25 replies to this topic

[chinton620]

33/m

First time posting, though I have spent quite a bit of time reading through all the great info this forum has to offer. Let me start out with a big THANK YOU to those that have dedicated so much of there time making this forum what it is. 

 

From reading other posts I know it helps to give y'all some back story before you can offer the right advice. I started on 30mg of Cymbalta around March due to anxiety and milder depression. My recommended dose from my psych was 30mg's twice a day but I only did that (60mgs) for about a week or two because it was causing me side effects - full disclosure I probably only took cymbalta correctly for about a month maybe 3 weeks around april-may. The other times I'd skip a dose here and there and never take it at the same time. I just never felt like it did anything except give me side effects. 

I've been tapering for probably a month or so now, and again, I didn't start out doing that correctly. Originally I was just dumping out a third of the capsule and taking that for a few days and then dumping out some more. I don't know if I experienced withdrawals from that or if the things that happen were just coincidence. Now I am down to between 15-20 beads. I give that range because I tried leveling at just 15 for a few days but I felt like it was messing with me a bit - very irritable that would quickly go to rage, dizziness, off and on nausea, so I took 20 yesterday and had the best day I've had in a while. I should also pause here to say, over the last two weeks I started noticing side effects going on with me that turned out to be from Losartan (blood pressure med), so I stopped that suddenly after being on it for two months solid - the things I was noticing left with that med. So, it's really hard to tell with me right now what is causing what. 

 

Now getting on to the advice. I have only been on one other anti-depressant, lexapro, and that sucked so I only took it for a week or so before getting switched to the cymbalta. Going through all of this has brought to light that I have/have had untreated ADHD. From what I understand, the adhd is most likely the root of my anxiety/mild depression, so the goal is to get that under control and therefor take care of the other stuff at the same time. I am wanting to try Wellbutrin since it also works to help adhd. What I am hoping I can do is to stop the cymbalta where I am and start the Wellbutrin now. I am hoping that the wellbutrin will combat the irritability/rage and dizziness from discontinuing the other. Maybe supplement with some 5-htp or L-tyrosine to help my serotonin balance out while making the switch? Or do I have to spend months tapering down off of this stupid med before I can get my life back? Give it to me straight

 

To help through this process I have been taking omega-3's, magnesium, and just started Ashwaganda. The nights I cant sleep, I'll either have a drink or take some hydroxyzine. 

[gail]

Clinton,

Welcome to the forum. Yes, you can go straight to Wellbutrin. No, you cannot stop the bead counting. Others will chime in, sorry, I'm having a bad day here.

[chinton620]

Clinton,

Welcome to the forum. Yes, you can go straight to Wellbutrin. No, you cannot stop the bead counting. Others will chime in, sorry, I'm having a bad day here.

 

Thanks for the response, sorry to hear that. 

[fishinghat]

Hi Chinton and welcome. Yes you should continue with the bead counting BUT I would stay at the dose you are at until you get feeling better. If you wish to start on Wellbutrin at this point you can. Your dose of Cymbalta is so low that the risk of Serotonin Syndrome is very low.

"L-tyrosine is the first dopamine supplement to consider. L-tyrosine and phenylalanine compete with tryptophan for absorption. Tryptophan is converted to serotonin by the body so if too much L-tyrisine is present n the blood stream then serotonin levels may decrease. "

This is from a thread called Summary of Cymbalta Withdrawal in the Medical support section which lumps together what everyone has tried, what worked, what didn't, medical research, etc. You might want to start skimming through this.

Also from that thread...

"L-tyrosine can make headaches/migraines and existing thyroid issues worse. The body uses tyrosine to make thyroxine, a thyroid hormone. Tyrosine seems to be safe when used in doses up to 150 mg/kg per day for up to 3 months. Some people experience side effects such as nausea, headache, fatigue, heartburn, and joint pain. (Webmd)"

L-tyrosine is a stimulant so if you are having trouble with anxiety such as rage, you need to use with caution.

Tryptophan and 5htp are used to produce serotonin which can help with the withdrawal BUT great care must be used when also taking meds like Cymbalta, Wellbutrin and other antidepressants due to the risk of serotonin syndrome. Several members have had this issue over the years.

I personally found the hydroxyzine to be a big help with my withdrawal. What dose and frequency are you on?

[chinton620]

I have definitely spent a good bit of time reading (and rereading) from the "Summary of Cymbalta Withdrawal" thread, great work there! Grovel grovel grovel

 

I believe I am on the 50mg pam and it is on an as needed basis. My dr gave me this to try instead of the xanax that I was using from time to time. It definitely doesn't have the benzo power but does help for sure. 

 

So, you recommend leveling off at the 20 beads and introducing the wellbutrin in before dropping anymore beads? And maybe staying away from the other serotonin supplements since I seem to have had a better day at 20 beads?

[fishinghat]

50 mg on the hydroxyzine is a good dose and considering that 400 mg a day is the maximum dose so you don't need to worry about taking it more than once a day. It also is not addictive and has no withdrawal so that is a definite advantage over benzos. During my withdrawal my dr put me on 36 mg 3 times during the day and 50 mg at bedtime. I am not suggesting you do that but I put it out there for your reference.
"So, you recommend leveling off at the 20 beads and introducing the wellbutrin in before dropping anymore beads? And maybe staying away from the other serotonin supplements since I seem to have had a better day at 20 beads?"

I would definitely stay away from the serotonin supplements during this time of change at least. As far as starting the Wellbutrin at this point it is really up to you. It acts as a norepinephrine–dopamine reuptake inhibitor (NDRI) so it may provide limited help during your Cymbalta withdrawal. Just my opinion but I would start to taper on to the Wellbutrin slowly over the next few weeks and continue to wean off the Cymbalta as your symptoms allow. As it takes Wellbutrin 6 to 8 weeks to kick in this will be a game of patience.

[invalidusername]

Hi Chinton and welcome...

 

I completely agree with what Hat has said here. The ADHD would explain the switching with the drugs abruptly. This will not have done you any favours, but this is who you are, and that is no problem! You really do need to stabalise as the more you keep switching, the worse it will get and the longer it will take for you to feel better overall.

 

So I echo what Hat has suggested for you to stay at the 20 beads of Cym and level out. Enjoy a few days and get some energy and patience back. The amino acids is for sure a no-no - especially while you are on two other AD's. They are usually used for withdrawal outright rather than switching and tapering. So keep them in mind for a later date when you get to that wonderful place where you can get rid of the AD's!

 

Therefore, consider your taper around the knowing that your Wellbutrin will take a good 6-8 weeks as Hat says. You really have to be patient here my friend. It will pay off in the long run.

 

For now, keep asking questions and pop back and keep us updated of how you get on!

 

IUN

[fishinghat]

20 beads, not 20 mg IUN. Sorry.

[invalidusername]

20 beads, not 20 mg IUN. Sorry.

 

Thanks Hat - at least you know I can blame my head today!! Edited post...

[chinton620]

I would definitely stay away from the serotonin supplements during this time of change at least. As far as starting the Wellbutrin at this point it is really up to you. It acts as a norepinephrine–dopamine reuptake inhibitor (NDRI) so it may provide limited help during your Cymbalta withdrawal. Just my opinion but I would start to taper on to the Wellbutrin slowly over the next few weeks and continue to wean off the Cymbalta as your symptoms allow. As it takes Wellbutrin 6 to 8 weeks to kick in this will be a game of patience.

 

Why do you recommend the slow progression of Wellbutrin? Is starting the Wellbutrin going to make the withdrawal harder somehow? I know these meds work differently but I can't totally wrap my head around how the do what they do. 

 

Any insight into whether or not to use the stimulants I am given for the adhd?

[invalidusername]

Essentially you have a number of neurotransmitters in the brain which regulate various states of mood. Depending on the condition of your mental health, you will use an SSRI, SNRI, NDRI or tricyclic. When you move from one group to the other, it can be more difficult to moving to one in the same group - for example, celexa to zoloft - both ssri, so would be easier than celexa to effexor being ssri to snri. 

 

An SDRI is used for depression and ADHD as it increases the response of dopamine which regulates the reward system of the brain. These are used when SSRI's do not work as these increase the response of serotonin which is a mood regulator (NOT a reward based system). When a boost of serontonin does not work, they try another chemical.. such as dopamine.

 

So... by using an SDRI when tapering off and SNRI or SSRI, they don't match, so there will always be a bit more of a risk. It is sort of stopping to eat oranges and trying grapefruits (which are your SSRIs) or stopping oranges (SSRI) and eating bananas (NDRI)! Sure they are both fruits, but a banana is far more removed from an orange than a grapefruit!

 

Hope that explains a little. Knowledge often helps with what we are going through, so again, please ask if you would like to know anything.

 

[EDIT] Why on earth am I comparing AD's to fruit!??! It has been a long day... It makes sense to me at least...

[fishinghat]

Chinton

Most antidepressants control one or more neurotransmitters in the brain. Various neurotransmitters stimulate different nerves and cause emotional responses, (sad, nervous, fear, etc.). They fall in one of three categories. An agonist is one that stimulates a nerve. An antagonist is one that blocks a nerve and a reuptake inhibitor stops your own neurotransmitters from being reused. For most antidepressants there is little understanding as to how exactly the actual chemical reactions occur and certainly no idea why a certain antidepressant t will help one person and not another. Then you mix in the 20 or so genetic variations that effect this whole process it gets real confusing fast.

The main reason to go slow when changing from one antidepressant to another is the risk of serotonin syndrome. By slowly bringing on the new AD you can watch for early signs of Serotonin Syndrome before it gets too bad. The other reason is what IUN mentioned. These antidepressants vary in what neurotransmitters they control so it is can be very unstable a change and best done slowly.

You asked about taking the stimulants that the dr prescribed for your adhd. What stimulants did they prescribe for you?

[chinton620]

You asked about taking the stimulants that the dr prescribed for your adhd. What stimulants did they prescribe for you?

 

I have adderrall and ritalin - we are still working through which one works best for me. I have had genetic testing done and it seems for cyp2d6 I an intermediate metabolizer. Due to this, the theory is that amphetamine stimulants will not metabolize as well as methylphenidate. I haven't taken much of either with all of this other crap going on - I have been scared that I will cause extra problems, you know?

[chinton620]

Essentially you have a number of neurotransmitters in the brain which regulate various states of mood. Depending on the condition of your mental health, you will use an SSRI, SNRI, NDRI or tricyclic. When you move from one group to the other, it can be more difficult to moving to one in the same group - for example, celexa to zoloft - both ssri, so would be easier than celexa to effexor being ssri to snri. 

 

An SDRI is used for depression and ADHD as it increases the response of dopamine which regulates the reward system of the brain. These are used when SSRI's do not work as these increase the response of serotonin which is a mood regulator (NOT a reward based system). When a boost of serontonin does not work, they try another chemical.. such as dopamine.

 

So... by using an SDRI when tapering off and SNRI or SSRI, they don't match, so there will always be a bit more of a risk. It is sort of stopping to eat oranges and trying grapefruits (which are your SSRIs) or stopping oranges (SSRI) and eating bananas (NDRI)! Sure they are both fruits, but a banana is far more removed from an orange than a grapefruit!

 

Hope that explains a little. Knowledge often helps with what we are going through, so again, please ask if you would like to know anything.

 

[EDIT] Why on earth am I comparing AD's to fruit!??! It has been a long day... It makes sense to me at least...

 

So, it would be much better to wait until I am off of this and stable before trying something different? Talk about adding to the depression. At this rate it will be this time next year before that happens and I am already miserable - hopefully I still have a job and family by then. 

[fishinghat]

"At this rate it will be this time next year before that happens and I am already miserable"

Unluckily that applies to nearly all the members. Some exceptions. I am sorry. More info to follow.

[invalidusername]

Often it is a case of weighing up unbearable weeks (which can lead to their own problems), or tolerable months. 

 

Moving around quickly decreases tolerance to these drugs and increases sensitivity. This is unfortunately where I am, and I would give my left arm to go back and change things.

[fishinghat]

OK, having trouble posting again so will try this is small posts. Keep your fingers crossed.

 

OK, no luck. I will try again later.

 

The bottom line was not to take Adderall or Ritalin with Wellbutrin and/or Cymbalta.

 

Risk of seizures and serotonin syndrome. I will try and post the detailed info later.

[fishinghat]

Adderall works primarily by increasing the activity of the neurotransmitters dopamine and norepinephrine in the brain. It also triggers the release of several other hormones (e.g., epinephrine(adrenaline)) and neurotransmitters (e.g., serotonin and histamine).

[chinton620]

So, I shouldn't take the stimulants? Sorry, I am confused

[fishinghat]

OK Chinton. I am going to try posting the information again now that the site is back up I have been trying to get on the site for 3 hours.

[fishinghat]

Ritalin is most active at modulating levels of dopamine (DA) and to a lesser extent norepinephrine. Ritalin binds to and blocks dopamine transporters (DAT) and norepinephrine transporters.

[fishinghat]

Ritalin may inhibit the metabolism of coumarin anticoagulants, certain anticonvulsants, and some antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors). Concomitant administration may require dose adjustments, possibly assisted by monitoring of plasma drug concentrations. There are several case reports of Ritalin inducing serotonin syndrome with concomitant administration of antidepressants.

[fishinghat]

Both of the above posts are excerpts from Wiki

[fishinghat]

https://www.drugs.co...606-979,440-203

Drug Interaction Report
Ritalin (methylphenidate)
Wellbutrin (bupropion)
Major
buPROPion methylphenidate
Applies to: Wellbutrin (bupropion), Ritalin (methylphenidate)
BuPROPion may rarely cause seizures, and combining it with other medications that can also cause seizures such as methylphenidate may increase that risk. You may be more susceptible if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma.

https://www.drugs.co...9-2273,190-1645

Drug Interaction Report
Cymbalta (duloxetine)
Adderall (amphetamine / dextroamphetamine)
Major (2)
Interactions between your drugs
Major
amphetamine DULoxetine
Applies to: Adderall (amphetamine / dextroamphetamine), Cymbalta (duloxetine)
Talk to your doctor before using DULoxetine together with amphetamine. DULoxetine may increase the effects of amphetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported. Combining these medications can also increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms while taking the medications.
 

[fishinghat]

Yea, I finally made it.

 

The bottom line is Chinton is that taking Adderall and/or Ritalin poses a risk of seizures and/or Serotonin Syndrome. In addition both of these drugs effect neurotransmitter(s) that are in imbalance during Cymbalta withdrawal. I can not tell you to take and try one or both. That decision is up to you but given how screwed up your neurotransmitters are right now I would hesitate to add more variables to the mix.

[invalidusername]

Sound advice in my opinion.