1636 replies to this topic

[ForLyla]

So stay at my current dose for a few more months and perhaps cross taper then?

[gail]

Right, perhaps a month or so. Something to look forward to. We need hope, don't we? All is not permanent.
Just more patience, I know it's hard Lyla, but you will make it! A bit more time.

[invalidusername]

I agree with Gail.

[fishinghat]

Ditto

[ForLyla]

I've been in benzo wd since Feb 2017 and cymbalta wd since October. I think I'm down to my last nerve! Are you guys sure this is a good idea? I've had the shakes for the last week which is something I thought left me nearly 2 months ago. Not sure what's happening.

[fishinghat]

I must confess that your body's response to the withdrawal is definitely not typical from what we normally see. The only choices I see are…

1) Stick it out until you stabilize (probably not a good choice)
2) Get a prescription for something that will give you some relief such as hydroxyzine and/or clonidine.
3) Cross taper to another antidepressant like Zoloft, Lexapro or Prozac and when stable taper off of that. They have a longer half life and are usually easier to taper.

[ForLyla]

I'm assuming because of my benzo wd? Why is it not a good choice to stick it out?

Also, will there be a big setback cross tapering? I seem to remember everyone telling me a few months ago that cross tapering was a bad idea.

[invalidusername]

If it helps, I have had recurring shakes for 4 months! This is par for the course, believe me.

 

You will cross taper from SNRI to SSRI, so there will be a few issues, but everyone is different. Don't like to say it, but shakes and fatigue are very common during this time, but should be short lived by comparison to stopping outright.

 

Timing the perfect cross taper is nigh on impossible, but chances are, it won't be much more than what you are currently experiencing. Bottom line is we do not know, but moving over to another AD will inevitably soften the blow of choosing Cymbalta to be the proverbial swan song drug you go out on.

[ForLyla]

IUN did you cross taper as well? You know, this might be a strange question because it seems rather insignificant but one symptom I've had throughout benzo and AD WD is extremely dry skin in the mucous membrane areas on my face. Is this a hormone imbalance caused by the meds? Is it just nerves?

[ForLyla]

IUN did you cross taper as well? You know, this might be a strange question because it seems rather insignificant but one symptom I've had throughout benzo and AD WD is extremely dry skin in the mucous membrane areas on my face. Is this a hormone imbalance caused by the meds? Is it just nerves?

[invalidusername]

I've cross tapered more times that I care to remember, and although I have not had itching, my wife has EXACTLY what you speak of since reducing her dose of Lexapro.

[fishinghat]

I'm assuming because of my benzo wd? Why is it not a good choice to stick it out?

Also, will there be a big setback cross tapering? I seem to remember everyone telling me a few months ago that cross tapering was a bad idea.

No not because of your benzo withdrawal. My main concern is that you are still at a significant dose of AD and yet you are having significant withdrawal and don't seem to stabilize. Too much withdrawal symptoms for that dose. You also did not recover as much as you should when you went back up to 25 mg. Just my opinion but you should be a lot better than you are. IUN is right about the shakes. Mine lasted several months also. I just feel that the way you are going it could be a very long tough ride.

Cross-tapering is a lot like AD withdrawal for about 6 to 8 weeks until the new AD finally kicks in and begin to help. One of the risks is that the new AD may not work. It does happen and unluckily you just have to try and see. There is no way to know ahead of time. I cross tapered to Prozac and it did nothing then cross tapered to Zoloft and after a few weeks was fine.

I really hate to see someone suffer as much as you are but I must say it may take you a few months to settle down at your current dosage and then a year or two to trapper from there. It all depends on how much you can handle and there are no guarantees which ever route you choose. Sorry

[ForLyla]

Maybe I should just stay where I am then and wait it out for longer. I was doing a lot better there for a few weeks before I went on my trip at the beginning of May. Now im back in hell. Today is the worst day I've had in several months. I assume my setback is a result of lack of sleep or perhaps there being alcohol in my food somewhere.

[fishinghat]

And it could just be a combination of things too. Alcohol, salt, the vacation, lack of sleep and I am sure other stress as well. I am sorry you are suffering so much.

God bless

[invalidusername]

I echo Hat's sentiments. It is such a shame to see people like yourself suffer at the hands of these meds. 

 

It must seem like a catch 22 at the moment for you, but ultimately, the decision is with yourself. Neither Hat or myself can advise as to the best route unfortunately. I personally would like to see you hang for a little longer as vacation by itself could have been enough on your system, let alone anything else. I took a chance by switching to Lexapro - didn't work. These things happen, but without knowing, there is little we can do. Listen to your body and it will tell you, Do not let impatience get the better of you, as that will not serve you well. 

 

We're here for you, whatever you do. Even if your condition is not consistent, our support is...

[fishinghat]

Well put IUN. I just couldn't find the right way to put it earlier.

[juli]

Hi ForLyla,

Any chance you can go up a bit on the Cymblata to see if you stabilize?  You have been suffering for so long,   I think it would be worth a try to see if zoloft or lexapro would give you some relief.

Juli

[ForLyla]

I am very skeptical about switching over to another med right now. I've been suffering so badly because I transitioned from benzo WD right into SNRI WD. Im assuming I have a combo of the two now because the cymbalta wd revved up my benzo wd and vice versa. My nerves are shot.

I went up on the meds a bit in Feb and I haven't stabilized. The goal is to get off these meds - further kindling will just make it that much more impossible. I think the best course of action is to stay at my current dose for a couple more months and see if I stabilize. If not, then I'll need to start weaning again until I get off this poison and hopefully I'll survive it. Maybe if I go at a rate of 2% a month I won't feel it. I was doing 10% a month or more before while also in benzo WD. I was finally getting over my benzo WD when I got destroyed by this so it makes sense that I need to be at a stable dose. Another question is how stable it needs to be as scales aren't 100% accurate. There's a 2% margin of error with my current scale.

[fishinghat]

2% error if you are weaning very slow should be OK. On a steady dose obviously the less fluctuations the better but there is only so much you can do without spending a fortune.

[ForLyla]

How would you guys describe the shaky feeling? I'm not actually shaking and I really have no idea how to describe it. It feels like I've just gotten into a massive fight and my nerves just won't calm down. It's been like this for a week now since I got back from my trip. Again this shaking only started after I updosed.

I have a feeling like I'm never going to recover from this. It would take me a couple years to wean off this stuff and even then I'll feel terrible after I come off of it. I just don't know what to do anymore. I can't take this nightmare anymore.

[fishinghat]

"I've just gotten into a massive fight and my nerves just won't calm down."

That is a good description. That kind of shaking is a product of a chronic adrenergic state. (A constant state of adrenaline production). My recommendation is still hydroxyzine or clonidine. The clonidine is particularly good for this.

[invalidusername]

I had both "internal" and "external" shakes for some time. I probably had the internals with the externals, but when it was external it was difficult to focus on anything else. As Hat said, its the adrenaline. 

 

I really do know how you feel. There were times that I couldn't even walk more than a few yards. I was falling over - medics out at one stage worried that I had a stroke.

 

If you cannot tolerate, short term use of meds might be the answer. My goodness, you poor girl. It is so hard to see you suffering like this. Wish there were more we could do for you.

[ForLyla]

I don't think starting a new medication would help me to be honest. It would just dig a deeper hole. Short term gain for long term pain. So updosing caused me to be in a constant state of adrenaline even though I'm super tired? Maybe I should just do a fast taper and get off this damm stuff and end up in a hospital or something. At least then I'll be done with it all and know that I can potentially recover eventually. It's been hell since feb 2017 and even worse hell since oct 2018. 

 

Last summer I was finally starting to get over my benzo wd syndrome. So we do know that I feel this way because I tapered the Cymbalta. Now I'm in Cymbalta wd syndrome or nervous system upregulation or whatever you want to call it. You would think that if I stay at the same dose that I'd recover from it but apparently that doesn't work.  

[invalidusername]

I can see your thinking, but if you decide to taper, fast is not the way to do it. I applaud your efforts for going that route, but if a slow taper is bad, it is a foregone conclusion that a fast taper will be down right untolerable. You might say it is already, but things can always get worse and I really don't want to see that.

 

I'd like to hear Hat's view, but he will already be in bed with his Ovaline and the last John Grisham...

[fishinghat]

"I don't think starting a new medication would help me to be honest. It would just dig a deeper hole. Short term gain for long term pain."

I don't want to come across as pushing you but clonidine and hydroxyzine have NO withdrawal and are used here instead of benzos because of their effectiveness and eliminates withdrawal later. They both take effect within one hour and if for some reason they aren't effective then you just stop taking them. There is no buildup in your system like an AD. So the good thing is one dose will tell you if they will work or not. Many of our members have successfully used them, especially clonidine.

" So updosing caused me to be in a constant state of adrenaline even though I'm super tired?"

The adrenaline is from some stimuli, such as your vacation. It will fade but may take months. Also adrenaline will drain your system of energy and cause considerable fatigue.

IUN hit the nail on the head. Slow taper is tough and fast taper is unbearable. You started having issues last Oct so you may have several months to a year or more ahead. Time and a lot of patience.

[fishinghat]

FYI

 

Clonidine

Clonidine (Catapres, Kapvay, Nexiclon, Clophelin) is a classic blood pressure medicine BUT it is very effective on anxiety. It is an alpha adrenergic antagonist which means it stimulates the alpha adrenaline synapses located in the frontal lobes of the brain. When these synapses are stimulated by the clonidine the brain thinks that it is due to adrenaline and it tells the adrenal gland to produce less adrenaline. It is a little slow to kick in, about an hour and a half. It has a 12 hour half life. Most drs prescribe 0.1 mg twice a day. One to be taken about an hour before bedtime and the other in the morning. Because it decreases adrenaline it has a strong calming effect which helps a person get to sleep and stay a sleep. It is not unusual for people to have a little drowsiness from clonidine until they get use to it (1 or 2 weeks). It does NOT work faster sublingual (under the tongue) like benzos. These have no withdrawal but your blood pressure may spike for a couple weeks if you cold turkey. Due to the lowering of blood pressure and sleepiness it is common for the patient to start with ½ tablet at bedtime. Once the patient adjusts to the medicine they begin a ½ tablet in the morning. As sleepiness and blood pressure stabilize they are slowly worked up to the 2 tablets (0.1 mg each) a day. They also make a slow release patch for clonidine which avoids the peaks up and down in blood pressure and sleepiness associated with taking clonidine every 12 hours.

Begins working 60 to 90 minutes
Peak levels – 3 to 5 hrs
Half Life – 12 - 16 hrs

There are too many research articles on clonidine's anxiolytic properties to list here.

FH - I started clonidine but it was a relief to me NOT to be able to feel my heart pound through my chest. As long as your bp is OK you shouldn't have a problem.

That is why the slow start up. This gives your heart a chance to adapt to the new med. I did the same slow start up and my bp stayed within normal range. Just keep monitoring your bp and you should be OK.

FN - clonidine worked wonders for me

http://www.cymbaltaw...elps#entry71818
Cymbalta, clonidine and hydroxyzine and alcoholism information

Hydroxyzine, (Vistaril, Atarax) - is an H(1)R antagonist, is very effective against anxiety in most people but some get no help from it at all. It is not addictive nor does it have withdrawal but it also can lower blood pressure some but that usually goes away with time. This medicine should be started slowly to give your body a chance to adjust to the blood pressure effect. Normal dose is 25 mg four times a day but can go as high as 400mg/day.

Begins working in 30 minutes or less
Peak levels - 2 hrs
Half Life – 15 to 20 hrs
https://www.ncbi.nlm...pubmed/21154375
https://www.ncbi.nlm...pubmed/12444816
https://www.ncbi.nlm.../pubmed/7875114
Anxiolytic, Sleepiness begins to subside after 1st week and no withdrawal.
https://www.ncbi.nlm.../pubmed/9809861
https://www.ncbi.nlm.../pubmed/2430410
Do not take with cimetidine as it increases hydroxyzine levels in the blood.
https://www.ncbi.nlm...les/PMC1512309/
Effective, sleepiness slowly decreases.

http://www.cymbaltaw...elps#entry71818
Cymbalta, clonidine and hydroxyzine and alcoholism information

https://dailymed.nlm...4b-8e1fae02af2e
(Manufacturer)
For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested: in adults, 50–100 mg q.i.d.; children under 6 years, 50 mg daily in divided doses and over 6 years, 50–100 mg daily in divided doses.

https://www.drugs.co...ose_for_Anxiety
Usual Adult Dose for Anxiety
-Oral: 50 to 100 mg 4 times a day
-IM: 50 to 100 mg immediately, then every 4 to 6 hours as needed

http://www.pdr.net/d...ine-pamoate-744
(Physicians Desk Reference)
Oral dosage
Adults
50 to 100 mg PO 4 times daily as needed, adjusted to patient response.


https://www.mayoclin...se/drg-20311434
(Mayo Clinic)
For oral dosage forms (capsules or suspension):
⦁ To help control anxiety and tension:
⦁ Adults—50 to 100 milligrams (mg) 4 times a day.

[ForLyla]

The most important thing to me is knowing if they act on benzo receptors. If they help you sleep and treat anxiety then I'd think that's the case, no?

[fishinghat]

Hydroxyzine is an H(1)R antagonist. Another words it works on histamine receptors. While most people think of histamines in terms of cold, flu an allergy symptoms the H1 and H3 histamines function in anxiety. It is commonly used to treat cocaine, benzo, AD and other withdrawal. IT does NOT bond with gaba receptors at all. It is considered very effective for sleep and there has been two papers that have done extensive research on hydroxyzine in comparison to benzos and show that hydroxyzine is as effective as benzos in controlling anxiety.

I would say that many psychiatrists often put people on too large a dose to begin with. many prescribe 50 mg every 6 to 8 hours. 50mg before bedtime is fine but 50 mg during the daytime is too much for some people. It controls the anxiety but leaves the person sleepy. I always recommend 25 mg for use during the day. If that helps but not enough you can always go up to 50 later. No sense in being groggy.

Clonidine is a unique medicine that gas been in use for over 40 years. The adrenal gland only has sympathetic nerves going to it and no parasympathetic nerves. That is important as sympathetic nerve signals tell an organ to speed up production while signals from the parasympathetic tells the organ to slow down production. There is a set of nerve cells in the pons area of the brain that is capable of detecting adrenaline in the blood. If adrenaline levels get too high it should decrease the signal to the adrenal gland to slow adrenaline production. This area in the pons perceives clonidine as it were adrenaline and slow the adrenal gland's production of adrenaline. It is considered one of the most effective anti-anxiety meds and has been around a long time. it only effects adrenergic receptors and has no effect on gaba receptors.

 

Most drs recommend 0.1 mg twice a day but again I always recommend taking 1/2 of that to begin with. It is often enough for many people.

I can provide medical research on any or all of this data. If you wish to see details on any of this just let me know and I will be glad to provide the research to you. I have been doing this type of research for over 40 years so it is not a major issue for me. I want you to be well educated and comfortable with any of your medical choices.

[invalidusername]

Nice summary Hat - few details in there which are new to me. 

[ForLyla]

Thanks FH. I read hydroxizine dries out your skin. My skin is literally peeling off my face since wd so that one wouldn't be good. I'll research clonidine some more and get back to you.