32 replies to this topic

[Martina]

Hi, I'm new here. Skip to the last paragraph if you're short on time! I've been on 3 different antidepressants for 24 years, Cymbalta starting about 13 years ago. (I'm not sure the meds were really necessary all that time, or that it was even really working much. I'd tried several times to get off but didn't know about tapering and never succeeded.) I think I'm in a really stable place right now, have some good strategies, and think I can do just as well without antidepressants.

 

After reading about tapering I started 16 weeks ago. I went from 90 to 65 mg with no symptoms. But a few days into 65 mg I suddenly couldn't sleep. There's no physical or psychological reason for this, but it's continued for 14 nights now. I've done different things different nights to help get SOME sleep since then, including from 1-3 mg. melatonin, ativan, clonazepam, and some nights nothing. Being sleep deprived all the time is beginning to wear me down. 

 

I have a big vacation coming up in 6 weeks. I'm now concerned that the effects of withdrawal might worsen. So I'm thinking of dosing back up a little for the time being. The duloxetine instructions say if withdrawal symptoms continue, increase back up to the original dosage. I hate to go back to 90 mg after all this time. I'm thinking maybe I could go up to 70, 75 or so because everything was fine there. I also read something about a 3 week rule... that if you go back up within 3 weeks it shouldn't take long to reverse symptoms. Does anyone have any experience going up just a little, but not all the way? I wonder if it would work. After vacation I'll work on getting off again, I'm determined.

 

Thank you for any insight.

 

PS, have people really been able to get off it for good???

 

 

[invalidusername]

Hi Martina and welcome...

 

Well done for getting as far as you have. Being on Cymbalta as long as you have will call for a very slow taper indeed. The 3-week rule you speak of is very subjective and cannot be applied in all circumstances and with all people. Insomnia is a very common symptom of withdrawal in general - not just Cymbalta, but there is no reason to reinstall the original dose. As you have suggested, I would say to go up a few mg and see how you get on. It will take 3 days for the blood levels to stabalise, but you might need to give it a few more days on top of this to see improvement in your sleep.

 

If you were to do right back to 90mg, this will bring its own issues being a 50% increase. You only want to updose enough to relieve your symptoms so you can then start again once you are happy to continue.

 

Melatonin is good, but it is not a long term solution, and steer clear of z-drugs! These will only cause more problems than they are worth. 

 

Let us know how you get on,

 

IUN

[fishinghat]

IUN is right but I would add not to lean on the benzos (Ativan and Clonazepam) too much as they have a strong withdrawal as well and are addictive. Most drs where I live use clonidine or hydroxyzine instead as they are not addictive and have no withdrawal.

[Martina]

I know about the addiction to the benzos with regular use. But can you get addicted taking Ativan (5 mg) or clonozepam (0.5 mg) by taking it 2 or 3 times a week for a few weeks?

 

Also, what is a safe % to increase? 65-70 mg is 7.6 % if my math is right. By the way, I read only today that I shouldn't be cutting the mini tablets inside the capsule because they're coated. That's how I've been tapering. I'll have to see if I can find a source that makes capsules with tiny beads instead.

 

Thank you both for replying!

[fishinghat]

Clonazepam is the most addictive benzo followed by Ativan. That level usually is relatively safe from addiction but that differs from person to person.

 

It has been my experience on this site that the level of increase is very person dependent. I usually recommend going up about 2 or 3 beads a day (for a capsule around 300 beads) until relief is acquired. You don't want to go up any further than necessary as that is just that much more that you will have to drop later.

 

Some have cut their beads with success BUT they must use enteric coated capsules (aka acid resistant capsules) to take their dose. They can be acquired at Amazon and most compounding pharmacies.

 

Hang in there and don't be afraid to ask questions. Unluckily drs are pretty much ignorant of this withdrawal.

[Martina]

Thank you both for the useful information.

 

Fishinghat, when you said some have cut beads with success, do you know if the beads were mini tablets rather than tinier pellets? My 30 mg caps have six 5 mg mini tablets inside. Is it OK to cut them if I put the cut one back into the capsule? I think I read on The Withdrawal Project site that that isn't good. I don't remember if it's because cutting breaks the coating on each mini tab or because you can't get an accurate enough dosage that way.

 

 

 

 

[fishinghat]

You are right. It is NOT recommended to cut the coating because the original capsule is only gelatin and dissolves quickly and therefore the Cymbalta is released in the stomach which can cause problems, BUT if you cut the small tablets and place them in an enteric coated capsule that will protect the tablets until they get into the intestines. The other members were using brands with 5 to 9 small tablets inside.

[Martina]

Aah, now I understand what you mean! Yes, I noticed the gel caps dissolve quickly. Thank you so much!

[Martina]

I just wanted to report that three days after I increased my duloxetine dosage by 5 mg, to 70 mg, I slept normally without a sleeping pill for the first time in 16 days. This is encouraging because it means that sometimes, when withdrawal symptoms occur during tapering, it's possible to reverse them by increasing the dose a little. The instructions that come with duloxetine say if symptoms occur to go back up to the originally prescribed dose, which I didn't want to do. It took me four months to taper from 90 to 65 and I didn't want that to be for naught. My plan is to stay on the 70 for a while, then try tapering again. 

[invalidusername]

The leaflet has to say to go back up to the previously prescribed dose as the Pharma does not endorse bead counting methods of withdrawal. But as you, and all of us know, you need only go as far as required to reach stability. The last thing you want to do is undo all of the work from the previous few months as you say.

 

Very glad to hear that you were able to sleep without any aid - great news. Agree that it is best to remain at 70mg for a while to allow your system to settle before going further.

[Martina]

It's a year and a half later and I tried on my own to reduce the 70 mg I'm taking but I started having the same trouble with sleep. I recently started working with a psychiatrist to help me get off Duloxetine. Her strategy is to get me on Lexapro while I taper off Duloxetine, then get me off Lexapro. I started two weeks ago on 5 mg. 

 

My question is about tapering by 5% per month, which I've read is a fairly conservative goal. At that rate it would take me six or seven years to be completely off. Does the 5% per month recommendation apply if you're taking something like Lexapro at the same time? Or does taking an SSRI like Lexapro generally make it easier to go faster?

 

Thank you again! 

[fishinghat]

Welcome Martina

 

Lexapro has been one of the favorites by members for cross tapering. I personally think the 5% a month is way too slow when cross tapering. A slow switch, but not that slow, is important though. It takes around 4 to 6 weeks for Lexapro to kick in so weaning off the Cymbalta should be slow at first. If things go well you should be able to stop the Cymbalta completely after the Lexapro kicks in. 

 

Be aware though that being on two antidepressants can carry a risk of serotonin syndrome, a very serious condition. Keep your eyes open for any fever which is  common with that condition. So, bottom line, weaning the Cymbalta too fast and the withdrawal can bite. Weaning too slow and there is a risk of seotonin syndrome. 

 

That 5 mg is a real low dose of Lexapro. Is your dr considering increasing it as time goes on?

[Martina]

Thank you for your reply! Yes, I think she will increase the dosage as needed. When you say once I'm on Lexapro I should be able to stop cymbalta completely, you still mean by gradually tapering off it, correct? (Though not as gradually as 5% per month.)

 

When cross tapering, is there a usual way the lexapro dosage is increased? I know it's always individual, but generally are people started on a higher dose of Lexapro than 5 mg before they start tapering off cymbalta? I guess she did this to avoid serotonin syndrome.

[fishinghat]

Typical cross taper is to drop Cymbalta to ) over a 4 to 6 week period and increase lexapro to 5 mg for 3 weeks and then 10 mg after that. This kind of taper does allow some bad withdrawal effects for a few weeks (4 to 6) but minimizes the risk of serotonin syndrome. Now having said that I have seen drs do way different patterns but the above schedule is typical. Just my opinion based on what I have seen, (and we are all different) I would drop the Cymbalta over a 2 month time period and start the 5 mg of Lexapro right away and then go to 10 mg after 2 weeks.

[Martina]

Thanks Fishinghat. Just to clarify, you said "drop Cymbalta to )". What is ")" ?

[fishinghat]

Well, that proves what a bood typist I am. In fact I even proofread it afterwards. Senility for sure. 

 

I meant to type "...drop the Cymbalta to 0 over a 4 to 6 week period..."

 

Sorry about that.

[Martina]

Ohh, haha, that helps! Thank you so much, this site is a godsend.

[invalidusername]

Hi Martina,

 

Sounds like Hat has got you off to where you need to be. Essentially, you need to be thinking that 5mg Lexapro is around 30mg of Cymbalta, so you want to make sure that you don't go beyond 20mg lexapro/120mg cymbalta (the equivalent thereof in a mix between the two). I agree with Hat insomuch that a good taper gives you a bit of a bit of breathing space whilst you wait through those 4-6 weeks for the new drug to kick in, but you need to make sure you are aware of the total dose as outlined.

 

If in doubt, that is what we are here for

 

IUN 

[Martina]

I just saw this, thank you so much! That's interesting information. 

[invalidusername]

My pleasure Martina - be sure to keep in touch.

 

Wishing you all the best

[Martina]

I just wanted to post a follow up on my Cymbalta (duloxetine) withdrawal experience in case it's of any use to anyone.

 

After several unsuccessful tries (on my own) through the years to get off duloxetine, I finally found a knowledgeable psychiatrist to work with. She put me on 5 mg Lexapro, which I took in addition to my dose of 70 mg of duloxetine. After two weeks I experimented with the rate of tapering off duloxetine. I started off very slowly and eventually found that I could comfortably handle a reduction of 1 mg/day. All told it took me three months to completely stop duloxetine. I didn't notice any real difference in the way I felt and thought it was miraculous that it hadn't been hard to get off at all, with the Lexapro. This was based on my belief that 5 mg of Lexapro was very low, and not enough to really help depression. However, my doctor told me 5 mg isn't that low for Lexapro, so I now think the reason I felt fine was that that dose of Lexapro was protecting me. But that's probably still good news for someone who just wants to get off duloxetine, and doesn't mind being on an SSRI.

 

I remained on Lexapro another 18 days, then stopped it. Three days after that I started having unusual moody symptoms that surprised me (like wanting to cry over little things) and it took me a few days more to realize it was because Lexapro was out of my system. I think that 5 mg of Lexapro was basically doing for my brain what the 90, then 70, mg of duloxetine had been doing before that. It was very rough for two weeks, some days very depressed, some days very anxious, some days both, with a few days of feeling ok mixed in. Unfortunately a major, external out-of-the-blue stressor happened to occur right at the same time, so it's hard to know if things would have been as hard otherwise. Now, six weeks off Lexapro, the most dramatic depression and anxiety have eased but I'm feeling far from calm or happy. I haven't decided if I'll start medication again but, if I do, it won't be duloxetine. I'm holding out hope that lifestyle management might work to decrease my symptoms. I'm not that confident it'll work but I want to give it a try. 

 

I'm grateful this forum exists, it was helpful to me when going through a difficult-to-navigate experience. It's hard to get reliable answers to specific questions, and find doctors who are qualified and also willing to listen to what you want. I've found some who just want to dispense drugs and frown on helping people get off them. 

 

 

[fishinghat]

Fantastic story Martina!! Let me be the first one to congratulate you.

 

You were amaxingly lucky. Lexapro only controls serotonin while Cymbalta controls serotonin and norepinephrine. For most using Lexapro to handle withdrawal from Cymbalta leads to a spike in norepinephrine ( a precursor to adrenaline) and a major spike in anxiety which can last months HOWEVER having said that thewre are ocassionally people who don't experience that reaction for some reason. I know several drs who use low dase Lexapro, prozac or sertraline to help the Cymbalta withdrawal. When I went through mine my dr tried a low dose of Prozac and Lexapro with no bebnefit. He finally tried Zoloft which did the trick. 

 

Again, way to go and I hope all is smooth sailing for you.

[Martina]

!!! I DO have higher anxiety after stopping the meds (higher than I used to before I went on them in the first place.) Maybe you just explained why. My doctor said the withdrawal symptoms should go away after 2-4 weeks and, because it's been 6 weeks, I feared I was stuck with the anxiety. (That's why I might eventually decide to go back on something - this anxiety level is hard to live with.) But from what you say it sounds like, even if the increased anxiety lasts months, it eventually does go away. Do you know if it always does, or does it sometimes remain forever? My guess is there are no absolutes.

 

And Fishinghat, you seem very knowledgeable about this - is it just from your personal experience or do you have a medical background?

 

Thank you. 

[fishinghat]

Hi Martina

 

There have been many lawsuits over Cymbalta with most relating to the withdrawal. I personally know three people who have cold turkey stopped it without any withdrawal. I also have met many who have withdrawal that lasts up to 2 years or even more. The standrd comment about 2 to 4 weeks from drs is accurate for some. I also would like to state that symptoms being worse after stopping Cymbalta is very common. Those who take Cymbalta for pain often have worse pain aftere stopping it but it does return to preCymbalta levels with time just as the anxiety does also. These conditions are called rebound pain or rebound anxiety. I am not aware of the "extra" anxiety lasting forever after stopping Cymbalta.

 

I have a Master's Degree in physiology and 30 years experience which included considerable work with work related health issues and the use of medical journal literature research. Do bear in mind that I am NOT a dr and my comments are strictly based on my experiences and research. If you have read over any of our ebook you will see that I always try to reference specific medical research on any medical statements I make.

[Martina]

It's encouraging to hear that symptoms usually dissipate after some period of time, and unfortunate that it's impossible to know what any given person's experience will be.

 

I understand that your comments aren't medical advice. It's just good to get as many points of view as you can.  

 

Can you point me to the ebook you mentioned? Where do I find it?

 

Thanks!

[fishinghat]

Sure Martina

 

This will take you to a post with a link to the document.

 

https://www.cymbalta...-ebook/?p=96693

 

If you have problems accessing it just let us know.

[Martina]

Wow, I hadn't seen that before! It's a great service to people, thank you again!

[fishinghat]

You are very welcome Martina. Just some light reading.  lol

[invalidusername]

Hi Martina...

 

Just caught up on the last few days. Did you mention how long the taper from Lexapro was? Did I miss it? This can obviously have a bearing of what follows. 

 

Hat has plenty of experience by himself, and given that we have the most vested interest in getting ourselves better, we are more likely to become experts in our own reactions to these meds as doctors will simply want their paychecks. Given that mental health is the biggest reason for time off work (in the UK at least), you would think there would be more attention and resources available. But no - it is all covered with the almighty little white pill. 

 

Maybe is the Lexapro was working at this point, it might be an idea to reinstate this. I hope you are finding the eBook of use. 

all the pertinent information from the published papers, combined with the experiences and opinions of over 10k members. 

[Martina]

Invalidusername,

 

I realize I misstated the tapering length above. It took me four, not three, months to get off duloxetine. I went on Lexapro two weeks before starting to taper off duloxetine, and stayed it for 18 days after I stopped duloxetine. Maybe I should have stayed on it longer, I don't know. It's been a rough 7 weeks. Anxiety and depression were really exaggerated for the first 2-3 weeks. That settled down but the depression that remains might be here to stay. 

 

Thank you for the work you put into this!