335 replies to this topic

[invalidusername]

Absolutely - as often as possible please as this is important data for other members.

 

Many thanks

[fishinghat]

Definitely need updates. They would really be appreciated.

[RoaldDahl]

So I will start here my story and updates about the move from Cymbalata 60mg to Citalopram 20mg:

 

I started directly with Citalopram 20mg and dropped the Cymbalta 60mg. Mainly because the 60mg Cymbalta didn't seem to work anymore like it did before. I have been on it for 10 years, dropped to 30mg and things went wrong. I bumped up to 60mg again but my body seemed to refuse it. I tried pushing through for at least 6 weeks but my results didn't get any better. It made me extremely tired (i could sleep 16 hours per day without a problem), my anxiety was still at the same level as before and my heart kept pounding. Constant Tinitus since 2 years as well. 

 

Day 1 of switch: Nervous about switching. Used 10mg Oxazepam to undermine anxiety. Had trouble falling asleep. Besides that no noticeable side-effects. 

Day 2 of switch: Slept A LOT. Besides that not really noticing any difference yet besides that I'm less tired (which is a huge positive for me). 

Day 3 of switch: Felt agitated. Adrenaline pumping through the roof. Takes little to snap at people. Had trouble falling asleep. 

Day 4 of switch: Feel great. Mind is clear again. Not the foggy clouds I had the last 6 weeks during Cymbalta. Heart rate is lowering. Less anxious. It's still there but at least my muscles are not shacking non stop anymore which they were during Cymbalta. Mornings are the best. Sex feels way better than with Cymbalta as well. 

[invalidusername]

The adrenaline controlled by the Cymbalta will be going out of sync so you will probably find that your system will over/under compensate making less/more time until it balances out.

 

The Citalopram does not control this so will have no bearing, so expect a bit of to-and-fro. You might feel weak, shaky etc - that is perfectly normal, and would be shocked if you didn't feel that at some point in the next few days, regardless of supplementing the absence of the Cymbalta.

 

You could read a lot in my very first thread about when I was doing this... if might give you some useful insights

[RoaldDahl]

The adrenaline controlled by the Cymbalta will be going out of sync so you will probably find that your system will over/under compensate making less/more time until it balances out.

 

The Citalopram does not control this so will have no bearing, so expect a bit of to-and-fro. You might feel weak, shaky etc - that is perfectly normal, and would be shocked if you didn't feel that at some point in the next few days, regardless of supplementing the absence of the Cymbalta.

 

You could read a lot in my very first thread about when I was doing this... if might give you some useful insights

 

Cheers mate. I do have some Atenolol for when things get too crazy

 

Could you share a link please? Had a look at your profile but I can't find it..Thanks a lot!

[invalidusername]

This is the link to my very first post when I was switching from Cymbalta back to Citalopram;

 

https://www.cymbalta...ea-where-to-go/

 

Then I followed up with this after my last dose;

 

https://www.cymbalta...fter-last-dose/

 

There is a lot of information in here that you may find useful - let me know if I can help or clarify anything, but my situation was very similar to your own and I documented almost every day purely for the purpose of helping people like yourself as I know how much of a comfort it can be reading about cases so close to your own.

 

IUN

[RoaldDahl]

So I will start here my story and updates about the move from Cymbalata 60mg to Citalopram 20mg:

 

I started directly with Citalopram 20mg and dropped the Cymbalta 60mg. Mainly because the 60mg Cymbalta didn't seem to work anymore like it did before. I have been on it for 10 years, dropped to 30mg and things went wrong. I bumped up to 60mg again but my body seemed to refuse it. I tried pushing through for at least 6 weeks but my results didn't get any better. It made me extremely tired (i could sleep 16 hours per day without a problem), my anxiety was still at the same level as before and my heart kept pounding. Constant Tinitus since 2 years as well. 

 

Day 1 of switch: Nervous about switching. Used 10mg Oxazepam to undermine anxiety. Had trouble falling asleep. Besides that no noticeable side-effects. 

Day 2 of switch: Slept A LOT. Besides that not really noticing any difference yet besides that I'm less tired (which is a huge positive for me). 

Day 3 of switch: Felt agitated. Adrenaline pumping through the roof. Takes little to snap at people. Had trouble falling asleep. 

Day 4 of switch: Feel great. Mind is clear again. Not the foggy clouds I had the last 6 weeks during Cymbalta. Heart rate is lowering. Less anxious. It's still there but at least my muscles are not shacking non stop anymore which they were during Cymbalta. Mornings are the best. Sex feels way better than with Cymbalta as well. Tinitus seems to become less and less?

[RoaldDahl]

Day 5 of switch: Oef....Woke up not feeling great. Feel week and flu-like. Also pretty darn tired. Had a few brainzaps while waking up. Not a good day. 

[invalidusername]

That is a textbook day 5. 

 

As difficult as it is to hear, there is nothing to worry about here. The flu-like symptoms and tiredness may well last for a good week or so - for the brainzaps, get yourself some Omega oil. All covered in the book, you need 2000mg+ of combined EPA/DHA for good effect, but let us know if we can help.

[RoaldDahl]

Please help out. Sweating a lot, feeling dizzy and confused. Can't escape it. Anxiety attack. Feel like dying. Do I push through? Just took an Oxazepam 10mg against the fear. This is hell. This must be what junkies go through after a heroin addiction. 

 

Shall I already take my Citalopram? I don't know what to do.

 

Got to be strong. I want of this Cymbalta ride. It's been nothing but hell. How many days can this last?

[Toblerone]

If you have access to ca-nn-a-bis (need to spell it this way or it's censored) products, they may help you. They have dramatically improved my daughter's symptoms. She is on a standardized dose of CBD oil that was recommended to her by a registered MD and uses the plant form in a vaporizer when needed (rarely). She has never used recreationally, so getting over the stigma and worry was a big deal at first.  I really hope you feel better soon. It's a tough process without the right kind of help.

[fishinghat]

You will be caught up on this until the change over to Citalopram is completed. Oxazepam

[RoaldDahl]

update: Spoken with Psych and 2 other doctors. I will be using a cocktail of Oxazepam and Zolpidem the coming days to get through. You don't wish this opon your worst enemy. 

[fishinghat]

Your drs are idiots. Benzos mixed with a Z drug like Zolpidem makes the benzos more addictive. They both act on the benzo receptors.

"Z drugs are indicated only for the short term management of severe insomnia that interferes with normal daily life, and should be prescribed for short periods of time only (up to two to four weeks for Zopiclone, Zolpidem and up to two weeks for Zaleplon)." (longer use greatly increases the risk of dependence. Oxazepam is like other benzos and is not to be used for greater than 4 weeks. (this information is from the manufacturers drug inserts and the FDA website "dailymed".

"Data from a clinical study in which selective serotonin reuptake inhibitor- (SSRI-) treated patients were given zolpidem revealed that four of the seven discontinuations during double-blind treatment with zolpidem (n=95) were associated with impaired concentration, continuing or aggravated depression, and manic reaction."

"Zolpidem tartrate is classified as a Schedule IV controlled substance by federal regulation."

https://www.ncbi.nlm...pubmed/14519173
Zolpidem and zopiclone can cause dependence.


https://www.ncbi.nlm...pubmed/24531568
We found that subchronic zolpidem and diazepam administration produced ...increased anxiety-like behaviors 1 day after drug termination.


https://www.ncbi.nlm...pubmed/26776243
This study demonstrated a significant association between using zolpidem and suicide or suicide attempt in people with or without comorbid psychiatric illnesses.


https://www.ncbi.nlm...pubmed/22444504
In 83.5% of cases, psychoactive substances other than zolpidem were detected, most commonly antidepressants (46.2%), benzodiazepines (35.2%), opioids (26.4%), and alcohol (39.6%). In summary, zolpidem was a factor contributing to death in a large proportion of cases, predominately involving drug toxicity and suicide.

[fishinghat]

https://www.ncbi.nlm...pubmed/24931450
Results revealed medium effect sizes for zopiclone and zolpidem on measures of verbal memory. An additional medium effect size was observed for zolpidem on attention. Finally, smaller effect sizes were observed for zolpidem speed of processing and for zopiclone on working memory. It is clear from these data that the use of a single dose of the z-drugs in healthy adults as measured in the morning following the exposure does produce a specific rather than a generalized negative effect on cognitive function. However, there were only enough studies to evaluate the individual cognitive effects of the zolpidem and zopiclone medications; the specific effects of zaleplon and eszopiclone cannot be ascertained because only one study met the inclusion and exclusion criteria for the review.


https://www.ncbi.nlm...les/PMC3906775/
This case showed that zolpidem can exert abuse capability, euphoric mood, tolerance, and withdrawal syndrome.


https://www1.ghc.org...benzo-zdrug.pdf
Benzodiazepine and Z-Drug Safety Guideline
This guidance document is an excellent over view of these two drug groups. It explains how the Z-Drugs act just like benzos, a little less effective on anxiety and a little more effective on sleep. They are just as addictive, severe withdrawal and because their action is the same as benzos they should not be taken with benzos as it increases the rate of addictiveness and severity of withdrawal.

https://www.ncbi.nlm...pubmed/18505619
There were no significant differences in patients' perceptions of efficacy or side-effects reported by those on Z drugs compared to patients taking benzodiazepines. Side-effects were commonly reported, which may have contributed to a high proportion of responders, particularly patients on Z drugs who were wishing to stop, or who had previously tried to stop taking this medication. Reported prescribing practices were often at variance with the license for short-term use.
About half of those with sleep problems seek medical help, which often involves a prescription of hypnotic drugs including benzodiazepines like temazepam, or Z drugs such as zopiclone, zolpidem, or zaleplon. Most hypnotic prescribing takes place in primary care, and drug treatments may be inappropriately prescribed for 4 weeks or longer in up to 50% of new prescriptions.
No significant differences between Z drugs and benzodiazepines were found in respect of perceived benefits or adverse effects, including withdrawal or dependence.

The Summary of Product Characteristics (SPC) specifies that treatment (with Zaleplon) should be as short as possible with a maximum duration of 2 weeks. The SPC states that the duration of treatment (with Zolpidem) should usually vary from a few days to 2 weeks with a maximum of 4 weeks, including tapering off where appropriate. The SPC also states that the duration of treatment (with Zopiclone) should be 2–5 days for transient insomnia and 2–3 weeks for short-term insomnia.

http://www.nhsgrampi...zo_649_1014.pdf
In practice short-term prescribing should be limited to a maximum of two weeks as signs of psychological and physical dependence can develop if prescribed for longer periods.

*Z- drugs which include zaleplon, zolpidem and zopiclone are non benzodiazepine hypnotics, they carry the same risks and dependence problems as benzodiazepines.

Z drugs are indicated only for the short term management of severe insomnia that interferes with normal daily life, and should be prescribed for short periods of time only (up to two to four weeks for Zopiclone, Zolpidem and up to two weeks for Zaleplon).

There is no justification for prescribing more than one benzodiazepine or Z-drug concurrently, except during the period of conversion.

[fishinghat]

Ambien (Zolpidem)
https://dailymed.nlm...96-8702a28e6e76
Note - The following is from the drug insert supplied with Ambien (Manu; Sanofi-aventis) and is an example of a typical drug insert for Z-Drugs. See above website for inserts from other Z-drugs and manufacturers.

"Sleep-driving" and other complex behaviors while not fully awake. Risk increases with dose and use with other CNS depressants and alcohol. Immediately evaluate any new onset behavioral changes.
Depression: Worsening of depression or, suicidal thinking may occur. Prescribe the least amount of tablets feasible to avoid intentional overdose.

Withdrawal effects: Symptoms may occur with rapid dose reduction or discontinuation
Observed reactions include anaphylaxis and angioedema.

Additive effects occur with concomitant use of other CNS depressants (e.g. benzodiazepines, opioids, tricyclic antidepressants, alcohol), including daytime use. Downward dose adjustment of AMBIEN CR and concomitant CNS depressants should be considered.

Abnormal thinking and behavior changes have been reported in patients treated with sedative/hypnotics, including AMBIEN CR. Some of these changes included decreased inhibition (e.g. aggressiveness and extroversion that seemed out of character), bizarre behavior, agitation and depersonalization. Visual and auditory hallucinations have been reported.

Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) have been reported in patients who are not fully awake after taking a sedative-hypnotic. As with "sleep-driving", patients usually do not remember these events. Amnesia, anxiety and other neuro-psychiatric symptoms may also occur.

In primarily depressed patients treated with sedative-hypnotics, worsening of depression, and suicidal thoughts and actions (including completed suicides), have been reported. Suicidal tendencies may be present in such patients and protective measures may be required.

[RoaldDahl]

Fishinghat, I am well aware of both the drugs and how addictive they are and which withdrawal symptoms they can cause. 

 

What would you suggest in this case to get through the direct anxiety attacks? Literally wanted to almost kill myself this afternoon. Without Oxazepam I probably wouldnt have pushed through today.

 

I will take it for the first four days as I expect the worst Cymbalta withdrawals in these days. Any suggestions are welcome!!!

[fishinghat]

There are 2 medications that tend to be very effective against anxiety that should be tried first.
 
1) Hydroxyzine - 25 mg at *Am, noon and 4 pm and 50 mg at bedtime MINIMUM. The max dose is 100 mg 4 times per day.
 
2) The second med is Clonidine - usually 0.05 mg (1/2 tablet every 6 to 8 hours.
 
Neither of these meds are addictive nor do they have a withdrawal. They also do not build up tolerance. If they don't work then one can look at a benzo or other med.
 
By the way, the withdrawal symptoms you were mentioning can last as long as 1 year for many weaning off of Cymbalta. A hell for sure. Once you are on the full dose of Citalopram you should strt feeling better. Hang in there.

[RoaldDahl]

Much obliged Fishinghat. However what you're stating is not completely true. I did some research and asked a well renown Cardiologist about both meds and he's not too fond of using them in this case. Funny how all doctors seem to have different opinions. 

https://en.wikipedia...iki/Hydroxyzine  <--- seems like not the best replacement? Loads of side-effects and you need to go through a detox as well? Can have very bad interaction with Citalopram!

 

Clonidine, as a cardiologist he prefers Atenolol in this case. Looks interesting however. 

[invalidusername]

Sorry for late response - busy Saturday for a change.

 

If Hat hadn't beaten me to it, you would have had the same response from me. You cannot trust a lot of what doctors will tell you. Z-drugs are frowned upon for many reasons - including the one stated above, but Zolpidem will quickly lose efficacy with or without other drugs. They should be an absolute last resort. They themselves can be addictive, and people end up going on higher and higher doses, and then you will end up with another withdrawal which you don't want.

 

A benzo is a good emergency pill, and you were absolutely right to take them today - we have all been there, and they can really save you in a moment of madness. But again, long-term wants to be monitored - depending on the daily dose, benzo's will be difficult to shift within 10-12 weeks of constant use. There is no harm in occasional use, but anything more than 3 months frequent use will cause problems.

 

I would say that you see the Citalopram kicking in by then, so long term shouldn't be an issue. Hat understandably has an aversion to benzo's and he warns with good reason knowing his back story. So my advice is try to hold short term for the first month - the worst should be over from the Cymbalta, but bear in mind it can take a good 3 months for the Citalopram to kick in fully. 

 

Hydrox and Clon are better long term (and of course you will see the internet littered with side effects and horror stories), but work quickly and have nothing like the withdrawal of a benzo taken frequently for a given timeframe. But they are better when used continually to maintain a balance in your system, so I would opt for sticking with your arsenal of the occasional benzo and wait for the storm to pass... and it will.

 

Toblerone also has a valid point about CBD - this can be a miracle for some - useless for others. Let me know if you would like help along this route and I will guide you...

 

Hang in there my friend.

 

IUN 

[RoaldDahl]

Thanks a lot friends and I wouldn't know what to do without you. I will deffo look into CBD oil as well. 

 

I am well aware of the dangers and addictiveness of Benzo's. My plan is to use them the coming 3/4 days. Stop on good days and not touch them at all. Hopefully the Citalopram can start taking over within 2 weeks time. 

[invalidusername]

You will have seen from my forum post that the first 2 weeks were the nightmare - we followed very similar lines as I was also cut short of doing a longer taper. So do what you must during this time, but be patient with the Citalopram. 

 

Also remember you are switching drug classes, and as per my earlier post, you will find some lingering symptoms from the Cym. Again, we are here for you.

[fishinghat]

Thgere is a lot of detailed information on both in the ebook and most with references. There are a lot of side effects listed for hydroxyzine but most are low risk with limited occurrence. Ehealthme (a website that monitors reported side effects to the FDA) has a list of reported side effects and there occurrence.
 
Most cardiologists don't like them because they effect blood pressure. The advantage of clonidine is that it reacts with the alpha adrenergic receptors in the frontal cortex (it crosses the blood brain barrier while atenolol does not). This stimulates these receptors and you would think that that is a bad thing but it is the opposite. The adrenal gland has no parasympathetic nerve going to it so the brain is incapable of down regulating the adrenaline production. Instead the frontal cortex monitors the stimulation of these alpha adrenergic receptors and as stimulation increases the frontal cortex reduces the sympathetic nerve signal to the adrenal gland and slows adrenal production. This helps control adrenaline symptoms inside the brain as well as in the body.
 
By the way, your plan on usage of the meds is a wise one. You should do well that way.

My local psych clinic has stopped using benzos as a last resort and went to hydroxyzine and/or clonidine instead. Way too many patients were getting hooked on the benzos. So many come in to that clinic who ask for benzos, ssri or anri by name and get upset if they are not prescribed. I am very glad to see you are well past that point and will worry a lot less now.

[fishinghat]

I just saw the last post from IUN. He is referring to the remaining effects of norepinephrine. Citalopram controls serotonin as does Cymbalta but Cymbalta also controls norepinephrine which Citalopram does mot. Not only is norepinephrine a strong stimulant but unused nor is converted to adrenaline. This is where the clonidine is the biggest help as it will knock back the adrenaline overdose.

By the way neither hydroxyzine or clonidine have a true withdrawal but they do have a 3 or 4 week elevation in the blood pressure so weaning slowly for a few weeks is recommended.

[invalidusername]

The adrenal gland has no parasympathetic nerve going to it so the brain is incapable of down regulating the adrenaline production.

 

Very valid point. One of which 1000's of Doctor's wouldn't know, nor use correctly in such a context.

 

...but some random massive dude in the swamps of Missouri can tell you

 

Where would we be without our resident Hat...

[fishinghat]

That is true but sad. I learned it in the same graduate school 'human anatomy and physiology' class (good old Grays Anatomy) as the medical students. If they forgot shame on them.

[RoaldDahl]

So much knowledge in here it's incredible. As stated, I won't use the benzo's for too long. Will keep using a low amount of Atenolol on the side to control the adreniline. 

[invalidusername]

Good plan. I had significant adrenal problems as a result of the norepinephrine Hat spoke of earlier. I wanted an rx of clonidine but my GP/Primary couldn't prescribe here in the UK. I approached the p-doc I was assigned to and he told me I didn't need it - but what did he know - he took my Cym beads off me when I starting having seizures instead of letting me go back up (which you should....).

 

Oh no, the stupid bloke with the beard knows nothing. Maybe, but what HE didn't know that some weeks later he would be fired courtesy of said bloke. 

 

This is a serious situation. There is no messing around when it comes to mental health. 

 

This forum is probably one of, if not, the best resource of Cymbalta withdrawal information available. Not for what people like Hat and myself offer in the way of knowledge, but more for the 1000's of people that have passed through here with their own stories, trials and tribulations. 

[RoaldDahl]

Good plan. I had significant adrenal problems as a result of the norepinephrine Hat spoke of earlier. I wanted an rx of clonidine but my GP/Primary couldn't prescribe here in the UK. I approached the p-doc I was assigned to and he told me I didn't need it - but what did he know - he took my Cym beads off me when I starting having seizures instead of letting me go back up (which you should....).

 

Oh no, the stupid bloke with the beard knows nothing. Maybe, but what HE didn't know that some weeks later he would be fired courtesy of said bloke. 

 

This is a serious situation. There is no messing around when it comes to mental health. 

 

This forum is probably one of, if not, the best resource of Cymbalta withdrawal information available. Not for what people like Hat and myself offer in the way of knowledge, but more for the 1000's of people that have passed through here with their own stories, trials and tribulations. 

 

 

Shit mate, I can only imagine what you've been through and feel incredibly sorry. 

 

So day 6 started...Had a traumatic experience yesterday. A panic attack which I couldn't escape with shivers all over my body. Being hot/cold non stop, sweating, vomiting A LOT. The benzo's at this point saved my life because I had non stop flashes of ''just end it now'' which I would have never expected as I am a happy person living life to the fullest (as far as it allows me). Woke up this morning after a 9 hours sleep. Feeling worried about my episode from yesterday. Started with 10mg of Oxazepam and 25mg of Atenolol at 11 AM. Day is going okayish. Will try to lift some weights later to get a bit of exercise. Will keep you updated. 

 

Too add some more information: I'm 6'7 and around 110kgs. 

[invalidusername]

Bless you mate - we have all been there, but we live to tell the tale. But when your Cymbalta withdrawal causes paramedics to turn up and take you to the ER, it does cause alarm you know!!

 

Wow 6'7.... Hat we have another one of us

 

Sorry to hear about the panic attack and so forth, but remember this is NOT YOU. None of this is. You have said exactly the right thing there.."which I would have never expected as I am a happy person". Just keep going like this. It will pass. What you are saying takes me back. So very similar. 

 

Just a note on the weights. Light exercise is good, but go easy as you will exacerbate the adrenal production and it will tip the balance and you will end up having more anxious-based symptoms. So many members come to us saying they had a "great workout at the gym" only to feel really bad afterwards.

 

So, a little is fine, but just a heads up on how our system works at these times.