Article: Duloxetine Withdrawal Seizure [Cold Turkey Withdrawal]

I think I had at least 1, possibly 2, seizures during hard, cold turkey withdrawal ... but don't know for sure, was alone and woke up on the floor ... yet another reason not to quit this poison cold turkey!

Duloxetine Withdrawal Seizure [full text]
Psychiatry (Sept 2006)
http://www.ncbi.nlm....les/PMC2963463/

From the article:

Much has been written about the use and side effects profile of duloxetine (Cymbalta®). We report a case of a patient who had generalized tonic clonic seizures after abruptly stopping duloxetine.

Case report. Ms. X was a 59-year-old Caucasian woman with a diagnosis of major depressive disorder recurrent severe without psychotic feature. She was stabilized on duloxetine 90mg p.o. daily.

She came to the emergency room with complaints of nausea, clear liquid vomitus, anxiety, “electical sensation” inside the body, restlessness, decreased liquid intake, abdominal pain, and decreased sleep.

She stopped taking her duloxetine two days previoiusly. She had two generalized tonic clonic seizures 20 minutes apart in the hospital.

Urine drug screen was negative. Urinalysis was negative. Complete blood count (CBC) was normal. Her sodium was 134, potassium was 2.5, chloride 86, glucose 110, calcium 9, and magnesium 1.5. Her blood urea nitrogen (BUN) and creatinine were normal. Her liver function tests were normal except mildly elevated alkaline phosphatase of 126. Computed tomography (CT) scan of her head was negative. There was no sign of infection at the point of admission. She was stabilized and was then started on a different antidepressant due to her history of nonadherence. She had no further seizures during her hospital stay.

Interesting that her potassium level was so low at 2.5. Normal levels are between 3.7 and 5.2. 

 

I know that Low potassium is dangerous because I have low potassium levels. I take an Rx called KlorCon M20 twice a day in order to maintain normal levels.

I never had low potassium before I took Cymbalta. I have been having my level check since I stopped the crap because I'm worried that my potassium will now go too high but my levels have not changed yet. I still need to take the Rx.

that's interesting, and important to know ... I wonder if FH has any additional info/research on a connection between low sodium levels and Cymbalta ....

Because of the effects on serotonin (which is most commonly found in the gut) most people who take ssri/snri have a marked decrease in sodium, potassium, magnesium and/or calcium. Sometimes the levels are still within normal levels (although on the low end of normal) and sometimes well below normal. I have blood electrolytes run twice a year. Over the years I have found what supplements keep me in the middle of the normal range. Obviously everyone has different diets so each person has to evaluate their own needs. The recommendations I have had from my endocrinologist is to not let my lab results fall to below 20% of the lower end of normal. So if an electrolyte has a normal range of say 10 to 20 then don't let your level drop below 12 (20% from the bottom).

interesting about the potassium. it helps regulate blood pressure. if cymbalta can result in low potassium levels, thats one explanation for higher BP when on the C. when i was in the hospital for an acute case of colitis, i was on the C at the time. my potassium levels were chronically low the whole time i was in the hospital. they were constantly taking my blood and coming back from the lab a few hours later making me drink that crappy potassium drink where they try and cover up the chemical flavor with overly sweet grape kool aid. i asked them if they could just dump it in tomato juice or carrot juice or something but they said no. my potassium levels never came up enough to satisfy them the entire 6 days i was there. i also had very high blood pressure at the time. i always blamed the C - i wonder if it was due to low P from the C, or some other cause. 

While I was on C, my blood pressure was borderline high to very high. I suggested the correlation of low potassium and high blood pressure and my Dr told me to "get off the internet"... She is not my doctor anymore 

 

Since I have discontinued the C, my blood pressure is absolutely perfect but I still need to take 2 enormous sized potassium pills every day to keep my potassium level within normal range. I'm hoping this will improve once I have been off the C for a longer period of time. 

 

I'm on my 3rd doctor since the one that treated me as if everything wrong with me, including high blood pressure, was all in my head. I have only met with my newest victim (Dr.) once so far. I'm not sure I like her yet (it is very hard to get an appointment with her) but at least she is willing to run test and or send me to a specialist rather than dismiss my medical symptoms.

 

I'm just worried that if the C is what caused my low potassium then if I continue to take the Rx potassium, my level will get too high.

 

Only time will tell.

Renee,

 

These Drs are a real trip, aren't they?  I, too, am on my 3rd one - I really like her and she takes the time to listen to me.  I have never had a Dr. sit down, fold her hands and look at me while I talk.  She also answers all my questions without the "God-like" quality that my last one tried to convey - he made me so angry when he said he thought I should go back on the poison (a lower dose!) after I had been off of it for 4 months!   Arrrrggg....

 

Good luck with the one you have now - hopefully she will work out for you!

 

BTW, how are things going with your daughter?  No need to answer if you would rather not.

 

I'm sure you're happy that the holidays are over!

 

Take care, my friend

 

Liz

What a relief to finally find people to who understand what this experience is like. I am sure that I had at least one seizure during the first couple of days of my cold-turkey DTs. There is so much of that first 10 days or so that I don't remember clearly. I do have the memory of feeling my body jerk hard, then sometime later I realized that I had lost consciousness. Luckily I was in bed and my college age kids were downstairs so they didn't see what happened.

Holy cow. Saturday I had a weird thing happen, I was In The steamer trying to sweat this crap out, and I felt like I was losing consciousness, made it to the bed and called for help, my hands and feet curled into claws and my lips were numb and breathing was labored. 10 min later I was fine with a normal bp, I guess it was a seizure of sorts. I'm so tired of the drama.

I am glad you are alright. This is nasty stuff. The faster you remove this material from the body the worse the effects (like seizures) thus the warnings about cold turkey.

Hi Mimi,

Cold turkey! Real brave you are.

What dosage were you on? Looking forward for your updates. Thank you!

that's interesting, and important to know ... I wonder if FH has any additional info/research on a connection between low sodium levels and Cymbalta ....

I have low sodium levels intermittently, not always related to the duloxetine. I have high blood pressure and I'm on a diuretic and have had low sodium levels before taking duloxetine which happened when I was put on a stronger diuretic. I really felt awful. The medical literature I have been able to find doesn't mention anything about hyponatremia (low sodium), but I will look further. Hyponatremia is a know cause of grand mal seizures, but low potassium is not.

Medical Journal articles concerning Cymbalta and low sodium levels.

https://www.ncbi.nlm...pubmed/26956638
https://www.ncbi.nlm...pubmed/25911354
https://www.ncbi.nlm...pubmed/25538343
https://www.ncbi.nlm...pubmed/23075738
https://www.ncbi.nlm...pubmed/20017411
https://www.ncbi.nlm...pubmed/18562431
https://www.ncbi.nlm...pubmed/17502788
https://www.ncbi.nlm...pubmed/17224730
https://www.ncbi.nlm...pubmed/17110834
And there are more...

From the drug insert for Cymbalta...
https://dailymed.nlm...f2-c185fbad64ba

5.13 Hyponatremia

Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including CYMBALTA. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Cases with serum sodium lower than 110 mmol/L have been reported and appeared to be reversible when CYMBALTA was discontinued. Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk [see Use in Specific Populations (8.5)]. Discontinuation of CYMBALTA should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted.

Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. More severe and/or acute cases have been associated with hallucination, syncope, seizure, coma, respiratory arrest, and death.

And for more late night reading...lol

https://www.ncbi.nlm...les/PMC3229538/
"Although the risk of seizures with antidepressants is generally very low, the association with overdose is well established [80]. However, the molecular mechanisms by which antidepressants cause seizures have not been clarified. GIRK2 knockout mice exhibit spontaneous seizures and are more susceptible to seizures induced by pentylenetetrazol than wild-type mice [37]. The risk of seizures in overdoses with sertraline, duloxetine, mianserin, and venlafaxine significantly increases [80]–[82], and amoxapine overdose is more likely to cause seizures [83]. "
80. Montgomery SA. Antidepressants and seizures: emphasis on newer agents and clinical implications. Int J Clin Pract. 2005;59:1435–1440. [PubMed]
81. Whyte IM, Dawson AH, Buckley NA. Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. Q J Med. 2003;96:369–374. [PubMed]
82. Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol. 2004;42:277–285. [PubMed]
------------------------------------------------------------------------------------------------------------
https://www.ncbi.nlm...les/PMC4683813/
"Epilepsy is a serious condition which can profoundly affect an individual’s life. While there is some evidence to suggest an association between antidepressant use and epilepsy and seizures it is conflicting and not conclusive. "
"Conclusions
Risk of epilepsy/seizures is significantly increased for all classes of antidepressant. There is a need for individual risk-benefit assessments in patients being considered for antidepressant treatment, especially those with ongoing mild depression or with additional risk factors. Residual confounding and indication bias may influence our results, so confirmation may be required from additional studies."
-----------------------------------------------------------------------------------------------------------
https://www.ncbi.nlm...pubmed/16534127
Neurology. 2006 Mar 14;66(5):773-4.
Duloxetine-induced syndrome of inappropriate antidiuretic hormone secretion and seizures.
Maramattom BV1.
"The syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia is a well known side effect of older selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, sertraline, fluoxetine, citalopram, escitalopram, and fluvoxamine.1,2 The frequency of hyponatremia is around 8 per 1,000 among elderly women receiving fluoxetine.2 Although the second-generation dual blockers, selective serotonin–norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine, are touted to have a wider therapeutic index, hyponatremia is encountered even with venlafaxine. To date, Medline searches do not reveal any reports of hyponatremia associated with duloxetine. We describe a woman who developed severe hyponatremia on exposure to duloxetine and recurrence on inadvertent rechallenge, suggesting the causative relationship of this drug to hyponatremia. "
------------------------------------------------------------------------------------------------------------
http://www.psychforu...topic69139.html
This is a thread about seizures and Cymbalta you might want to check out.
---------------------------------------------------------------------------------------------------------------------------
http://pi.lilly.com/...ta-Medguide.pdf
Under side effects the manufacturer (Eli Lilley) lists seizures as a possibility.
---------------------------------------------------------------------------------------------------------------------------
http://www.ehealthme...mbalta/seizure/
84,701 people reported to have side effects when taking Cymbalta.
Among them, 598 people (0.71%) have Seizure
------------------------------------------------------------------------------------------------------------

This is the only post I could find that relates....


Posted by Alicemarie on 26 April 2013 - 06:27 PM in What are you feeling?
I was recently diagnosed with atypical trigeminal neuralgia and my psychiatrist thought I would benefit from taking Cymbalta. She started me off at 30 mg. Within 3 days of starting it, my blood pressure plummeted, my resting breathing rate and depth slowed down and was very shallow and my temperature went down to 96.1 and my urine output had also decreased. I developed a horrible cough and became hoarse. By the 5th day I was in the emergency room. I seriously thought my body was shutting down. What they found at the emergency room was low sodium, chloride and calcium and a high lactic acid level (lactic acidosis indicates that your body is not getting enough oxygen.