309 replies to this topic

[PrincessNutella]

Hello hello,

25/F here, diagnosed with Social Phobia, used Duloxetine HCl 30 mg for 20 months, it was all great before having one of the worst weeks of my life. Palpitations, numbness of hands, bloated and gas stuck in throat, feel like I'm having a heart attack or I'm going to die. Lost my marbles more than once and ended up in ER (not proud of that). I have my airways blocked because of my clogged nose and gas, can't breathe properly or at all, sometimes.

My duloxetine dosage was upped to 60 mg, and it has been a nightmare. Shaking, hyperactivity, palpitations, feeling out of it, nausea, no sleep, depressed, don't want to talk to people, irritable. I endured for 20 days (wrong move, people) before dropping duloxetine for the day and going to another psychiatrist today. Prescribed me sertraline 50 mg (25 mg the first 8 days) to be taken in the morning and propranolol HCl 20 mg to be taken in the morning and evening. I almost fainted from palpitations and breathlessness, so I took 10 mg of propranolol, I feel out of it and tired but it took care of the palpitations (20 mg is to much for me, speaking from experience).

I know I -or the psychiatrist- have to taper, but he told me to get the duloxetine out of my system as fast as possible by increasing fluid intake, and I will start taking sertraline tomorrow morning. Is this another way of changing meds?

P.s.: English is not my native language, so I'm sorry if I made any mistakes.

[fishinghat]

Welcome Ozgvun

Your English is perfect, don't worry.

The method your dr is using is called cross tapering and the usual method is to drop your Cymbalta a little each week and be off by the end of 4 to 6 weeks an d at the same time increase your Zoloft a little each week and be fully on it in 4 to 6 weeks. While your adverse reaction will lessen as you come off the Cymbalta you will have some withdrawal symptoms until the Zoloft fully kicks in (4 to 8 weeks).

By the way don't apologize for the trip to the ER. Most of us have done that and more than once.

Oh yea. Each time you up the dose of Zoloft you will have an upset stomach for about 4 or 5 days but it is temporary.

Keep us posted on how you are doing and feel free to ask questions.

[PrincessNutella]

Hello Fishinghat. Thank you for the reply. What I'm scared of is transitioning from too much C (60 mg) to no C in about 2 days as he did not wean me off the traditional way from C. Will Z cushion my fall, so to speak?

I've been reading the topics and you guys are awesome, by the way. I am impatient but the replies have restored a little bit of my hope.

[fishinghat]

2 days...I understand that with the reactions you had but it will be tough for a while. The Zoloft will cushion the fall as you go up on dosage.

[PrincessNutella]

I'm relieved.

Half day update (it's midnight in Turkey);
The beta-blocker started to cause shortness of breath about 2 hours in, contributing to my anxiety. I tried to stay calm. As the evening progressed, I think I flushed most of the C out of my system.

I feel more like myself? My sass is back, my wit is mostly back. I feel like laughing, even for a little bit. Beta blocker beat me down, though. I think I will talk to my psychiatrist about the dosage.

What do you guys think?

[fishinghat]

That sounds like you are going to have an easy withdrawal. That would be very good.

I agree with you on the propranolol. I am a little surprised they didn't put you on Atenolol instead. Itr is more effective on heart palpitations and more effective on anxiety as well. Yea, talk to the dr about your dosage.

[fishinghat]

I just looked on the FDA database and 5% of those going on propranolol have shortness of breath so you are probably right.

[invalidusername]

Hi Ozgun and welcome.

 

Just to reiterate the ER trips count. I've had 4 in the last 8 weeks, so nothing to be worried about here. We do what we have to. And it is good that I see something for the amount I pay in tax every year!!

 

I think whilst your means of coming off the Duloxetine isn't what is normally recommended, what you have is a very dire set of circumstances which means you will need to do as advised. From what it sounds like, your symptoms are comparable to what you would experience from an abrupt stop anyway, but given that you have Sertraline to help you, I hope it will be a smooth transition back out of your current situation.

 

Fishing Hat is incredibly knowledgeable about these things as you have already seen from his posts, and you have done the right thing in coming here to seek further advice. We are all here to help each other, and that makes up for a lot more than what most people get in their own community of medical workers (particularly here in the UK!).

 

Please keep us posted Ozgun - wishing you all the best. 

[PrincessNutella]

Hello IUN, thanks for the good wishes! I totally agree about the community. I forgot to mention I'm a pharmacist doing her masters, and my thesis advisor told me to "up my propranolol and be grateful for everything I have" and to "come the next day for about 9-10 hours of experimental work" while I considered almost checking myself in a psych ward. I still have people telling me to "not care" or "not exaggerate my symptoms". Good times, right?

FishingHat - I did know beta-blockers caused the shortness of breath, but I thought 10 mg was too low of a dosage for that. Got me surprised more than anxious, really.

Now I have the smallest body zaps, did not cause discomfort. Will update probably after taking the sertraline in the morning. Hope to sleep well, or to sleep at all

[invalidusername]

 "come the next day for about 9-10 hours of experimental work" while I considered almost checking myself in a psych ward.

 

OMG!!! The joys of study - and as a pharmacist too! You would be a valuable part of the forum

 

To be doing this level of work while you are going what you are at the moment is an amazing thing. Just be aware of when you have a decision to have a rest that you take it - even if you do not sleep and our brain is still spinning over and over - rest is going to help.

 

Sleep well dear Ozgun - speak tomorrow.

[PrincessNutella]

Thank you for the kind words. I've been resting for a month now, I dropped the studies as soon as I had the first debilitating panic attack.

I don't know if I'm needed, as FishingHat here took care of everything

Update: Slept at 5 AM and for 7 hrs. My problem is health anxiety by not breathing properly because of my clogged nose. And bloating. And I don't know if it's morning anxiety but after I wake up, I get shaky and feel uneasy. Took the Z now. I'll edit this post.

I wanted to know if our receptors change structure to accommodate the AD's, won't AD's in similar molecular structure be easier to exchange? And do you think the severity of withdrawal symptoms is connected to the person's adaptability such as in if I have a fast recovery rate from diseases or my body reaches equilibrium faster?

I am so sorry for the nerdiness.

Edit: Z made brain fog and weakness, no nausea for now. Feels like when I started C without the sleeping spells. I am taking life very slow, I've been in bed. Still can feel my heart beating, it's annoying

[PrincessNutella]

Spoke too soon. I don't know if I'm adapting to my own norepinephrine, but I'm breathless now, and shaky. No palpitations weirdly.

[fishinghat]

"I don't know if I'm needed, as FishingHat here took care of everything"

Oh trust me, your help would be invaluable. Also we are an honest and open forum so if you ever see me or anyone else make a mistake do not hesitate to mention it. This is all about giving the best help to our members.

[gail]

Hello Ozgun,

Welcome to our place. Since I'm not as knowledgeable as my two friends, all I can do is greet you warmly. You came to the right place Ozgun!

[PrincessNutella]

Hello Gail, appreciate the hospitality certainly seems like it. I want to thank all of you for allowing me to use here as a diary.

FishingHat - I hope so. I don't remember much, but you cite the studies and they seem to be right and on point. Though a comment on here (don't remember whose) needs to be repeated that said to look at the funding source and institutions. That's "academic research" for ya.

[PrincessNutella]

FishingHat - I told my psychiatrist about the breathing problem and the propranolol dosage, he told me it's normal and adviced to exercise. I dunno. I did not take it today, my chest feels normal.

[PrincessNutella]

Today's update: I spent the day in bed with weakness and brain fog but I feel like poop now. Shakiness has returned with muscle rigidity. I have small body zaps again. I think I was clenching my teeth the whole day. Can't lie down because of the breathing problems.

Don't know what to do.

[fishinghat]

Hold on. The Zoloft will eventually kick in.

[invalidusername]

Ozgun... just catching up on today's post from you.

 

Glad you got some sleep - it is very important for clearing all the cerebral fluid through the brain. Especially with anxiety as it weakens us so much as you well know.

 

I fully understand health anxiety. I almost died in a car accident 10 years ago. Whilst it is better now, it still never leaves me.

 

Fishing Hat will know more about propranolol than myself, but if you do exercise, make sure it is light exercise light yoga or stretches. Cardio will not do well for your anxiety, despite what the Internet tells you. Fishing Hat and I discussed this at length a few weeks ago.

 

With regards to our brain structures, AD's prevent the re-uptake of serotonin by blocking the receptors, so yes they change. However, research shows an imbalance of serotonin (either too little OR too much) can cause mental health problems, which is why AD's often do not work. This is sometime because levels cannot be accurately measured. Most serotonin is made in the gut and when it reaches out brain, that is when our science stops. 

 

Most people experience their worst symptoms in the morning. Most put this down to the serotonin levels, but again, we can never be 100% sure of the true cause. The best we can do outside of medication is make sure we eat well, drink plenty and rest. The adrenal glands are working overtime for you which will cause a lot of adrenaline to be pumping around your body, which mimics the same effects of exercise, which is why the above it good. 

 

Hope that helps a little. Again, if you need to know more about propranolol, Hat will be the one to ask. 

[invalidusername]

I also think your breathing will be caused a lot by tense muscles in your chest.

 

We do not exercise these nearly enough, and the tightness can get worse.

 

A very good exercise is to stand with your back against the wall. Raise your upper arms so they are parallel with the floor and your hands up to the ceiling. Sort of like what people do to surrender when a gun is pointed at you!!

 

Make sure your arms are also touching the wall if you can. Then gentle breath in. Hold for 2 seconds, and release all air out.

 

Do this for 10 times to start, and gradually increase over a few days to 20, and slowly increase how much air you take into your lungs. You might feel your hands tingle as the muscles block blood flow, but it will improve and nothing to worry about. Gradually it will feel like someone has freed up a lot of space in your lungs. Trust me. It will take a few days to feel the benefit, and it might ache a little at first, but it will help.

 

Do about 3-4 sets of 10 a day at equal intervals.

[fishinghat]

Ozgun, is your dr planning on keeping you on 50 mg Zoloft or will he up that dosage if needed?

Oh yea. Do you take aspirin? Because that makes the breathing problem worse with propranolol.

[PrincessNutella]

FishingHat - I think Z kicked in very early on, but I'm not sure. I've been calming myself down.
He told me to take 25 for about a week, and 50 afterwards. I'm very sensitive to meds, so if I'm good with 25, hope not!
And no, no aspirin. Nothing actually. A very very low dose of muscle relaxants would be nice.
IUN - Thank you for putting things in perspective. Even if I know meds, it's a bit frustrating to live through the symptoms.
I've been "deep breathing" but never did I think to exercise that way. I will do that with my light stretches.

[invalidusername]

Please do try.

 

This was shown to me by a chiropractor after my car accident when I had pains and obviously the anxiety that went with it. It really helped me.

 

Start light though and let us know how you get on.

 

I'm also allergic to a load of meds. Wish I could take pain killers, but I go into anaphylactic shock and straight to the ER unless I am near a shot!!

[PrincessNutella]

Oof, that's tough. I have so much respect for all of you.

[PrincessNutella]

Small update: Slept at 6:30, woke up to small construction work 6 hrs later. Because I know I'm going to be anxious while I wake up, I've been spending time in bed before breakfast. Seems to do the trick.
My mind has cleared up a bit. Still don't want to leave the house though :/
And a weird thing, when I had trouble breathing, not once did my heart palpitate. All calm.
Waiting for Z's serotonin reuptake inhibiting property come from war.

[invalidusername]

Glad you got 6 hours sleep. I also have construction work in the building next to mine. Has been for 2 months now.

 

Odd that spending time in bed while anxious helps you. For most it does the opposite, but if it works for you, then why wouldn't you do it!?

[PrincessNutella]

Update: I have an inflamed throat. I feel feverish (36.4C, so no fever, my normal temp). My extremities, especially my left arm feels weak. A bit of a tension headache, extends to my neck, but it's manageable. My sinuses are killing me, as always. And I have a condition that's a bit TMI.

Actually, I do what I want in terms of anxious situations when I can control them. It gives me extra comfort as well. I pace if I need to. The bed thing is new to me, cut me some slack

[fishinghat]

"Odd that spending time in bed while anxious helps you. For most it does the opposite, but if it works for you, then why wouldn't you do it!?"

Actually that is a standard approach in CBT for anxiety. Typically it is combined with progressive relaxation techniques. Secondly it is also used for endorphin generation. When one first lays down there is a feeling of relief and relaxation. That is due to endorphins being released. The method involves laying there with the eyes closed until one begins to feel the anxiety start to build. Get up and slowly walk around for 2 or 3 minutes and then lay down. This repetition will continue to release endorphins with each cycle. I have used these two methods for years to control my anxiety. The second one is also a good method to use if you wake in the middle of the n ight and can't get back to sleep. Repeat the cycle until you do not feel the anxiety building.

Now these techniques will not cure the extreme anxiety of withdrawal but will help.

[PrincessNutella]

I will try it now as I am anxious. Still feel like I don't take in enough oxygen. Nauseous and feel like passing out. Reading: 134/78 mmHg, HR: 113 bpm, maybe higher now. Took 5 mg's (maybe less) of propranolol.

I did the chest exercise IUN, it works.

[invalidusername]

Ozgun - I am with you...

 

I have had a terrible day and want you to know that I am here for you.

 

Not knowing age/weight etc (which I am not asking!!), 134/78 is not a bad reading for someone anxious and at 113bpm. Mine was 132/84 when I was last in hospital freaking out, and pulse was only in the 90's. My usual resting is 112/60 @ ~60-65bpm which I am glad about. I don't have any equipment at home as it would cause OCD for me, and I would be taking reading way too often.

 

Glad the chest exercises worked - and Hat, thanks for clarification about the bed rest. Might not help with withdrawal levels as you say, but very useful nonetheless.