25 replies to this topic

[Rheeny]

I worked with a psychiatrist and successfully tapered Cymbalta down to the last few mgs over 3 months after being on the drug for two years, but now I am stuck. I stopped reducing the dose because I am tried of being angry and full of rage every day that I titrate. Unfortuanately the dosage I am at now leaves me constantly dizzy, headaches, loss of depth perception, spacey, unable to focus, making easy mistakes in my school work, forgetful, needing to re-remind myself what I am reading or writing - basically feeling 'high'. This made life very difficult so I upped my dose after feeling this way and staying steady at the same dosage for 15 days. After bringing the dosage back up the symptoms decreased but are still present. Unfortunately these symptoms increase and make it hard to function in the few hours before bed, and when I first wake up in the morning. I try to take my pill (20 beads) and then fall back asleep until the sympoms subside but this is not working very well. 

 

Last night I had my first brain zap. When I updated my doctor on this he suggested I try a SSRI - which I don't want to do. I don't think I needed anxiety medication in the first place - I was anxious about marrying my boyfriend who convinced me to try meds and then became abusive once we got married. I am out of that relationship now and prefer a holistic approach.

 

Does anyone have OTC recommendations that may help reduce the “high” feeling and help me heal please? 

 

Prior to COVID I was doing neurofeedback. Currently I am taking .25g of Citicoline, Omgea oils: 1g of EPA &. 15g of DHA, Astragalus equivalent to 9g of dried herb, tulsi tea, .2g magnesium bisglycinate, 500gm L-Tyrosine, 1000 vit D, and a 15Billion probiotic which I can provide details on.  

 

 

Thanks, all support is appreciated!!

 

ps. I belive cymbalta helped clear up my adult acne and reduce period cramps - from your experience should I expect those to both come back?

[fishinghat]

Bad news first. Your current symptoms can last for months and months before stabilizing. BUT, there are some things that you cn take to help, Suntheanine is a good choice, N-Acetylcysteine, cbd oil, certain antihistamines and more. You need to check out our ebook which details what members have tried, their comments as well as a lot of medical journal information.
 
As far as the supplements that you are taking I would start by saying that both the magnesium bisglycinate and L-Tyrosine can make anxiety worse. Many members have had strong reactions to magnesium supplements. In addition, as magnesium increases in the blood stream calcium decreases and that causes its own issues. Magnesium supplements should not be taken unless blood serum levels are shown to be low.

As you read through the ebook I am sure you will have questions so feel free to come back and ask anything you want.

[Rheeny]

Thanks for such a quick response FH. I checked first thing this morning and I was shocked and grateful that you had already responded to my question last night.  I looked through your PDF and highlighted what I have already on hand: Vit C, and essential oils (eucalyptus, ylang ylang and lavender). My housemate gave me a 3 day trial of what she had on hand as well: Rooibus, Reshi, Apple cider vinegar, and CDB as a vape. This way I can get a jump on what works while I wait for supplements to arrive in the mail. 

 

It’s 6pm my time and I can feel the high feelings increasing - does it make sense that this is starting earlier in the day?

In case you’re wondering, there is no cannabis in my system or anything at all that would cause this sensation.  I am trying to do some homework and really and at my brain that now, lol.  
 

I plan on ordering Suntheanine and N-Acetylcysteine tonightor tomorrow. What should I look for to make sure I get the right type and daily amount to give them a proper trial?

Also, if I maximize my self care and supplements, what improvements can I expect for my brain function? I don’t want to get discouraged by hoping for changes that are unrealistic. 

 

Thnak you! 

 

p.s.  I took magnesium and L-Tyrosine out of my routine starting tomorrow. Anxiety is a minor concern for me, my top complaints are feeling spacy/unfocused, and secondary is the unnatural anger I feel. All tips are appreciated. 

[fishinghat]

When you start down the supplement rout I would suggest you take one supplement at a time. After 3 or 4 days you can decide if it worked for you or not and then move on to the next one. By starting 2 or more new supplements at the same time it will be hard to tell which on helps or which one is causing side effects. when I start a new supplement or medication I always start with a low dose so if I get a side effect it will not be too bad. I work the dose up from there. By testing one supplement at a time you can eliminate those that do not work and avoid the expense of buying unnecessary supplements.

 

Suntheanine is a purified version of L-theanine and members usually start with 50 mg or 1200 mg per dose to see how effective it might be. Some work up to around 100 mg four times a day. I would not surpass that. N Acetylcysteine is usually taken at 600 mg twice a day.

 

You may see as much as a 50% increase in mental clarity but I doubt if you will see more than that. Omega 3 is the most effective ut I see you are already taking that. The concentration looks good too.

[Rheeny]

Hi again, FH Can you provide me some advice?

 

My body has adjusted to 20 beads and I no longer feel the withdrawl symptoms at this number. I would like to get off the drug entirely, what do you suggest my next step should be? (Should I go down to 19 beads / day? Should I accomodate the half life somehow by taking 19 most days, but 20 at gradually longer intervals?)


By they way, I added Suntheanine (200mg/day) and NAC (600mg) as suppliments with no side effects.

[fishinghat]

I would go to 19 and stay there for t least 2 weeks or until any withdrawal fades again.
 
May I ask what you think of the Suntheanine and NAC? Do they help any?

[Rheeny]

Thanks FH, I added both suppliaments at the same time becuase I guaged the risk of sideffects to be low, and I really wanted quick relief from the Cymbalta side effects. Thankfully, the spacy feelings dissapated and then dissapeared within 4 days of taking NAC and Suntheanine as noted above.

With that symptom gone I was able to pay attention in myself to moments of physical anxiety which I believe is my body's dependance on Cymbalta. These feelings have decreased now (I sometimes manage them by taking an extra 200mg of Suntheanine), so I feel ready to take out another bead. 

Thanks for your knolwedge in this area, and your time!

[Rheeny]

...and a followup quesiton so that I an set my expectations:

19 beads reducing at a max rate of 1 bead per 2 weeks means I will be on this drug for at minimum another 40 weeks.  ...is that your correct estimation?

[fishinghat]

That is about right.

[Rheeny]

Just wanted to let you know FH that I reduced by 1/20th and felt slight withdrawl durring the first day, that's it. I am now completing day 4 at this reduced rate and so thrilled to not be feeling aweful! I belive the suppliaments you recomended contributed heavily with this. Thank you.

[fishinghat]

You are very welcome Rheeny. I am glad you are doing well. Slow but steady wins the race.

[Rheeny]

Hi again, I have not gone down another bead yet because I have been feeling anxious. Can you give me any info or insight on this?

[fishinghat]

It is a matter of time and patience. You will settle down. Just try to be kind to yourself and stay away from stress as much as possible. Your body will let you know when you are ready to drop from 19 to 18 beads.

 

The Cymbalta was controlling your serotonin and norepinephrine and now it is trying to relearn how to control them on its own. That takes time.

[Rheeny]

At my next Dr. appointment, I expect my doctor to say that I am not at a theraputic dose, and strongly encourage me to try a different approach than the slow taper. 
Do you have any resources I can print off and bring with me? Or any other suggestions that will help explain where I am at to my doctor?

[fishinghat]

I have spent countless hours searching the medical journals for Cymbalta withdrawal research but it is very limited and mothing that would really be on point except....
 

 https://wayback.arch...e/UCM172866.pdf

 

This is an archived FDA document that addresses weaning off of Cymbalta.

Key points in the article are...

The following document was issued by the FDA warning of the severity of Cymbalta Discontinuation Syndrome.

Page 1
Cymbalta (Duloxetine) Discontinuation Syndrome
Issues of Scope, Severity, Duration & Management
June 9, 2009

Page 3
⦁ The effects of discontinuation can be severe and extend for weeks or even months Extreme mood swings (anger, irritability)
Debilitating “Brain Zaps”
Physical and neurological problems

⦁ Page 4
⦁ Claims

⦁ Cymbalta discontinuation syndrome is more severe and much more widespread than acknowledged by Eli-Lilly

⦁ Lilly sales representatives and marketing materials do not adequately inform physicians about the likelihood and severity of discontinuation syndrome

⦁ Lilly Direct to Consumer (DTC) advertising is misleading related to the probability, severity and complexity of Cymbalta discontinuation

⦁ Lilly has not developed and fielded a clinically proven protocol for safely discontinuing Cymbalta

Page 8

⦁ 2) Lilly sales representatives and marketing materials do not adequately inform physicians about the likelihood and severity of Cymbalta discontinuation syndrome

⦁ Unaware physicians unable to discuss Cymbalta benefit-risk profile (including discontinuation) with their patients
⦁ Physicians can not make an accurate comparative assessment of Cymbalta vs. alternatives
⦁ Patients can not make an fully informed choice to take the drug
⦁ Practical effects (common in anecdotal reports):Patient becomes totally distrustful of the physician who did not advise/warn them in the first place
⦁ Doctor /patient relationship is wrecked
⦁ Patient in distress refuses to ingest Cymbalta under any pretext
⦁ Tapering is taken off the table
⦁ Patient fires the doctor or the doctor disengages from the patient
⦁ Syndrome mood swings militate anger directed at the physician
⦁ Physician may deny syndrome even exists
⦁ Physician may jettison a newly “difficult” patient
⦁ Physician seeks to avoid malpractice implications
⦁ Patient becomes deeply suspicious of any psychotropic medication
⦁ Underlying problem may go untreated
⦁ This is a process flaw – there is no excuse for it

Page 9

⦁ Lilly Direct to Consumer (DTC) advertising is misleading related to the probability, severity and complexity of Cymbalta discontinuation

Also states that “opening the capsule is required to taper”

Page 14

⦁ Lilly does not offer small dose Cymbalta formulations to facilitate tapering. Patient required to open capsules and count drug beads
⦁ Patient may require compounding pharmacy services at his/her expense

⦁ Tapering may take weeks or months
 

[Rheeny]

My Dr. is encouraging me to taper with a temporary prescription of prozac.

I have finally stabilized at 15 cymbalta beads and I agree with him that each adjutment to one less bead is agonizing.

However, I am very hesitant to introduce another medication after having such a poor experience with cymbalta.

 

Do you have any reocomendations, advice, internet resources, or words of caution? etc

 

Thanks

[Rheeny]

...the idea is that I take a partial dose of prozac while taking cymbalta, then continue with prozac for a few weeks while I stop cymbalta, and then fade out the prozac to be prescription free.

[fishinghat]

Rhenny, I can tell you this, many members have been through the same thing. I would say around 30% are successful but what the dr probably didn't tell you was that it takes Prozac 6 to 8 weeks to kick in. Myself and others have been put on prozac at 5 mg for a month, 10 mg for a month and 20 mg for a month with no effect. I can also tell you that the only better ssri that I have seen are Zoloft and Lexa[ro and there is no guarantees with those either. Sorry i couldn't be of more help.

[Rheeny]

Hmm, so I can possibly ask to be on Zoloft/Lexapro instead to increase the support, would you guestimate that brings it up from 30% successful to 50% successful compared to prozac?

 

What have you observed on success in this approach, vs just sticking with cymbalta bead counting?

[fishinghat]

Just my personal observation but I would choose either Zoloft or Lexapro before Prozac. Also they only take 4 to 6 weeks to kick in. All three tend to be easier to come off of than Cymbalta hot that they are a picnic. As far as comparing the success, well it varies tremendously. Many who cross taper get little to no benefit and if they do get a benefit it is limited because Cymbalta regulates serotonin and norepinephrine while the three mentioned above only control serotonin. This leaves the norepinephrine to cause anxiety to still be quite severe until your body adapts. On the other hand Cymbalta withdrawal can last up to 2 years after your last dose (6 to 8 months for the majority of the symptoms to subside). I can honestly say I personally know 2 people who quite Cymbalta cold turkey and never had a symptom. I wish there  was a clear cut answer to your questions. I will just summarize by saying if it was me I would not introduce another antidepressant into the mix which may or may not work, may have side effects and has its own withdrawal. Which ever way you decide we will be here to help. 

 

Have you ever considered any of the non-addictive prescription meds to see if they will help?

[Rheeny]

Thanks FH for your insight. I didnt know non-addictive prescription meds might help. Tell me more.

[fishinghat]

I have listed these in the order I would recommend them.

 

"Clonidine (Catapres, Kapvay, Nexiclon, Clophelin) is a classic blood pressure medicine BUT it is very effective on anxiety. It is an alpha adrenergic antagonist which means it stimulates the alpha adrenaline synapses located in the frontal lobes of the brain. When these synapses are stimulated by the clonidine the brain thinks that it is due to adrenaline and it tells the adrenal gland to produce less adrenaline. It is a little slow to kick in, about an hour and a half. It has a 12 hour half life. Most drs prescribe 0.1 mg twice a day. One to be taken about an hour before bedtime and the other in the morning. Because it decreases adrenaline it has a strong calming effect which helps a person get to sleep and stay a sleep. It is not unusual for people to have a little drowsiness from clonidine until they get use to it (1 or 2 weeks). It does NOT work faster sublingual (under the tongue) like benzos. These have no withdrawal but your blood pressure may spike for a couple weeks if you cold turkey. Due to the lowering of blood pressure and sleepiness it is common for the patient to start with ½ tablet at bedtime. Once the patient adjusts to the medicine they begin a ½ tablet in the morning. As sleepiness and blood pressure stabilize they are slowly worked up to the 2 tablets (0.1 mg each) a day. They also make a slow release patch for clonidine which avoids the peaks up and down in blood pressure and sleepiness associated with taking clonidine every 12 hours.

Begins working 60 to 90 minutes
Peak levels – 3 to 5 hrs
Half Life – 12 - 16 hrs
There are too many research articles on clonidine's anxiolytic properties to list here."

"Hydroxyzine, (Vistaril, Atarax) - is an H(1)R antagonist, is very effective against anxiety in most people but some get no help from it at all. It is not addictive nor does it have withdrawal but it also can lower blood pressure some but that usually goes away with time. This medicine should be started slowly to give your body a chance to adjust to the blood pressure effect. Normal dose is 25 mg four times a day but can go as high as 400mg/day.
Begins working in 30 minutes or less
Peak levels - 2 hrs
Half Life – 15 to 20 hrs
https://www.ncbi.nlm...pubmed/21154375
https://www.ncbi.nlm...pubmed/12444816
https://www.ncbi.nlm.../pubmed/7875114
Anxiolytic, Sleepiness begins to subside after 1st week and no withdrawal.
https://www.ncbi.nlm.../pubmed/9809861
https://www.ncbi.nlm.../pubmed/2430410
Do not take with cimetidine as it increases hydroxyzine levels in the blood.
https://www.ncbi.nlm...les/PMC1512309/
Effective, sleepiness slowly decreases.
http://www.cymbaltaw...elps#entry71818
Cymbalta, clonidine and hydroxyzine and alcoholism information

https://dailymed.nlm...4b-8e1fae02af2e
(Manufacturer)
For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested: in adults, 50–100 mg q.i.d.; children under 6 years, 50 mg daily in divided doses and over 6 years, 50–100 mg daily in divided doses.

https://www.drugs.co...ose_for_Anxiety
Usual Adult Dose for Anxiety
-Oral: 50 to 100 mg 4 times a day
-IM: 50 to 100 mg immediately, then every 4 to 6 hours as needed

http://www.pdr.net/d...ine-pamoate-744
(Physicians Desk Reference)
Oral dosage
Adults
50 to 100 mg PO 4 times daily as needed, adjusted to patient response.


https://www.mayoclin...se/drg-20311434
(Mayo Clinic)
For oral dosage forms (capsules or suspension):
⦁ To help control anxiety and tension:
⦁ Adults—50 to 100 milligrams (mg) 4 times a day."

"Atenolol is a beta 1 adrenergic receptor antagonist, also known as a beta blocker. It does not pass through the blood brain barrier which limits its side effects compared to other beta blockers. It has been linked to a higher risk of type 2 diabetes. It may cause drowsiness and lower blood pressure. Typical dosage around 25 mg four times/day. Dosage should be slowly increased.
Begins working in 30 minutes to an hour
Peak levels – 2 – 4 hrs
Half Life – 6 - 8 hrs
https://www.ncbi.nlm.../pubmed/3549876
Effective but blood pressure drops.
https://www.ncbi.nlm.../pubmed/4054193
Side Effects
https://www.ncbi.nlm.../pubmed/1777372
https://www.ncbi.nlm.../pubmed/4047384
Not effective
https://www.ncbi.nlm.../pubmed/2196620
30% found it effective.
SF - So now I am on one. It is called Atilonol (Atenolol?) and calms down your heart rate too."

"Propanolol is a beta blocker similar to atenolol.

Frog - I did want to tell you that the Propranolol beta blocker has been working REALLY well for me. I had little to no anxiety at all yesterday. All day. I still don't feel like totally myself and totally comfortable but I can see that more clearly now than when I was filled with uncontrollable physical fear and dread all day long."

[VaguelyFamiliar]

FH,

 

Great timing.  I was searching everywhere on here, trying to find info on help with the intense anxiety piece.  

 

Are you currently taking just Propanolol?  Or, do you take Clonidine as well?  

[fishinghat]

I use to take atenolol and a benzo at the very beginning (2002, yes, I am that old). The drs in my area no longer prescribe benzos but instead use hydroxyzine and/or clonidine.

 

Right now I take the clonidine, hydroxyzine, buspar and Zoloft. I will be weaning off the Zoloft in the near future.

[Rheeny]

Hi FH, I am curious about the Clonidine patch for cross-tapering away from cymbalta.

 

Would I wear the patch and continue reducing cymbalta by a bead every two weeks? ...and then how long after finishing cymbalta would I remove the patch?

 

I am still holding steady at 15 beads of cymbalta, because I found when I tapered every two weeks, I started fighting depressive symptoms that are not part of my normal -  thankfully they cleared up when I stayed at a steady dose for a thrid week - but obviously I'd prefer not to go through that again.

 

Is clonidine stil what you would recomend trying first?

[fishinghat]

I would not recommend the patches as they do not give you the flexibility to taper down your dose as the symptoms fade. To be more specific...Lets say the dr recommends 0.1 mg every 8 hours and after a couple months you are feeling better then you can try 0.1 mg every 12 hours or even 0.1 mg at say 8 AM and 4 PM and a half tablet at 2 AM. Just an example not the actually dosage and schedule that you may wind up with.