When I made the decision to start coming off some of my medications, I was taking 72mg methylphenidate, 120mg duloxetine, 30mg citalopram, 80mg latuda. I weaned off the latuda within 4 weeks, and did not have any major withdrawal symptoms. The only time I ever experienced very unpleasant withdrawal symptoms was when I missed 2 doses of methylphenidate, and when I quit taking zoloft after 3 days due to the adverse side effects. Quitting zoloft caused brain zaps, and panic attacks for about a week, even though I only took 3 pills.
Next I decided to tackle duloxetine, because I never felt like it had much benefit for me, but of everything else I had tried, the side effects were a bit more tolerable (the only troublesome effect was the occasional tachycardia), so I left it in my cocktail.
I have gone from 120mg to 90mg, in a month, no problems. I went from 90mg to 60mg in a month, and continued the 60mg for a total of 2 months. Here is a summary of what has occurred.
90mg to 60mg duloxetine: 2 months
- insomnia, unable to sleep most nights until I eventually flickered out by the end of the week. lasted 1.5 months before able to fall asleep before 4am.
- dizziness, occurs randomly
- confusion, occurs randomly
- increased frequency of headaches
- daytime drowsiness, even after insomnia subsided. need 1 to 2 naps per day, drowsiness is severe enough that I have fallen asleep waiting in public places. just an intense need to 'rest my eyes'
These withdrawal symptoms seemed manageable enough, so I dropped from 60mg to 30mg on Feb 28, 2018. This seems to be too much for me to handle, it hasn't been a week yet, and I have:
- numbness/tingling/pain in my arms and hands.
- daytime drowsiness, need 2 naps or a rest period throughout the day.
- muscle stiffness in my back, along the spine and across shoulder blades. neck seems stiff too.
I am not sure how to proceed, what the options are, but there seem to be 2 main choices.
- Do I stay on the 30mg and tough out the symptoms until they stabilize? How long does that typically take? The numbness/tingling/pain in my arms and hands is what is bothering me the most. It is difficult to hold things, like pencils, so writing is difficult, sometimes it makes sleeping difficult because I cannot get comfortable, I drop things because my grip and perception are out of whack.
- Do I return to the 60mg dose until my symptoms subside? How long does that typically take? Once I am stabilized, what is the recommended dose reduction on the 60mg capsule? I don't know how much to reduce the dose by, or how long to take the reduced dose. Is there a recommended dose schedule?
I do trust my doctor and he is very good at discussing options with me and letting me call most of the shots, but I feel he is lacking the experience in this area. When I brought up the taper plan before and asked how a 10% reduction would work, he indicated it would be extremely difficult to do, but probably not necessary at the higher doses and since I am on other antidepressant medications the withdrawal shouldn't be so noticeable, so the 120 to 90 to 60 was the starting point.
I am currently taking 72mg methylphenidate and 30mg citalopram with the duloxetine. I would really appreciate some input and insight on which method I should consider to continue my tapering. I have looked up some previous posts on this forum, but hadn't found much beyond reducing doses by 10%, but not clear as to how long this is done, and how to taper from a 60mg to a 30mg capsule, and then how to further taper off the 30mg capsule. I do have both dosage forms at my disposal for bead counting presently. I usually kept all medicines I was prescribed, even if the dose was changed quickly or I was tried on a different medication. I feel like I have tried most everything for my depression. I have not tried the MAOIs, but my doctor and I both agree it isn't worth the trouble and is not recommended to go that route due to the restrictions, and I have not yet tried the tricyclics, but I would need to come off my current meds to do that anyway. So it is undecided if I will try them down the road or not.