221 replies to this topic

[fishinghat]

Stahl SM, Grady MM, Moret C, Briley M (September 2005). "SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants". CNS Spectrums. 10 (9): 732–47. doi:10.1017/s1092852900019726. PMID 16142213.

Bymaster FP, Lee TC, Knadler MP, Detke MJ, Iyengar S (2005). "The dual transporter inhibitor duloxetine: a review of its preclinical pharmacology, pharmacokinetic profile, and clinical results in depression". Current Pharmaceutical Design. 11 (12): 1475–93.

[fishinghat]

Whew, finally made it.

[Vinpin]

Hi FH,

 

I had a similar problem posting a week or so ago. Not sure what's been going on.

 

Thanks for the latest info. Not quite sure how to sufficiently interpret:

 

"Duloxetine has no significant affinity for dopaminergic, cholinergic, histaminergic, opioid, glutamate, and GABA reuptake transporters, however, and can therefore be considered to be a selective reuptake inhibitor at the 5-HT and NE transporters."

 

Does this mean in is not anticholinergic at all??? Or, does the second phrase in the sentence suggest it could be minimally anticholinergic overall?

 

Sorry for so many questions.....

 

-Vin

[fishinghat]

Does this mean in is not anticholinergic at all???

That is what it means. Not anticholinergic.

Don't worry about the questions. Anytime

[Vinpin]

HI all,

 

Well - had my Pharmacolgy Psychologist appt today. Very interesting, albeit I am bit skeptical (aren't we all after all we've been through???)

 

I should preface her suggestions by saying her emphasis is on sleep medicine withdrawal, and remedying folks' normal sleep patterns through natural, non-prescription drugs strategies. She is very big on setting up your body to find and respect its natural, circadian rhythms. So, she is of firm belief that folks should be in bed by 10-11 and up by 7-7:30, to be in synch with natural light of day. Napping during the day is a big no-no - it disrupts the body's natural sleep pattern, and ability to provide quality REM sleep that night following the nap. Preferably no TV/Computers/Cell Phones in the evening - and absolutely not past 9pm. These are her recommendations for everyone ...... whether we all like it or not .....(-;

 

For me, her most immediate impression and takeaway was that I should not be taking Duloxetine in the afternoon or evening at all, despite my desire to bead count. She was very emphatic that SNRIs taken late in the day would interfere with REM Sleep, which is the time at which "memory consolidation" occurs. In theory, this seems correct now that I think about it - blocking the reuptake of Serotonin and Nonephinephrine help create an "energized" feeling - probably not what you want at bedtime. On the internet, I'm seeing some partial confirmation of this, but not complete - some sites instead say SNRI effects on energy level vary by individual (some feel sleepy after taking their SNRI at night) Although many sites confirm my doc's opinion regarding dosages in AM instead of PM .... nothing on the web factors in the final stages of weaning of SNRIs and bead counting....which would make avoiding PM doses challenging.

 

Although we didn't discuss bead counting in detail .... she seemed to not have much empathy about the occurrence of inter-dose symptoms. She stated that the inter-dose symptoms would not be dangerous at this point in the withdrawal, and she didn't feel I was at a risk for a seizure. She suggested "distracting" at the precise point when inter-dose symptoms arise. (Easier said than done ......)

 

Regarding the Alprazolam, she did feel the 1mg/day amount I did increase to for the sake of handling my drop from 3 beads to 2 back in April was too much ( I wound up staying on 1mg of Alprazolam for about 6 weeks).... and certainly feels being on 0.5mg of Alprazolam for the last four years is negatively impacting my short term memory. She did totally agree with my game plan of getting is back down to 0.5mg/day, stabilize, then resume dropping the Dulox bead count , with the next drop from 3 beads to 2 maybe mid-to-late summer (depending on how I feel).  Then, farther down the road, I need to be completely off the Alprazolam, too.

 

To be fair to her .....  she did acknowledge:

1. that Cymbalta/Duloxetine (and Alprazolam, as well) are extremely difficult to come off of,
2. that research may yet show that long-term Cymbalta/Duloxetine usage could result in permanent cognitive impairment
3. that it is smart of me find a way off the medicine off of it completely (as opposed to a Prozac cross-taper)
4. that doctors, in general, are too quick to prescribe SNRI/SSRIs, because that was part of their original medical training, and for many, that's all they know 

 

I will wait to see what impressions FH, IUN and others have on her opinions and recommendations. But, I am contemplating shifting my daily single bead doses from 7am-3pm-11pm to 7am-1pm-7pm for now, and see how I make out with a new 12 hour interval between 7pm and 7am each night. I don't know if I can handle it, but it might be worth a try. Then, maybe down the road I will shift it to 7am-11am-3pm.

 

I'm really not sure. Would love some feedback (have a feeling I'll be getting some..... )

 

Best,

 

-Vin

[fishinghat]

"She is very big on setting up your body to find and respect its natural, circadian rhythms. So, she is of firm belief that folks should be in bed by 10-11 and up by 7-7:30, to be in synch with natural light of day. Napping during the day is a big no-no - it disrupts the body's natural sleep pattern, and ability to provide quality REM sleep that night following the nap. Preferably no TV/Computers/Cell Phones in the evening - and absolutely not past 9pm. These are her recommendations for everyone ...... whether we all like it or not .....(-;"

That has helped me BUT there is a side note. Some people do not have a normal circadian rhythm.

",,,blocking the reuptake of Serotonin and Nonephinephrine help create an "energized" feeling - probably not what you want at bedtime. On the internet, I'm seeing some partial confirmation of this, but not complete - some sites instead say SNRI effects on energy level vary by individual (some feel sleepy after taking their SNRI at night) Although many sites confirm my doc's opinion regarding dosages in AM instead of PM"

For most, the blocking of serotonin and NE cause a calming and sometimes sedating effect. However, there are those will genetic abnormalities for which that does not apply. It is an individual thing.

"...feels being on 0.5mg of Alprazolam for the last four years is negatively impacting my short term memory. She did totally agree with my game plan of getting is back down to 0.5mg/day, stabilize, then resume dropping the Dulox bead count , with the next drop from 3 beads to 2 maybe mid-to-late summer (depending on how I feel). Then, farther down the road, I need to be completely off the Alprazolam, too."

I fully agree. That sounds good.

In general I like her approach. It is certainly a game of time and patience.

[invalidusername]

"Some people do not have a normal circadian rhythm."

 

Me for one. Diagnosed with delayed sleep phase disorder. Sleep between 4-.4.30am and rise around 11.30-noon (on a good day)

[Vinpin]

Test post - for some reason, posts with either bold or icons are not being allowed to post (I think .....)

[Vinpin]

Update on using sieves to segregate larger beads from smaller:

 

Unfortunately, this was a fail. Both the 30 mesh and 35 mesh sieves captured all the beads - or in other words, the holes in the screens of both sieves were too small to allow any smaller beads to pass through.

 

I will continue with sizing the beads I select for my single bead dosages as I already was - by first inspecting them closely, then gently depressing my index finger on several "candidate" beads to then select those that I feel are sufficiently large enough. This seems to be working - I haven't had a bad experience with horrible inter-dose symptoms since June. (Back in June, we discussed on my thread that this may be occurring, along with possible solutions using sieves to screen out smaller beads).

 

-Vinpin

[Vinpin]

It's been awhile since I've posted an update, so here goes......

 

July's been my best month in quite awhile - maybe since about a year ago. I allowed myself to stay on 3 single bead doses per day for about 3 months. May and June were still rough, in part because I was trying to work the Alprazolam back down from 1mg to 0.5mg per day. By the end of June, the Alprazolam was down to 0.5mg, and by the end of the first week of July, things were pretty good. I've kept all the medicines pretty stable for the entire month of July, and I fared well. I wouldn't say I was 100% myself, but most days I was very functional. I took advantage of my improved condition by taking a short vacation to Hilton Head Island, SC, and last week spent time with family in Colorado.

 

However, I am hellbent to get off this stuff .... so starting this past Sunday, I've started on 2 single bead doses per day. To accommodate the wishes of that Pharmacology Psychologist I saw about a month ago, I am trying to avoid taking the Dulox in the evening/night. For now, my daily dosage schedule is 7am & 5pm.

 

Although it probably isn't the best attitude to anticipate a return of the bad symptoms .... I think they have already started. The headache was low-level and manageable in July, but has intensified since yesterday. Lethargy & sluggishness is starting to set in, too. However, no terrible dizziness, brain fog, nausea or brain zaps as of yet. 

 

The good news is ..... I've literally cleared my schedule for August - no expectations regarding trips or even home projects (and, if everyone remembers, I am on disability from work due to hearing loss - so no work obligations, either). As bad as it sounds - I'm ready to be incapacitated for awhile. But hopefully, the 3 months I allowed for stabilization on 3 beads will still pay dividends, and I'll make it through. I will hold the Alprazolam steady at 0.5mg per day for now. BTW .... I am off the Suntheanine, since I didn't feel any noticeable improvement taking that. I will try to make it through this bead drop without adding anything else into the mix, since nothing much has helped for the bad spells, anyway .....

 

I am learning my lesson, though - will stay on 2 beads a good long time, being patient and allowing stabilization to occur as it will at some point. I'm trying not to set a date in my mind for how long I'll be on two beads .... and will certainly not even consider a drop to one bead a day until mid-to-late fall. I will make sure I stabilize a decent number of weeks first.

 

One final note: I exercise 3-4 times a week, but I'm also making sure I'm getting outside at least 20 minutes a day. The neighbors see me out and about more often on neighborhood walks - they've remarked how, unintentionally, I've graduated to the top of the class for "Neighborhood Watch" duty I do think the dual benefit of dopamine production from the exercise and assistance with serotonin reuptake from outside sunlight/daylight is helping .....

 

Thanks all!!! For those weaning off currently - hang in there with me! We'll all make it through!!!!

 

-Vinpin

[fishinghat]

I was afraid of that. The only way to use the sieves is to know the bead size before purchasing so you know you are getting the right size. If the beads are too big for 30/35 mesh than you could try a 20/25 mesh and see if it works. At that size all the beads may drop through. who knows. You could wind up spending some money before you get the right size mesh. And each person would have to go through the process from scratch as they may use a different brand or it may be produced in a different facility than yours.

[invalidusername]

Nice interesting update Vin - thanks.

 

It is still shocking that people have to go to such measures to stabalise in the first place - regardless of whether or not they are successful. I am so glad you have had a good month - about time! I think you are right in not setting anything in terms of 2 bead reduction. Listen to your body as you have done from the start and only then will you need to concern yourself about when to reduce further. 

 

I very much admire your bravery with it all. So many would just stick at the 3 beads and say that's enough for the rest of my life! You have gone so far with it - and to still have it in you to get it gone is nothing short of impressive - really well done my friend.

 

Here's to a good August of further stabalising and hopefully the flash symptoms that have returned will soon let you go.