1191 replies to this topic

[Mxpro32]

My family went to the beach last weekend and it was nice, and I was able to enjoy it, other than the 4 am panic wake up call.

[invalidusername]

Finally caught up with this thread - been a lot of activity.

 

Frog has made some very valid points here along the way - about the doctor, as I would have done things differently had mine not have agreed to work with me rather than against me. The last one that went against me ended up getting fired from his position - I am sure my complaint against him didn't help none too much, but he deserved what he got in my opinion. For those that don't know - this guy took the last of my beads when I was at 10mg, thus forcing me to a cold turkey. Not how a professional behaves in my book.

 

I also agree with her regarding the getting outside - as difficult as that is. I have not been out for around 36 hours now and I am ashamed, but I really do need the rest. The slightest thing will set my stress right off the chart. Natural absorbtion and ingestion of vitamins is obviously the better way to go; the body will take what it needs rather than being "force fed" what it might not.

 

The body is a very complex and amazing machine. Just like the doctor comment, we need to work with the body rather than against it, and in doing so, we need to understand how it works...

[Mxpro32]

when I went to see my dr. I was a pile of mush, so I can't blame him for prescribing something serious.  I just don't like how he replied when I asked him directly if it was possible my mind was still adjusting to not having the meds.  I see him again in a couple weeks so I'm going to tell him I never started the new prescription and broach the topic again and see if hes willing to take me seriously on my experience.  

[fishinghat]

Good luck mxpro. Remember, this is your health not his. He works for you. You hired him and you can fire him. If only he would listen and advise and not dictate.

[Mxpro32]

are the symptoms during tapering typically better or worse than the symptoms once you are completely off?  for me, the physical symptoms (brain zaps, dizziness) were much worse during tapering, and I was very emotional as far as crying easy and getting easily moved to tears by happy events or touching stories, but since I've been completely off, my physical symptoms are gone, but my anxiety is out of control.  I still have the tears over touching events, but not to the extent it was.  

[Mxpro32]

man, I'm having a hard time coming to grips with the idea of just feeling bad for a while.  I've been listening to mindfulness books while working and reading cbt books before bed and trying to relax and control my thoughts.  at times I feel like I can make myself feel better, but even during the "good" times, it just feels like so much work and nothing has any intrinsic enjoyment.  its like my life isn't mine and seems foreign.  the only constant is that I feel bad and I can't shut my mind up as it tries to reason a way out of the pain.  I find myself asking what I would normally even want to do in this or that situation because I just feel uncomfortable and nothing sounds appealing.  the anxiety is always there, as I imagine every potential vulnerability, whether financial, or emotional, like what I would do if I lost one of my children or my wife.  before meds, my depression was mostly numbness and disinterest, but not pain.  before, I never even understood how someone could commit suicide.  I'm not suicidal, but I understand now.  now the emotions I mostly feel are sadness, pain, and anxiety.  and they are intense.  when I was on Cymbalta I felt like my life was passing me by in a hurry.  I thought about my age (almost 40) and felt like the rest of my life was going to be gone in a flash unless I figured out a way to savor it.  now each day is such a struggle the rest of my life seem like forever.  its almost unfathomable that I can make it through the rest of a long life.  I just wish I knew for sure that time will heal and I will feel better eventually.  

[frog]

I can't remember if you've already said if you're taking any supplements to help ease the withdrawal? I take Ashwagandha twice a day: 300mg in the morning and 600mg at night an hour or so before bed to help tame any lingering anxiety, it can also make you physically feel 'relaxed' so it's easier to drift off. I know other people also have success with Suntheanine and then there's also the two prescription ones that FH mentioned. I like Ash because its job is to promote natural reactions your body is already doing anyway, but because the brain is struggling with those reactions at the moment the Ash kind of gives it a gentle push. 

 

For whatever reason I was spared of sleep problems for most of my withdrawal with the exception of last week when I started having a hard time falling asleep. Everytime I would feel my mind clear and my sleepy brain take over and start to drift off, my 'awake' brain would basically jerk me awake and I'd get a wave of anxiety and get really hot. I took melatonin to at least help fall asleep but I would still wake up every few hours and struggle to fall asleep again as the jerking awake and anxiety would repeat itself. After a few nights of this misery, I've been trying to change up my pre-bed time routine to set myself up for success. I don't know if it's the changes or whatever was causing it has just simply resolved itself BUT I did sleep a solid 8 hours last night with no interruption!

 

What I'm doing: 

If you're not already, take a walk around 6 or 7 to help clear your head and to tire your body out a bit

Try not to go to bed TOO early. I try to shoot for 10:30-11. This can be hard when the anxiety is bad because you just want to try to sleep instead of being awake with your thoughts and anxieties but I think it's worth staying up a bit

Take Ash an hour before bedtime (obviously this depends on if it works for you to calm anxiety. it does for me)

No screens at least 30 mins before bedtime, ideally an hour. 

I read the research IUN posted about journaling before bed. Basically take the time before bed to get all of the day's stresses and anxieties down on paper and release them from your head. Apparently during the day our brains will often store away certain worries and thoughts and then at night do like a brain dump which can cause nighttime anxiety, or something like that. If you write them all out then they won't bother you as much. 

Read a bit in bed just to settle in and calm down my mind. 

Take some melatonin before bed if you can tell you're going to have a hard time falling asleep

 

None of this is really rocket science, but personally I never had a nighttime routine before because I've always been an excellent sleeper, so it was a big change for me. 

 

Everything you're saying is very reminiscent of how I've felt through the past month. I did not have depression going into this, so I'm convinced that what you're feeling is just straight withdrawal which means it WILL get better. I don't think this is the new normal or anything like that. I know this because I am getting better. But honestly just a week ago I felt so hopeless because it felt like it would NEVER end and the last month already had me pushed to my limits. And then one day I just started really taking stock of how far I'd come since a month ago and I continue to notice things get easier every day. I think one thing that helped me a little was to rationalize how I was feeling rather than trying to change it. So reminding myself that the crazy anxiety is because my brain is trying to heal itself and needs to remember what it needs to do and how now that the crutch of Cymbalta is gone. Or if I was able to go out but came home with my head buzzing and feeling super anxious, well that's because my brain got overstimulated because I don't have a well functioning stress response right now, so it got all worked up, etc. I'm a very logical person so it helped me make sense of what I'm going through. 

[fishinghat]

are the symptoms during tapering typically better or worse than the symptoms once you are completely off?  for me, the physical symptoms (brain zaps, dizziness) were much worse during tapering, and I was very emotional as far as crying easy and getting easily moved to tears by happy events or touching stories, but since I've been completely off, my physical symptoms are gone, but my anxiety is out of control.  I still have the tears over touching events, but not to the extent it was.

The symptoms associated with Cymbalta withdrawal seem to follow a pattern of what symptoms hit first and then what follows. However, the time it starts and the duration do not. Some members have started having issues at around 40 mg, for most it is around 5 to 10 mg, and mine was on the last bead. Others still do not have issues until a couple of weeks off. Some of the things that effect this seem to be age and weight. Cymbalta is fat soluble so any unused Cymbalta is stored in fat tissue. As one weans off the fat tissue will slowly release Cymbalta as the body demands. Likewise if one starts losing weight during withdrawal then that will release Cymbalta into the blood stream and effect the symptoms.

[Mxpro32]

The symptoms associated with Cymbalta withdrawal seem to follow a pattern of what symptoms hit first and then what follows. However, the time it starts and the duration do not. Some members have started having issues at around 40 mg, for most it is around 5 to 10 mg, and mine was on the last bead. Others still do not have issues until a couple of weeks off. Some of the things that effect this seem to be age and weight. Cymbalta is fat soluble so any unused Cymbalta is stored in fat tissue. As one weans off the fat tissue will slowly release Cymbalta as the body demands. Likewise if one starts losing weight during withdrawal then that will release Cymbalta into the blood stream and effect the symptoms.

I was wondering about that. I haven’t had much of an appetite and have been losing weight. The released Cymbalta doesn’t seem to be helping though.

[fishinghat]

Just think about how bad it would be without the extra Cymbalta being released. On second thought don't think about that. It may drive you crazy. lol

[Mxpro32]

I went to my new counselor yesterday (5th time seeing him) and I think I need a new one. I started the first session by explaining I had tapered off my Cymbalta. Now it’s like he’s examining me for a diognosis more than trying to help me cope and work through things. This session I was explaining everything I’m going through and he says “I wonder what your psychiatrist would say. I wonder if he would think this is bipolar behavior”. I’m trying to explain to him that this isn’t who I am. I feel like a crazy person, but this isn’t typical me. I told him about this site and he kinda rolls his eyes in that “you can’t believe everything you read on the internet” kind of way. I explained that I was reading a book about mindfulness and letting go of internal emotional scarring (I’ve been through a lot of serious family and other traumatic issues) and he kinda shrugs that notion off. It’s like he’s made up my mind and doesn’t believe the withdrawal theory and that I can’t work through my issues without meds. The. What am I paying him for? I’m going to counseling to face and work through my issues?

[fishinghat]

Not what a therapist is suppose to do. Fire him and het someone who really cares to help you. What idiots.

[Mxpro32]

Just think about how bad it would be without the extra Cymbalta being released. On second thought don't think about that. It may drive you crazy. lol

Well I’m down to 205 and I’m a pretty big guy so I don’t have a lot more to lose lol. How long does ashwaghanda take to work. I tried some this morning and ive felt the most normal I’ve felt in a while. Typically I feel like I’m amped up on adrenaline in fight or flight mode with a mind that just won’t shut up and goes a million miles an hour. Today, my thoughts aren’t racing and I don’t feel like my heart is racing or anything. Hopefully it’s helping and not just placebo.

[Mxpro32]

I was just reading and I found this:

“Chronic stress, poor nutrition, and taking certain medications, such as methylphenidate (Ritalin), can make your less sensitive to epinephrine and norepinephrine. These factors can also cause your body to start producing less epinephrine and norepinephrine.”

I've been on methylphenidate for years too. Could this be contributing to my symptoms. Without the cymbalta, I have less norepinephrine, and the Ritalin has driven down my sensitivity to and levels of epinephrine, and low levels of epinephrine causes anxiety.

So now it sounds like I may need to ween off the Ritalin once I’m done weening off the Cymbalta.

[Mxpro32]

I was also reading that concerta (methylphenidate) increases the levels of dopamine and norepinephrine, and as it wears off throughout the day, you can have a crash where your dopamine and norepinephrine are lower than normal because your body has started making less. So it makes sense my anxiety and depression are worse in the morning and why I wake up at 4 am buzzing without the Cymbalta crutch.

There have been times where I go without my Ritalin for a few weeks just to be sure I still need It. My head is a mess and I can’t concentrate or remember anything, thus concluding that I do in fact need it. It hadn’t occurred to me that those symptoms may have been withdrawal, or at least that they wouldn’t be as bad once I recovered completely from the withdrawals.

[frog]

I don't know anything about Ritalin or how it may be impacting your withdrawal, but in the mornings your cortisol levels are normally higher because it's the chemical that tells your body to wake up and prepare for the day. Cortisol is also the chemical that's responsible for your stress response. From what I understand one side effect of quitting Cymbalta is that your cortisol becomes deregulated and can get elevated and since it's already naturally higher in the mornings, mornings are often the toughest part of the day. They definitely are for me. A lot of the time I feel worse in the morning and it gradually eases as the day goes on. 

Ash worked pretty quickly for me so it could be that it's working for you. For me I would feel almost like a 'body high' which indicated to me that it was kicking in. 

[fishinghat]

Frog, Serotonin is actually the wake up chemical in the body. With the rising in light intensity the pineal gland produces serotonin, a stimulant. In the evening the as the light wanes the poineal gland directs the production pf an enzyme which converts serotonin to melatonin which is a depressant and makes us sleepy in the evening.

As serotonin levels increase to a certain level in the morning the cortisol levels increase and further stimulate us. The cortisol awakening response (CAR) is an increase between 38% and 75% in cortisol levels peaking 30–45 minutes after awakening in the morning in some people.

 

To give a practical example. We wake up in the morning due to increased serotonin but are only slightly stimulated. We may still be groggy and sluggish, in about an hour the cortisol kicks in and we become fully awake and functional. It is interesting to note that some people do not have there cortisol kick in until in the afternoon or evening due to genetics. We sometimes use the expression " not a morning person"  or even "night owl" for these people. phrase applies.

[Mxpro32]

I don't know anything about Ritalin or how it may be impacting your withdrawal, but in the mornings your cortisol levels are normally higher because it's the chemical that tells your body to wake up and prepare for the day. Cortisol is also the chemical that's responsible for your stress response. From what I understand one side effect of quitting Cymbalta is that your cortisol becomes deregulated and can get elevated and since it's already naturally higher in the mornings, mornings are often the toughest part of the day. They definitely are for me. A lot of the time I feel worse in the morning and it gradually eases as the day goes on. 

Ash worked pretty quickly for me so it could be that it's working for you. For me I would feel almost like a 'body high' which indicated to me that it was kicking in.

I feel relief from my fight or flight response, and my mind isn’t racing.

[fishinghat]

“Chronic stress, poor nutrition, and taking certain medications, such as methylphenidate (Ritalin), can make your less sensitive to epinephrine and norepinephrine. These factors can also cause your body to start producing less epinephrine and norepinephrine.”

"I've been on methylphenidate for years too. Could this be contributing to my symptoms. Without the cymbalta, I have less norepinephrine, and the Ritalin has driven down my sensitivity to and levels of epinephrine, and low levels of epinephrine causes anxiety."

Not so. Ritalin does not make you less sensitive to epinephrine and norepinephrine. It actually increases them (as you indicate later) and acts as a stimulant.

Without the Cymbalta to control the norepinephrine you actually start to overcompensate and produce too much norepinephrine with the excess being converted to epinephrine (adrenaline). This is why anxiety is often referred to as a "chronic adrenergic state" inb the medical literature.

[fishinghat]

FYI

Methylphenidate, s a strong stimulant.
Methylphenidate primarily acts as a norepinephrine–dopamine reuptake inhibitor (NDRI).
By increasing the effects of norepinephrine and dopamine, methylphenidate increased the activity of the central nervous system and produced effects such as increased alertness, combated fatigue, and improved attention. Common side effects include trouble sleeping, anxiety, and weight loss. Norepinephrine is converted to epinephrine (adrenaline).

Methylphenidate Hydrochloride Monograph for Professionals". Drugs.com. AHFS. Archived from the original on 19 December 2018. Retrieved 19 December 2018.
Iversen L (January 2006). "Neurotransmitter transporters and their impact on the development of psychopharmacology". British Journal of Pharmacology. 147 Suppl 1 (Suppl 1): S82–8. /wiki/Digital_object_identifier

[frog]

Oops sorry for spreading misinformation. Thanks for correcting me FH. But I think the general idea remains that there can be a lot more anxiety in the morning

[Mxpro32]

“Chronic stress, poor nutrition, and taking certain medications, such as methylphenidate (Ritalin), can make your less sensitive to epinephrine and norepinephrine. These factors can also cause your body to start producing less epinephrine and norepinephrine.”

"I've been on methylphenidate for years too. Could this be contributing to my symptoms. Without the cymbalta, I have less norepinephrine, and the Ritalin has driven down my sensitivity to and levels of epinephrine, and low levels of epinephrine causes anxiety."

Not so. Ritalin does not make you less sensitive to epinephrine and norepinephrine. It actually increases them (as you indicate later) and acts as a stimulant.

Without the Cymbalta to control the norepinephrine you actually start to overcompensate and produce too much norepinephrine with the excess being converted to epinephrine (adrenaline). This is why anxiety is often referred to as a "chronic adrenergic state" inb the medical literature.

I was just quoting this: https://www.healthli...-norepinephrine

 

I understood it as the body pushing back against the effects of Ritalin by making you less sensitive to norepinephrine, and creating less norepinephrine on your own.  I was reading about "ritalin crash" where you can feel anxious and depressed at the end of the day as your norepinephrine and dopamine dip below normal.  before I just experienced the loss of the stimulant as sleepiness when it was wearing off.  I was just curious if now that I don't have the Cymbalta propping up the norepinephrine, maybe the Ritalin crash is more intense.  does that make sense?

[Mxpro32]

"Without the Cymbalta to control the norepinephrine you actually start to overcompensate and produce too much norepinephrine with the excess being converted to epinephrine (adrenaline). This is why anxiety is often referred to as a "chronic adrenergic state" inb the medical literature."

thats interesting. I understood cymbalta to prevent the reuptake of norepinephrine, so there would be more, then when the cymbalta is discontinued, we wouldn't have enough norepinephrine. so cymbalta really is suppressing norepinephrine? it sure feels like you are right, like I'm coursing with adrenaline.

[Mxpro32]

i think understanding the adrenaline thing will help me to cope with the anxiety.  instead of interpreting it as a distress signal of a threat that needs to be worried about and figured out, Im going to try to see it as if someone gave me a shot of adrenaline.  try to just feel the physical symptoms instead of letting it cascade into a torrent of racing thoughts, which makes it much worse.  

[fishinghat]

"I understood it as the body pushing back against the effects of Ritalin by making you less sensitive to norepinephrine, and creating less norepinephrine on your own. I was reading about "ritalin crash" where you can feel anxious and depressed at the end of the day as your norepinephrine and dopamine dip below normal. before I just experienced the loss of the stimulant as sleepiness when it was wearing off. I was just curious if now that I don't have the Cymbalta propping up the norepinephrine, maybe the Ritalin crash is more intense. does that make sense?"

I agree with everything except the word sensitive and the statement of "creating less norepinephrine on your own". Your body actually produces more norepinephrine when on Ritalin that is why it is a stimulant.

[Mxpro32]

What about when it wears off, or you stop taking it?

[fishinghat]

"thats interesting. I understood Cymbalta to prevent the reuptake of norepinephrine, so there would be more, then when the Cymbalta is discontinued, we wouldn't have enough norepinephrine. so Cymbalta really is suppressing norepinephrine? it sure feels like you are right, like I'm coursing with adrenaline."

You know I think that in a round about way you brought up an interesting point. when first taking Cymbalta (or other snri) your body produces less serotonin and norepinephrine. After 2 months it begins to make significantly more serotonin and norepinephrine, yet that is the time that one really starts seeing the antidepressant effects. This is also the time where the synapses have assumed their new shape to accept the Cymbalta molecule. All of this has lead to several research papers on how Cymbalta and other antidepressants work. The bottom line is they really don't know.

[fishinghat]

"Im going to try to see it as if someone gave me a shot of adrenaline"

You are exactly right. That is exactly what happens. I would suggest you look at the section in the ebook called "Chronic adrenergic state". This is a summary of the adrenaline response during stress and is an excerpt from a paper I published in 19... well you don't need to know the year and how ancient I am. lol

[fishinghat]

"What about when it wears off, or you stop taking it? "

Yes, I fully agree that there is a crash. Adrenaline and dopamine levels drop dramatically and the bottom falls out of your emotions.

[invalidusername]

It is interesting to note that some people do not have there cortisol kick in until in the afternoon or evening due to genetics. We sometimes use the expression " not a morning person"  or even "night owl" for these people. phrase applies.

 

That'll be me then - I have delayed sleep phase disorder...as does LDN, and it is well documented that this occurs due to a shift in the circadian rhythm.