 to 20 is only 10. I should be thinking percentages. 60 to 30 was a whopping 50%, and even now, 30 to 20 is 33%. Still significant. I guess this is why the end is tough as the percentages are represented by such small doses....

[invalidusername]

So - a quick update... mood leveled off on day 4 (last post), but yesterday was more difficult, and this morning have woken to a very low mood. 

 

I am REALLY regretting not giving myself some time in-between dose drops. I should at least have gone 25mg, or bead counted if I wanted to carry straight on. This is so so SO difficult. I was hoping that taking my 20mg of Citalopram in the evening would help the mood in the morning, but not at this point...

 

Knowing this is all part of the withdrawal, I am trying to maintain the thought that the low mood is just like the cough or sore throat that comes with a flu, but equally like the cough, the low mood is so hard to ignore.

[fishinghat]

You are very perceptive and a good judge of the circumstances. That will serve you well to keep things in perspective.

Time and patience.

[invalidusername]

Thank you. Really have increasing respect for Cymbalta veterans...

[invalidusername]

So Friday turned out to be a good day, but over the weekend, the depression has crept back in. Unfortunately life circumstances do not aid the situation.

 

My wife suffers very badly from social anxiety and she has had a bad week. Only been outside once and refuses to go out again. It has also become too easy for her to reach for the Valium when she gets down. I woke to her having taken another dose which has put me in a very troubling place as I feel she has got addicted...

 

I need to stay put on my current level of meds. Won't consider tapering further just now.

[invalidusername]

Really scared this morning. Woke up to immediate suicidal ideation, just like someone was talking into my ear. It was passive thoughts, but just wouldn't leave me alone. Now I have full body jerks and depresonalisation - just feel so disconnected. Even speech is not working properly.

 

Really - this is what withdrawal can do? 2 weeks on 30mg (from 60mg), and a week on 20mg? But I have only been on these things for 15 weeks?

 

This is so worrying... I am self-employed - I need to work!

[fishinghat]

Unluckily this happens. You can take a few beads if you want to try and bring yourself a little relief. Just don't act on those thoughts. If you feel like acting you my want a friend or someone to stay with you for a while.

[invalidusername]

Thank you Fishinghat. I am very fortunate to have a partner with me during these times (although she too has mental health problems). 

 

I have been reading about the symptoms, and best way I can describe is a "mini-seizure". My eyes involuntarily wander, various muscle twitch, sense of not being with it and the occasional full body jerk. Sincerely hope they pass soon.