97 replies to this topic

[ESRoar]

Frog - thank you for telling your story.  It makes me sad how it affects so many people in such a bad way and for years on end!

 

I met with a 4th psychiatrist yesterday to find out what to do with my medications after Monday's episode, since the Dr. I was going to stick with isn't available until 12/15.  It's so frustrating not having any continuity of care.  Anyway, she thinks I need to start tapering the cymbalta.  She thinks I might never feel good being on both the cymbalta and zoloft.  The morning nausea has been pretty unbearable.  I'm so sick, I'm dry heaving.  It's just awful.  I've been trying the ginger root tablets, which I think help.  This morning they seemed to give me heart burn.  So she wants me to drop 2mg of cymbalta this week.  I started that dose this morning - 37mg.  We'll see how it goes.  Hopefully it can't get much worse than how I'm feeling now.  She told me to reach out to her if I have trouble with the cymbalta drop causing anxiety.  She mentioned giving me guanfasine for that.  I've never heard of that before, so I'll have to do some research.

 

She also thinks it's good I stopped the buspar.  She thinks the cymbalta + zoloft + buspar was too much serotonin.

[fishinghat]

Guaifenesin for anxiety? I couldn't find anything on that at all.

[ESRoar]

Guaifenesin for anxiety? I couldn't find anything on that at all.

It's guanfacine.  It looks like it's usually prescribed for ADHD.

 

So I dropped the 2mg yesterday morning and I feel like a truck hit me today.  I'm stuck in bed because I'm so dizzy, nauseous, jittery, tearful.  Just overall feel so sick.  I feel like I forgot to take my cymbalta pill, but I did take it.  I don't know where to go from here.  I can't live like this.  I don't know if I should add 1mg back in.  I'm so desperate to feel better.  Maybe I should just go back on a higher dose of Cymbalta, stop the zoloft, and be done with it.  

[fishinghat]

Ahhh, now I understand. Not a typical drug used for anxiety but it does have anxiety fighting properties.

Side effects of guanfacine are dose-dependent.[12]

Very common (>10% incidence) adverse effects include sleepiness, tiredness, headache, and stomachache.[13]

Common (1-10% incidence) adverse effects include decreased appetite, depressed mood, anxiety, irritability, mood changes, insomnia, nightmares, dizziness, lack of energy, slowed heart beat, low blood pressure, feeling faint when standing quickly, vomiting, nausea, diarrhea, constipation, dry mouth, urinary incontinence, and rashes.[13]

Typical side effects such as fatigue, irritability and stomach upset can take a week or two to subside. Increases in dosage can have the same adjustment period.

 

A 2 mg drop is a big drop. I normally recommend a 0.3% drop or less.  I would return to the previous dose and stabilize which will take 3 to 7 days. Once you are doing better try a much smaller drop. 

[ESRoar]

Thank you, as always for your guidance FH.

 

I put 12 beads in a capsule and took it.  I was hoping I'd be able to drop from 39mg to 37mg with the help of the zoloft on board, but I'm still as sensitive as ever to the cymbalta.  

 

I also ordered enteric-coated capsules from the advice on the other thread.  I'm wondering if they'll help with any of my nausea/diarrhea.  

[fishinghat]

They might help.

 

How long you been on the Zoloft now and at what dose?

[ESRoar]

They might help.

 

How long you been on the Zoloft now and at what dose?

 

I've been on the Zoloft 2 weeks and 2 days.  50mg.  That's the dose I was on for ~12 years prior to going on Cymbalta.  It doesn't feel like it's doing anything except maybe helping me to fall asleep at night and contributing to my nausea.

[fishinghat]

Zoloft has a very long half life and normally takes 6 to 8 weeks to kick in. It is way too early to see any effects.

[ESRoar]

I'm really struggling.  Bedridden.  Extremely nauseous.  It's hard to eat and drink.  Dizzy, tremors, sweating.  I don't think the cymbalta and zoloft together are agreeing with me.  I'm so physically sick that I don't even notice my mental health.  I think I need to stop the Zoloft, but I'm not sure how to do that.  I reached out to the dr. through the patient portal.  At this point, I almost wish I could be hospitalized.  I cannot function.

[fishinghat]

Definitely dr time. You have been on the Zoloft over 2 weeks so it is possible that stopping it may cause some additional withdrawal symptoms. Just my opinion but I would say that dropping the dose to 25 mg to see if it improves would be a good next step but I would strongly suggest you talk to your dr first to see what they think. 

[ESRoar]

I ended up back in the ER on the 24th.  I met with a young, angry psychiatrist who suggested that I had serotonin toxicity and that I should stop all meds for 3 days.  I told him I couldn't do that because of the withdrawals.  He actually threw his arms up and told me he didn't know how to help me.  The nurse practitioner overseeing my care at the ER recommended I dial back the Zoloft to 25mg.  I did that for Tuesday night.  Then Wednesday, again soooo sick.  Extreme nausea, dry heaving, internal tremors.  I met with the new psychiatrist and she agreed that I keep getting worse and said that while I may not have full blown serotonin syndrome (no fever), I was experiencing too much serotonin.  She told me to stop the zoloft and zofran and then try taking 20mg of Cymbalta in the AM and 20mg in the PM.  She wanted me to try splitting the dose to see if that helped with the side effects.  Friday morning I started the 20mg BID of the cymbalta.  To make this even more interesting, the brand is changed because the old brand is no longer manufacturing cymbalta.  Saturday and today have been terrible.  Severe nausea to the point that I can barely eat or drink until dinnertime.  I've tried using Emetrol and Dramamine, but they haven't seemed to help much.  I also have the terrible internal tremors that make me want to jump out of my skin.  I feel so irritated by everything and sounds.  I again reached out to the psych dr. through the patient portal and asked if there's anything I can do.  She recommended I take 40mg cymbalta tonight and go back to taking it once per day at night, which is what I've done for years.  

 

Is it possible to have withdrawals from me splitting the dose into 2?  Dr. doesn't think I'm having zoloft withdrawals since I was only on it for 2.5 weeks.  I'm not sure if I should take 20mg or 40mg tonight.  I'm upset that I ever went to these drs and got all of these meds prescribed.  I should've just stayed on the 39mg of cymbalta and dealt with the side effects.  

 

Is there anything I can do or take to help the internal tremors and irritability I'm feeling?  I tried taking Propanolol 10mg earlier and I think it helped a little, but I still couldn't get up and be productive.

[fishinghat]

This is a complicated situation. This is part of the dilemma of adding other serotonin related drugs during withdrawal. 

 

First of all, 2.5 weeks of Zoloft is enough to generate some withdrawal when stopping it. Other than that I pretty much agree with the drs approach but....

 

unluckily it will be a difficult rebound. My experience on being on this site for years tells me it normally takes 3 to 7 days to settle down when going back to a higher dose of Cymbalta. Given the mess these drugs have made and the sensitivity of your nervous system then it may take longer. Even when you start to stabilize you will still be very uncomfortable for quite awhile.

 

Secondly, I really don't understand why they didn't put you on either clonidine and/or hydroxyzine to help the symptoms. They wouldn't cure you but they would typically help a bunch. They do not effect serotonin but do relive the effects of increased adrenaline and histamine AND do not have a withdrawal. 

 

Thirdly, there are some supplements that may help your situation but I hate to recommend anything given the mess your neurotransmitters are in. What if you had a reaction to one or it caused bad side effects? You have enough problems as it is. The supplements may help you but their effect would be limited. What ever you decide we will be here to support you and if you decided to try some supplements just let me know and I will recommend some that other members have used with some success.

[ESRoar]

fishinghat, thank you for weighing in.  I know that it's a complex situation because there have been so many factors changing.  

 

Last night I took the 40mg Cymbalta.  I slept good, despite a lot of sweating.  I woke up and feel like I did weeks ago when I was taking the 39mg of Cymbalta at night.  I feel very anxious in the morning, nausea, but I've been able to eat toast.  This is the same feeling that made me seek out a psychiatrist a few weeks ago.  And here I am feeling grateful that I'm back at this point.  

 

Are clonidine and hydroxyzine different than Propanolol?  

 

I tried taking L-theanine this morning for the first time.  I haven't noticed much effect.  

[ESRoar]

Regarding the cymbalta brand change, I went from Prasco to Breckenridge.

 

This morning my husband opened up the Breckenridge capsules to see what we're dealing with.  The beads appear to be the same at the Prasco beads; however, there was a difference in bead counts.  He counted out 3 of the Breckenridge capsules.  They varied:  113, 115, and 117 beads.  So an average of 115 beads.

 

I was on 39mg of Prasco brand and 40mg of Breckenridge is an average of 8 beads less.  In recent months, I have only been able to handle drops of 4 beads at a time.  So here I was thinking that I had increased Cymbalta dosage by 1mg and it appears that I've actually gone through a drop of twice what I can normally tolerate.  This would explain how terrible I've felt.

 

The Dr. recommended I try taking 5mg of cymbalta to see if that helps my symptoms, so I just did that.  

[fishinghat]

"Are clonidine and hydroxyzine different than Propanolol?"
 
Yes, propranolol blocks the action of adrenaline on beta adrenergic receptors in the nervous system thereby reducing the effects of adrenaline in key systems. Clonidine effects the center that controls adrenaline production in the brain and thus reduces the production of adrenaline and reliever anxiety system in all the adrenaline receptors. Hydroxyzine reduces the effects of histamine on the histamine H1 receptors. Histamine is also involved with anxiety. By blocking these receptors it has a calming effect. 
 

"I tried taking L-theanine this morning for the first time.  I haven't noticed much effect." 

​What dose are you taking and how frequently?

 

 

"Regarding the cymbalta brand change, I went from Prasco to Breckenridge."

Oh yea, that could make a big difference.

 

 

"The Dr. recommended I try taking 5mg of cymbalta to see if that helps my symptoms, so I just did that. "

This was a good idea by your dr.

[ESRoar]

I took L-theanine 200mg.  I only tried it 1 day so far.

 

I am hanging in there.  I'm pretty much back to my baseline of the past year:  wake up with lots of jitters, nausea, diarrhea and then these symptoms dissipate throughout the day.  I feel my best at nighttime.  Then I go to bed and the cycle starts all over again.  I never had any of these issues when I was taking 90mg of Cymbalta for years.  Something has changed in my body since I had my daughter.  

 

I asked the psychiatrist about clonidine or propanolol, but she didn't think it would help the withdrawal symptoms I was having.  She said the clonidine would put me to sleep.  

[fishinghat]

Clonidine put you to sleep? Well if the dose is real high it might. Most drs start at a low dose and work up anyway. The drowsiness would only last a couple days but that is her call. Did you ask about the hydroxyzine?

 

With the L-theanine is usually started at around 100 mg a day and then raised by 100 mg every 2 or three days until relief is obtained. So in other words 100 mg every day for 2 or 3 days, then 100 mg twice a day for 2 or three days, etc up to a max dose of 400 mg/day.

[frog]

FH

I'm also planning on trying L-theanine again. I was taking it over the summer and then stopped when I ran out because I wasn't sure if it was helping, but I think I felt better when I was taking it than I do now so wanted to experiment and see if that was true. 

 

Is it ok to take 200mg at once or better to take 100 in am and 100pm? 

[fishinghat]

It is better to take separate 100 mg doses as it tends to provide a more stable serum level and less of a rollercoaster.

[ESRoar]

Hi All,

I've been hanging in there, but still dealing with a lot of anxiety.  This past weekend on Saturday and Sunday, I felt great.  I barely had any anxiety or nausea.  Monday morning I felt awful as soon as I woke up.  So I guess it is my work week stress that is taking me over the edge.  I meet with the psychiatrist again on Friday.  I'm kind of scared to rock the boat and try anything different at this point, even though it's not easy dealing with anxiety all day and almost every day.

[frog]

Work stresses me out a lot too. Sunday nights I start to get super tense and Mondays are really rough and it slowly eases as the week goes on. During the week I have this constant anxious nagging feeling like I'm forgetting to do something. It's very uncomfortable. 

 

As far as your psychiatrist just remember that you do not have to do anything or take anything at all until you are ready to do so. This should be a conversation and your psychiatrist should really be helping you weigh the pros and cons of adding in a new medication. As well are providing you their overall plan, like how long should you expect to need to take it, how long will it take to taper off of it, are there known withdrawal side effects, etc. 

 

I've also been considering starting an SSRI to manage a lot of this anxiety. I don't think my issues are withdrawal anymore but just anxiety due to life circumstances. I have a lot of reservations too. My husband and I are considering starting a family in the near future and I know being on antidepressants while pregnant can have side effects. That worries me most of all. My therapist is helping me find a psychiatrist who is familiar with dealing with patients who have had complications with their medication. Right now my plan is to wait to start anything until after the pandemic is over, but maybe I will feel differently after talking to someone. 

[ESRoar]

Hi frog - what you described with the work week is usually how it goes for me too.  Before I had the baby, I would just work at night until I got the job done, but now I can't do that and it makes me anxious leaving all kinds of unfinished work.

 

The psychiatrist appointment went well.  After being prescribed Cymbalta and told nothing about the withdrawals, I'm really cautious about taking anything.  My dr. recommended trying to take 1mg of guanfacine at bedtime to see if it will help my anxiety that is at it's worst in the mornings.  I took it last night and today I am sooo fatigued.  I have my usual anxiety, but now on top of it I'm fatigued, had worse nausea, and some dizziness.

 

I think much of my anxiety is due to 2020 and the world we're living in right now.  I am ready for life to go back to normal.  I feel like I've been living in a personal hell this year.  If I wear a mask, I get severe panic attacks.  I got a face shield for if I need to go anywhere, but I sometimes get treated like absolute crap for not wearing a mask and of course that triggers my anxiety as well.  

 

I was on Cymbalta 90mg when my husband and I started thinking about having a baby.  My mental health had been stable for years.  I tried dropping 30mg unsuccessfully and then learned about bead counting.  I went to a psychiatrist to find out what needed to be done with the cymbalta before I was to get pregnant.  He advised that it's perfectly safe for me to stay on the 90mg.  I wasn't OK with that, so I began the slow tapering.  I was on around 65mg when I got pregnant and continued to slow taper.  I was on 46mg when I delivered.  I then breastfed my daughter for 14 months.  I never noticed any ill effects with her - thank God.  She's always been a happy, easy going baby.  My mental health issues started at 2 months postpartum, which was also the time when I returned to work.  I miss not taking care of her all day.  Right when I started to feel better, is when covid lockdowns started.    

[frog]

Leaving unfinished work is definitely stressful. I find the more I can write things down I need to do on a sticky note in front of my face the easier it is, because then my brain can feel less anxious about trying to hold on to all of this information. 

 

I'm so glad to hear that your psychiatrist is being super thoughtful and considerate of your experience. Sorry to hear the first thing you tried wasn't the right one. Sometimes it does take a few days or even a week to adjust to something new so you may want to give it a little bit longer. Since guanfacine is used to treat high blood pressure it makes sense that you would feel tired or dizzy after taking it. I think any blood pressure med has the potential for that kind of effect. 

 

I'm sure that much of your anxiety can be attributed to a lot of stressors in your life: pandemic related (wearing a mask makes me anxious too, I find it hard to breathe in one and I start to hyperventilate a little); taking care of a small child; stressful job; and then withdrawal is just the cherry on top. I think we'd all be having an easier time if the rest of the world was just normal. If you were taking your full Cymbalta dose like you always did you would feel better because the Cymbalta would be shielding you from the stress and anxiety you're experiencing. With your lowered dose I think you're just feeling much more of the full weight of everything. But the pandemic will end sometime next year and we can all slowly pick up the pieces and move forward

[ESRoar]

Hi All,

I hope everyone is doing well and was able to enjoy the holidays.

 

Last night I forgot to take my cymbalta.  I woke up at 5am feeling awful and I took it then.  Was that the right thing to do when you miss?  Should I take the full dose tonight?

 

Thank you.

[fishinghat]

I would take the full dose tonight. With more than 12 hours between the two doses you should be OK. Just my opinion.

[ESRoar]

I would take the full dose tonight. With more than 12 hours between the two doses you should be OK. Just my opinion.

 

Thank you, I will do that.  UGH..it's crazy how awful I feel after not taking it for only 8 hours.

[fishinghat]

Ahhh, the gift that keeps on giving....NOT! Cymbalta sucks.

[ESRoar]

Hi All,

I hope everyone is doing well.  I have continued my taper off of Cymbalta and I'm now down to 33mg.  I've been lowering by taking 1 less bead every 3 days.  Does this sound like an ok strategy?  I haven't noticed withdrawals, except maybe fatigue, by doing it this way.  Previously, I was doing a 2% drop and holding for 2 weeks.  I did have withdrawals then.  

 

I'm still dealing with tachycardia and nausea, so I'm trying hard to get off of cym!

 

Thank you.

[fishinghat]

ESRoar, you are doing great!! I would say just hold at that rate until you get down to around 10 mg and then see how you are doing and consider slowing down at that point as the last part is by far the hardest.

[ESRoar]

Hi there friends,

 

It's been a long time since I've posted.  I successfully tapered down to 8mg.  My husband has been counting my beads for years now.  In August we were starting a fertility cycle with my last remaining embryo that was frozen.  My husband decided to taper me off of the 8mg by dropping me 5 beads every 7 days:  (45, 40, 35, 30, 25, 20, 15, 10, 5, 1, 0).  He didn't tell me he was doing this.  During this faster taper, I was feeling fine.  My last dose was Aug. 19th.  I started taking hormones for fertility on Aug. 26th.  On Sep. 27th I was informed that the embryo didn't stick and was told to stop all hormones.  Maybe the hormones were masking the withdrawals, because on Sep 29th, I got hit with lots of withdrawals (nausea, sweating, insomnia, cortisol/adrenaline surges in the early AM hours, racing heart, terrible headaches, noise sensitivity etc.)  

 

My question is, where do I go from here?  Do I ride this out and pray I'll eventually heal?  Do I reinstate to a low dose?  If I do reinstate and I don't feel any better, do I then need to taper that low dose?  I'm currently not on any pharmaceuticals.  I just take a multi-vitamin, B-complex, EPA/DHA, and magnesium.

 

Thank you, as always.