335 replies to this topic

[RoaldDahl]

Dear friends,

 

This will be quite a long story but I am desperate and really need advice from experienced people on this beautiful forum. Thank god I found it! I've read through a lot and have written down a lot of useful advice/tips. 

 

My story:

 

At the age of 22 after several very nasty family problems I experience my first real panick-attack which lasted around 3 hours. No clue what was happening to me and thought it must be due to family stress. This panick attack developed in a wrong way and I developed agoraphobia/depersonalization/floating outside of my own body and constant anxiety. Basically I was stuck in my studentroom afraid to go out. 

 

Thanks to a doctor in my family I ended up seeing a psychiatrist. He immediately started with a weekly session plus Cymbalta 60mg. I got diagnosed with an anxiety disorder and a depression (didn't feel that depressed tbh). Cymbalta at this point saved my life and I will be ever grateful for it. It started working quite rapidly and after several months of rest and therapy I was able to enjoy a good life again!

 

However: the Cymbalta gave me small side effects but also a mayor one, my libido started tanking. Embarrassed at the age of 24/25 of struggling with something as awesome as sex this sure put me down a lot of times.

 

Anyhow, thinking that life was going ok, having a good job, lovely girlfriend, nice house etc I decided to taper down from the cymbalta 60mg. I had been on cymbalta for 13 years by then and wanted to get of it badly. I tapered down from 60mg to 0 mg in 7 months time. Here comes the weird part:

The first 3 weeks of Cymbalta were completely fine. I started feeling 'human' again with real emotions. I even traveled/flew without any problems ( my job requires me to travel quite a bit ) and I thought I got of easy. Boy was I wrong. 

After 3 weeks I experience one of the worst panick attacks ever completely out of the blue which ended up me going to the ER. To calm down I got a strip of Oxazepam. Next day same story but my panick attack was combined with HUGE EAR ringing and a heavy feeling of fever. I got to experience tinnitus for the first time in my life. 

I literally couldn't control my muscles, had to lie down 18 hours a day in bed shaking like crazy with non stop anxiety/beating heart and I could not stand any noise. This lasted for at least 4 weeks. Every time I went to the GP and told about my problems her solution was more oxazepam. I was up to 70mg of Oxazepam daily after 4 weeks and the problems didnt go away. 

In the meanwhile I still have a job...I told them I had pneumonia with a nasty infection and couldn't come to work for the coming weeks... 

The complete exhaustion from shaking non stop, not being able to even watch tv (it felt like my eyesight completely went away and I couldnt even read my phone properly), the non stop anxiety made me wanted to kill myself. I have never experienced this before but I was ready to jump of a building. 

 

Being this desperate made me go back to Cymbalta 30 mg in combination with Ambien 10MG. This got me out of this cycle after around 2/3 months. I wish I had never done it. The tinnitus was now permanent. My eyesight recovered however. I was still struggling with anxiety and panick attacks on a daily basis and have been for the year that I have been on 30mg. It has been extremely hard for me to function and have a normal day to day life. Last month however when I had to drive from Milan to Dortmund I completely broke down in the car. I experienced an anxiety attack which lasted around 9 hours non stop. The 6 hour trip took me around 13 hours to complete as I had to stop numerous times to calm myself down. 

 

For a large part I blame the Ambien and I have quitted it since 2 weeks. The withdrawal of it feels horrible but It seems peanuts compared to getting of of cymbalta. 

 

After this long story (apologies) my question to fellow people is:

 

- Were my symptoms of withdrawal weird to show up after 3/4 weeks? Do they seem abnormal? Could I have prevented them?

- Do you think I will need to be on cymbalta forever?  

- Any tips when I want to retry getting of of cymbalta? 

 

Sorry for the long story. I just need advice as my Psychiatrist thinks I'm making my withdrawal symptoms up 'cause all her other patients experience no trouble going cold turkey'. I don't know what to do anymore. 

 

Any advice is welcome. Thank you very much.

 

Roald

[fishinghat]

Welcome Roald
 
 
The delayed withdrawal symptoms is unusual but we have seen it a few times before.

The symptoms you experienced are within the normal range with what we have seen on this site. As far as could you have prevented them? Well I wish I had an answer to that! lol There were/are some things to try that might help. You need to check out our ebook which is a collection of things members have tried and their experiences as well as a lot of medical research articles.

https://pdfhost.io/v...of_Contents.pdf

The only way to find out if you need to be on Cymbalta forever is to come off it and see how you do after the withdrawal is over.

To come off Cymbalta I would suggest that you read the section in the ebook on 'bead counting'.

Cymbalta, like other antidepressants can cause the loss of testosterone production and require testosterone replacement treatment for the rest of your life. You might want to have your estrogen and testosterone levels checked.

Last but not least, the severity of Cymbalta withdrawal is well documented in the medical literature and your dr should be aware of that. Even the manufacturers warn of Cymbalta withdrawal AND the FDA has a warning of going cold turkey as it can cause suicidal thinking and even suicide. Your dr is an idiot. (sorry0 and you need a new one very soon.

[RoaldDahl]

Thank you very much for the reply God-Like! I will read through the Ebook and will try to find a new psych asap!

[fishinghat]

Definitely not god-like.  lol  That is a title given by the website depending on the number of posts made. Just call be fishinghat. 

[invalidusername]

Hi there Roald and welcome.

 

Thanks for sharing your story with us, and I am sure we will be able to help you. 

 

So 13 years on and 7 months to come off as you probably will have found out is too quick, and the 3 weeks that you had following the zero hour was what we call the "honeymoon" period where you feel everything is good prior to the inevitable backfire.

 

The shaking you got was due to the brain taking over the production of adrenaline. This is perfectly normal and I had something similar myself, and I also had seizures in combination. 

 

My question to you is whether these anxiety and panic attack are biological or circumstancial. Do you feel them coming on? What is going through your mind when they are happening? Did you not go through any form of CBT or establish any coping mechanisms with your doctor?

 

Not wanting to say it, but Cymbalta is a band aid for the brain. It is there to protect you while you tend to the wound. But if it is not seen for what it is, then you take the band aid off and the wound is still there, which appears could be the case with yourself.

 

There are lots of things that can help, but if you can help us out with the above and we can go from there...

 

IUN

[frog]

Hi Roald,

Welcome to the forum. The guys here can answer all of your logistical questions and concerns. They've both gone through this and come out the other side and seen and helped countless others on this forum, including myself who was really suffering when I came here last November desperately in need of advice. 

 

I just wanted to pop by and assure you that there's nothing wrong with you for having had a few problemless weeks before your withdrawal hit. The very same thing happened to me and I didn't even do as good of a job as you did with the taper. I didn't really know what I was doing and I tapered rather quickly down to 18mg and then just dropped it altogether. Well the first 3 weeks weren't completely problem-free, but it was just brain fog, brain zaps and a lot of irritability. All manageable and all familiar from when I would forget to take my dose in the past. I thought I was in the clear until 3 weeks later I entered into a state of round the clock panic attacks, agitation, anxiety, fear, the works. It was truly hell. It's been 4 months since then now and I'm still going through ups and downs, but it is WAY less severe than it was then. I know this is probably cold comfort because 4 months is a long time but that doesn't mean that your recovery will take this long. Just know that what you went through is normal and it does get better, it just takes TIME AND PATIENCE! (as FH would say)

[RoaldDahl]

Hi Iun & Frog,

 

First of all thank you very much for taking the time to write back. 

 

@IUN, I got the panick attacks after I had quit cymbalta while chilling doing nothing in my garden. I felt it coming up and I couldn't get it under control although I know some techniques. During my panick attacks it feels like I'm dying and I get brain 'zaps'. My heart starts racing/pounding and I start to sweat. No coping mechanism works against it. 

I felt like I was mentally in a good place when I started tapering down. Didn't have any worries and I don't see what triggered the extreme state I went into. 

 

Fun fact: In the period of my total meltdown I have adviced 4 different GP's and none of them knew about cymbalta withdrawals or what to do..Oxazepam was their answer to everything. 

 

Is there anything to calm down the production of adrenaline after you've stopped taking Cymbalta? In case I end up in the same situation again. Is prozac a good option?

 

@frog, that's terrible to hear mate. I hope you're in a better place now. I am however a bit shocked that the effects are still there after 4!!!! months..How did you push through the hell? Did you take oxazepam? What did you do to get out of it?

 

Thanks a lot again guys..

[invalidusername]

Dammit Frog... it's bad enough Hat saying "time and patience", don't you start as well... I WILL sit on you...

[invalidusername]

Roald...

 

So it sounds like you have got withdrawal-based anxiety which is very common. When things like the heart pounding and sweating starts, its hard not to feel anything but panic. 

 

For now you need to stabalise back on the Cymbalta. If you were fine on it before, then there is hope that you will return there. Kindling effect is possible whereby the second time round, the efficacy is reduced, but odds aren't that high and is more biochemically based to person.

 

As Hat said, you will need to bead count when the time comes, but for now, I think you will be looking at another 2/3 months at least before thinking about coming back off. For now, know that this is all the "work" of the drug and not anything you have done. Put simply, the plaster came off before you could walk. Nothing more.

 

Hang in there my friend.

[frog]

Roald, I think it helps to start at the beginning to maybe help you understand why you're getting the symptoms you're getting: Cymbalta is an SNRI so it inhibits the reuptake of your serotonin and norepinephrine neurotransmitters. Initially this will result in an increase of the two as your brain continues to make the same amount it used and it starts to build up. THat's why often people experience side effects for some weeks when starting one of these drugs. I think usually the levels will go down after that once the brain adjusts production. For reference, Norepinephrine is the neuro transmitter that spikes when we enter the 'fight or flight' mode. It increases heart rate and blood pressure and makes us super alert and as a result increases anxiety as well since these are very common symptoms of anxiety too. 

 

The brain is super adaptable (which is amazing! but sometimes works against us) and as you stay on the Cymbalta for enough time the brain says Aha! I don't really need to worry about regulating the production of S and N anymore because the levels seem to be good on their own, so it may start to over time turn off certain neural pathways that were once used for these purposes. The longer you've been on this drug, I think the higher chance there is that some of this would occur, but everybody is different and everybody's brain chemistry responds differently. 

 

Anyway, when you decide to quit Cymbalta you are basically taking away that mechanism that used to regulate two of your most important neurotransmitters. Suddenly your brain has to take over this duty again and it's not prepared because some of the neural pathways have shut down. Your body essentially enters a high stress mode as it works to sort this out. Typically this can be avoided by doing a slow taper because it allows the brain to adjust gradually. THat's why going cold turkey is really not recommended with this stuff. Cymbalta is also stored in our fat reserves so it's possible if you've been on it for many years and stored some up, that maybe your body continues to release it and that's why it takes a little longer for you to hit that withdrawal hell phase. Just a speculation!

 

The good news is that our brains have incredible plasticity, they are constantly changing and adapting, and our brain is always striving to get back to status quo, whatever that means for each one of us. The bad news is that this process happens quite slowly (this is really good news. can you imagine if our brains were constantly making huge changes?? we'd all need to be in padded cells rocking back and forth). For what it's worth, most people don't seem to struggle this severely coming off these drugs, but if you're one of the unlucky ones whose brain needs to reset a bit, you'll find that it can take months to come out on the other side. 

 

I know 4 months sounds insane and back in November I would have said the exact same thing, "there's no WAY anyone can handle this for that long!!!" but it's possible. You have to keep your eyes on the prize and have a good support system. Things are better for me now, but they're not great. The worst of it is behind me but I still feel maybe 65% of the way back to myself but it's gotten easier to keep going. 

 

I'm not sure what Oxazepam is, the only thing I take is a beta blocker which has been a huge game changer since I started taking it 2.5 months ago. I also take a couple of meds at night to be able to get sleep. The withdrawal gave me insomnia in the form of hypnic jerks that prevent me from falling asleep. I'm hoping eventually these will go away as well. My biggest symptoms now are just a remaining anxiety/agitation though it varies in intensity day to day, inability to sleep on my own, frequent feeling of exhaustion and fatigue, and lingering gastrointestinal issues. 

 

All your symptoms sound VERY familiar. Trust me you are not alone. You can do this! 

[frog]

FH and IUN please correct me if I got any of the above wrong. Sometimes the sciencey stuff gets too confusing. 

 

Dammit Frog... it's bad enough Hat saying "time and patience", don't you start as well... I WILL sit on you...

It's annoying because it's true

[invalidusername]

Pretty much it Frog, yes... and a common misconception is that the once "in-duty" transmitters and receptors lay dormant and then have to jump back into life. Once out of action, they are gone, so the brain (yes due to neuroplasticity) is capable of growing replacements to counteract the function previously undertaken by the meds. The rate at which this occurs varies greatly from one person to another, hence there being no withdrawal like another. But generally what you say about the cold turkey is exactly it.

 

Oxazepam is a benzo... anything ending -epam is a benzo.

[fishinghat]

The best med for controlling the adrenaline is clonidine. It reduces the signal from the brain to the adrenal gland and thus reduces adrenaline production. While some SNRIs like Cymbalta help control adrenaline by controlling the precursor nor adrenaline they all have serious side effects and withdrawals. SSRIs like Prozac do not control adrenaline and although safer than a SNRI they still have serious side effects and withdrawals. Clonidine is not addictive and has no withdrawal. I would suggest it be your first choice.
 
Addendum - I just saw frogs post. He is pretty much dead on with his info. I would point out that during stress the noradrenaline levels do spike but it is the excess that is converted to adrenaline and causes the anxiety. Also when he says that "because some of the neural pathways have shut down." He is exactly right. Cymbalta and other antidepressants can actually change the shape of receptors in the brain to render them useless and/or effect the proteins that transport the neurotransmitters. These all take time to heal.

Frog also brought up a good point. Beta blockers block adrenaline receptors in the body and minimize the physical symptoms of adrenaline, such as heart pounding, fast pulse, etc. It does not cross the blood brain barrier though and therefore does not actually effect adrenaline production. Certainly a good option as well.

[fishinghat]

My drs tried oxazepam for my withdrawal and it did nothing but on the other hand benzos don't do much for me anyway.

[frog]

The best med for controlling the adrenaline is clonidine. It reduces the signal from the brain to the adrenal gland and thus reduces adrenaline production. While some SNRIs like Cymbalta help control adrenaline by controlling the precursor nor adrenaline they all have serious side effects and withdrawals. SSRIs like Prozac do not control adrenaline and although safer than a SNRI they still have serious side effects and withdrawals. Clonidine is not addictive and has no withdrawal. I would suggest it be your first choice.
 
Addendum - I just saw frogs post. He is pretty much dead on with his info. I would point out that during stress the noradrenaline levels do spike but it is the excess that is converted to adrenaline and causes the anxiety. Also when he says that "because some of the neural pathways have shut down." He is exactly right. Cymbalta and other antidepressants can actually change the shape of receptors in the brain to render them useless and/or effect the proteins that transport the neurotransmitters. These all take time to heal.

Frog also brought up a good point. Beta blockers block adrenaline receptors in the body and minimize the physical symptoms of adrenaline, such as heart pounding, fast pulse, etc. It does not cross the blood brain barrier though and therefore does not actually effect adrenaline production. Certainly a good option as well.

 

I'm a she But I'm glad I got the info correct either way

[invalidusername]

LMAO - I popped the Hatster a PM to this effect my lovely, but clearly not in time

 

He'll most likely blame the Cymbalta....

[fishinghat]

I should have known better. She is to smart to be a he.  lol

[RoaldDahl]

Thank you all for the great answers! Will keep you updated about how it is going and when I will start tapering down. First have to feel stable and normal again.. 

 

Kind regards,

 

Roald

[invalidusername]

More than welcome Roald.

 

Please keep us posted, and anything you might need, just ask....

[RoaldDahl]

Hello all,

 

So I'm back to my old dosage of 60mg. Stabilizing. I did my bloodwork and it seems that my Testosterone levels are low. I got a score of 8.6 and the average lies between 9-36. Any idea if this is connected with depression/anxiety? Does cymbalta have an impact? What to do? Take test hormones?

 

Kind regards..

[fishinghat]

Research has well established that antidepressants and especially Cymbalta can cause low testosterone. In fact this happened to me and several other members. Normally the patient is weaned off the Cymbalta and then given 3 months time to try and reestablish testosterone levels. The majority of patients do het a return to normal with their testosterone.

 

Several things to consider. First as your levels drop there will be an increase in depression and fatigue, especially in the evening.

 

Second, this will make any withdrawal symptoms worse.

 

Testosterone replacement therapy is permanent. As soon as you start the therapy your body will decrease its natural production down to zero.

 

Because I have been through this I have a lot of experience and medical research on the issue so please do not hesitate to ask me any questions.

[RoaldDahl]

Thanks so much Fishinghat!

 

A few questions:

 

- Do you by any chance have some scientific research on AD's/Testosterone levels

- Would lowering my dosage improve my test levels?

- Will working out increase my test levels?

 

This will be my 2nd week on 60mg again. At 7pm an incredible wave of tiredness hits me and I need to lie down...It's horrible. Might be the test levels or the cymbalta. Cant wait to build up to financial needs to quit Cymbalta, it has been hell. 

 

Any tips are welcome! Thanks so much for your advice mate, literally a lifesaver. 

Research has well established that antidepressants and especially Cymbalta can cause low testosterone. In fact this happened to me and several other members. Normally the patient is weaned off the Cymbalta and then given 3 months time to try and reestablish testosterone levels. The majority of patients do het a return to normal with their testosterone.

 

Several things to consider. First as your levels drop there will be an increase in depression and fatigue, especially in the evening.

 

Second, this will make any withdrawal symptoms worse.

 

Testosterone replacement therapy is permanent. As soon as you start the therapy your body will decrease its natural production down to zero.

 

Because I have been through this I have a lot of experience and medical research on the issue so please do not hesitate to ask me any questions.

[fishinghat]

- Do you by any chance have some scientific research on AD's/Testosterone levels?

 

https://pubmed.ncbi....h.gov/28179152/
https://www.ncbi.nlm...les/PMC4632899/
https://pubmed.ncbi....h.gov/24642156/
https://www.tandfonl...401230500464612
https://www.ncbi.nlm...les/PMC4321007/
http://mental-health...m/rx/testos.htm
https://www.bmj.com/...re-we-surprised
http://scielo.isciii...632008000400002

 

- Would lowering my dosage improve my test levels?
Not according to the three specialists I saw. you must come completely off for at least 2 or 3 weeks to see it improvement.


- Will working out increase my test levels?
Not at this point. (I tried that too)

[RoaldDahl]

Fishinghat, much appreciated for all your advice. Wanted to give an update and ask for general advice. 

 

I am back on 60MG Cymbalta since 4 weeks now. My heartrate and bloodpressure is high. My average pulse a few hours after taking the meds is around 100/110 bpm. 

 

I really want to get of this goddamn devildrug. My psychiatrist offered me to ''switch'' to Citalopram 20MG. She said I could switch at any time from Cymbalta to Citalopram...I dont believe her. Shall I take the risk? Any experience with this? I'm starting to become more than hopeless..

[invalidusername]

That is a simple answer - NO WAY.

 

You are talking about going from an SNRI to an SSRI. Guidelines published by just about every medical body states that this switch should be done slowly and cautiously. I have been there and done it, so if you need any information relating to this switch, I can give you help from my perspective - it is all on the forum for everyone to read as well!!

 

However, the dose they have about right in that 20mg Citalopram is equivalent to 60mg Cymbalta.

 

IUN

[fishinghat]

I agree with IUN completely. Usually a 4 or 5 week cross over taper is used.

[RoaldDahl]

IUN/Fishing, I think my Psychiatrist is following the national Pharmacy advice. It states that a crossover from Duloxetine to Celexa should be done immidiately. 

 

What should I do in this case? What has been your experience going to an SSRI?

 

I have looked up some guideliness IUN and I think she adviced me Citalopram because of the direct crossover? It's on our official pharmicy national website. I already had a lot of doubts about this advice. What would you advice?

[fishinghat]

Many drs prefer to do a immediate cross over to reduce the risk of serotonin syndrome but the resultant withdrawal can be pretty bad, especially going from an snri to a ssri. Many other drs choose to do a slower crossover to reduce the risk of a serious withdrawal period even though there is a risk of serotonin syndrome.

 

In our ebook is a section on different government, association and study groups on how to do specific cross overs. You might have a read on that. 

[invalidusername]

Hat is right on there that you will find some that do not consider research articles - they make the assumption that there will be serotonin syndrome issues, but this is not the case, and by far the better way to do it. 

 

This article shows that a cross taper was perfectly safe when run alongside a direct switch;

 

https://www.ncbi.nlm...d?term=18312043

 

Unfortunately, they didn't follow up a suitable length of time to show the potential aftereffects of the direct switch, but my point is that there is proof enough to show that a taper is perfectly safe, and given the option between the two, it is for sure the one to opt for.

[RoaldDahl]

Thanks both Fishinghat and IUN.

 

Have started with Citalopram yesterday and dropped the Cymbalta 60mg. Do you want me to share updates?