7 replies to this topic

[ESRoar]

Hello,

I've weaned off of Cymbalta 90mg down to 47mg since July 2018.  I started having depression problems about 2 months ago after the birth of my daughter.  I started going to therapy and the therapist suggested I see a psychiatrist.  I had this appointment yesterday and was kind of baffled because it was with a Physicians Assistant.  Anyhow, he had no clue about cymbalta withdrawals.  He suggested I go up in dose, but I hate to do that since the weaning off is so hard.  He then suggested adding Nortriptyline.  Has anyone been on these 2 drugs together?  I hate to add something else, but if it will help my depression and help me wean off Cymbalta, then I guess I'm OK with it.  I'm also breastfeeding my daughter, so taking drugs like this concerns me.  But then again, a depressed crying Mom isn't a great thing either. Any advise?

I could also try scheduling a teladoc appointment with an actual psychiatrist and see what they think.

Thank you.

[fishinghat]

Welcome to the site ESR
 
Yes, it can be quite a challenge to wean off this drug for sure. I did some quick looking into your situation and here is what I found. The drug incompatibility was my biggest concern. Please let us know if there is anyway we can help.


https://dailymed.nlm...dience=consumer
FDA approved drug insert for nortriptyline
Use in Pregnancy
Safe use of nortriptyline hydrochloride during pregnancy and lactation has not been established; therefore, when the drug is administered to pregnant patients, nursing mothers, or women of childbearing potential, the potential benefits must be weighed against the possible hazards. Animal reproduction studies have yielded inconclusive results.


https://www.drugs.co...tic_duplication
Interactions between your drugs
Major
nortriptyline and DULoxetine
Applies to: nortriptyline, Cymbalta (duloxetine)
Using nortriptyline together with DULoxetine can 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 seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns.


https://www.ncbi.nlm...pubmed/11243492
The aim of the present study was to investigate the transplacental transfer of amitriptyline (AMI) and its main active metabolite nortriptyline (NOR) in isolated perfused human placenta.Both AMI and NOR cross the human placenta. However, the fetal exposure with NOR may be somewhat smaller compared with AMI, probably due to the higher lipophilicity of AMI.

https://www.ncbi.nlm...les/PMC3973612/
The TCAs nortriptyline, clomipramine, and their metabolites pass readily into umbilical cord serum in in vivo studies (Loughhead et al., 2006b).
Weissman et al. (2004) conducted a large scale meta-analysis of 57 studies that examined mother-infant breastfeeding pairs to determine the amount of antidepressant exposure via lactational transfer. Overall, nortriptyline, sertraline, and paroxetine usually had undetectable concentrations in infant serum.

[fishinghat]

I thought you might also want to look at these.

Autism research and Antidepressants

http://www.huffingto...4b0e292150f72e3

http://archpedi.jama...ticleid=2476187

[ESRoar]

Thank you.  I haven't picked up the prescription.  I'm too afraid to take it.  I'm trying to get through this without meds, but really struggling on a day-to-day basis.  I'm thinking if I have to increase Cymbalta that may be the way to go.  I'm presently on 47mg.

[fishinghat]

If you do decide to raise it please raise it only 2 or 3 beads. It takes 3 to 7 days to feel the full effect so be patient.

[ESRoar]

OK thank you.  I haven't changed anything as of yet.  Yesterday I had a great day and had no depression or anxiety.  Today I'm back to feeling bad.  It's so strange to me how it comes and goes.

[fishinghat]

Oh do I understand but it sure is a rollercoaster.

[invalidusername]

It can be a frightening concept, and ultimately, it is you who will need to make the call as to whether it is worth gong ahead. 

 

The problem is that if you leave it too long, then it will take longer to come out the other side, but if by going back on them will be a source of anxiety in itself it becomes a rock and a hard place. This is where we cannot jump in and make a decision for you - only you can decide that one...