[s.r.]

Started taking Cymbalta just under 2 years ago along w/ Lamictal. Diagnosis bipolar type II and generalized anxiety. Nothing unusual from other anti-depressants as far as side-effects. Increased sweating, dry mouth, decreased libido.
I switched to Cymbalta from Effexor XR, which I had been taking since 1994, due to my health insurance's decision not cover it except at a non-formulary copay. It would cost me about $100 for a 30 day supply. Insurance and mental health benefits are another subject entirely!!

My discontinuation of Cymbalta began as such.
I have sleep apnea and went for a follow-up sleep study about a month ago. Turns out while sleeping I'm having Periodic Leg Movements or (PLM). Basically, it's the same motion as moving your foot up and down to pump a brake pedal on a car. I'm doing it w/ both feet about 130 times an hour!! Not conducive to sound sleeping.
The PLM connection to Cymbalta is b/c, Cymbalta and others in its drug class can cause these side-effects. In my prior sleep study I was taking Effexor XR and Neurontin to treat my bipolar & generalized anxiety.

Based on the sleep study results my sleep Dr. & my psychiatrist decided, much to my approval, to discontinue the Cymbalta and once having done so replace it w/ another like med. Unknown at this time as to what it'll be. Dr. is sending a request to my insurance company to cover my Effexor XR prescription at the formulary copay price. $25.

My dosage was 120mg per day. Every 7 days I lowered the dosage and then discontinued. So, from 120 to 90 to 60 to 30mg and then discontinued. I imagine the increments were determined by the capsule strengths manufactured. 30 mg being the smallest amount available.

Initially nothing of any real significance developed while tapering off it. I did notice my dry mouth and increased sweating went away, and my libido increased. The PLM remained. A few times I noticed a pin pricking or tickling sensation on my skin while lying down to sleep. I say this in hindsight b/c, at the time I just thought the tickling was from dog & cats hairs on my sheets tickling my skin when blown by my ceiling fan. Later I found it a withdrawal symptom.

The first withdrawal symptom began on the first day I stopped taking Cymbalta entirely. At first I was "space brained". I'd experienced this before when I was later than usual taking my dose. This was an expected and not very upsetting effect.
That first night is when all of the others started to appear. I developed a headache that night and had trouble sleeping due to very vivid dreams. They were horrible and violent in nature. Disturbing. I've had the occasional dream like that before except these persisted every time I fell asleep that night. I awoke much earlier than normal for me the next morning feeling completely unrested. Had a hot burny sensation on my face and around my head. I 'd felt that way before when I'd gotten really rotten sleep or not enough. Throughout the day this persisted.

Additionally, I started to notice a rushing sensation in my head. Something like when you hold your breath and you hear a whooshing sound from I guess the blood vessels in your head throbbing. Best I can describe it. Noticed some other people calling it "brain flashes". I also started to become nauseous and lost my appetite a little. When I eat I didn't gag or feel like I wanted to throw-up. Just persistent nausea.

That second night while lying bed to go to sleep I felt the pin pricking and tickling sensation described above. Since then the sensation has reoccurred every time I lay down to sleep, even just for a nap.

I've since felt very emotional just while watching TV. It ranges from very happy to wanting to cry. The emotions are intense and come and go very quickly. This is definitely not usual for me.

I'm on my 4th day w/o Cymbalta and the nausea, "brain flashes", "space brain",emotional cycling, prickling and vivid dreams remain. I've listed them in order of severity. The dreams have seemed to lessen in intensity over the subsequent nights. I only had the headache the first night and it has since not reoccurred.

I'll do my best to update my post as hopefully I'll be able to report back as they decrease and eventually go away in the preferably immediate future. Hopefully sharing my experience will help me and others get through the withdrawal. Plus, I'm keeping my Dr. informed as to avoid a potentially worsening mental state.

I've been on and off different psy. meds and meds in general, but am having a hard time recalling such an unpleasant set of symptoms.

If you read this post and have had these withdrawal symptoms can you let me know how long you had them for.

[s.r.]

Greybeard,

Thanks for your reply and your many other posts throughout the website. Definitely the symptoms I'm having are common to others and that is some comfort. However, the lack of a need for a website devoted to the nightmare of Cymbalta withdrawal would be far more comforting to all, I'm sure.

You are quite right that anti-depressants such as Cymbalta should not be used alone for the treatment of Bipolar. In my case the Cymbalta is being used to treat my General Anxiety Disorder and depression in conjunction w/ the Lamictal as the mood stabilizer. For BP you must have the mood stabilizer first and foremost. Once mood is stabilized other meds may be used to treat possible additional disorders.

Specifically regarding Lamictal and other SSRI/SSNRI withdrawal and a likely way to avoid it is: as you slowly reduce the dosage (over at least a month or more) you introduce the replacement antidepressant at low dosage and move up to the desired therapeutic amount specified by your Dr. As one goes down in dosage the other goes up. Looking back at my notes from 12/06 when I switched from Effexor XR to Cymbalta my Dr. had me do just that. To my knowledge I had no significant withdrawal symptoms to speak of. In my case this was possible b/c, the discontinuation of an antidepressant was not on the cards which, looking at these notes now I wonder why the hell the Dr. didn't do it this time and why I'm not replacing Cymbalta w/ something else!!!! Not to fear I've been in contact w/ the Dr. twice since my discontinuation of Cymbalta last Fri. and have an appointment in less than a week to get things moving in a better direction.

One thing in my case that may have some significance is that what seems to have become common practice w/ psychiatric offices is that for med. management you usually just see the psy. nurse. Your initial intake visit is w/ the psychiatrist, but after that unless you specifically request the Dr. you'll have the follow-up w/ the nurse. Psy. nurses of course have different training and often different levels of practical experience from psychiatrists. Sometimes it is insignificant and sometimes their attitude is better and more accommodating than the psychiatrist. It's a mixed bag.

This time my med. switch was monitored by the psy. nurse and not the Dr. I'm regretting that decision now. As a general rule I would recommend having an appointment w/ the psychiatrist for any issue above having to go in & get your RX renewed. Based on the American Psychiatric Association's recommendation my Dr.'s office requires an office visit every 4 months max. in order to keep renewing the RX.

As far as GP's and Dr.'s of any other specialty prescribing meds like Cymbalta I'm feel very uneasy. An exception would be a Dr. in a specialty where these meds have proven efficacy and had widespread usage. GPs, etc. prescribing antidepressants? A recipe for disaster I feel.

Thanks

[s.r.]

Update:

Early evening of 6th day off Cymbalta:

Symptoms:
Persistent Nausea
"Brain Flashes"
"Space Brain"
Pricking/tickling on skin, usually noticeable when sitting or lying still.

Vivid dreams have lessened in intensity. Sleep quality is still poor, but better than before.

New symptom developed this evening: "cold sweats".

Food: I've noticed I'm craving & consuming more carbs.

Since stopping I also get overwhelmed very quickly w/ too much external stimuli or talking to more than one person at a time. Not really a huge surprise w/ all this going on!

[s.r.]

Update:
16th day off Cymbalta

This second week off has seen much improvement for me.

-Nausea has all but gone. Slight lingering.
-Brain "Flashes"/"Zaps" almost entirely gone. When they do occur they're infrequent and mild.
-"Space Brain" occurs when I get hungry and my blood sugar gets low. Eating frequent small meals has helped. No weight gain to report.
-Prickling/tickling still persists. (Now seems to be a side effect of the Lamictal instead.)
-Vivid dreams gone. Not aware of any dreams, which is normal for me.
-"Cold Sweats" occurred only that one evening.
-Still get overloaded quickly and confused easily and have to try to slow things down. (Possibly Lamictal)
-Notice I'm not as tired and lethargic, sweat as much, or have such a dry mouth as when taking.
-I seem to be more sensitive to smells that didn't bother me before quitting. (Possibly Lamictal)


From what I've read the Cymbalta will be well out of my system already and leads me to the new conclusion that unfortunately, for me the side effects I'm experiencing now, including the original one of leg movements during my sleep; the whole reason I was taken off Cymbalta in the first place, are more than likely related to the 200mg of Lamictal I'm still taking. Looks like Lamictal is the culprit. That's a whole other web site I'll need to find! Would've been great to have known that prior, but w/ most psy. meds listing the same possible side-effects, it's hit-or-miss and then a balancing act.

My Cymbalta withdrawal seems to have ended here. I see my psychiatrist tomorrow for the first time since all this happened so, we'll have lots to discuss! Anything pertinent to this web site I'll post.

-Take care and hope my posts can help others through this shared ordeal.

[CathyH]

Just a quick note about bipolar II disorder and anti-depressants. I have bipolar II and have read and researched this issue. "They" have determined that anti-depressants make bipolar symptoms worse, and irreversibly worse over the course of time. The only drug approved for the depression in bipolar disorder is Lamictal, as it has anti-depressant properties, along with being a mood stabilizer.