Switch Duloxetine To Sertraline

Hello everybody,

 

I´m from Germany. Please apologize my bad English ;-)

 

I´m so happy to found this forum and I want to know about my plan for switching. The reason for changing the drug are very bad eye side effects.

 

short history:

- duloxetine since 2013 (60mg at hospital, 3 months later reduced to 30mg)

- oct 2018: 30mg to 20mg in one step...very critical, but i survived ^^

- diagnosis: panic disorder, agoraphobia, compulsive thoughts (don´t know if it ist correct translated) since my childhood

 

my plan will be:

- 20mg duloxetine + 12,5mg sertraline for 3 days

- then 10mg duloxetine + 12,5mg sertraline for....? maybe two weeks

- then 10mg duloxetine + 25mg sertraline for 3 days

- then 5mg duloxtine + 25mg sertraline for....maybe two or three weeks

- then 0mg duloxetine + 50mg sertraline, hopefully it will deal with my diagnosis

 

By the way, last week I forgot my complete duloxetine dosage of 20mg. 24 hours later I felt horrible: nausea, dizziness, vomiting and so on. That´s why, I decided to reduce duloxetine gradually (20-10-5-0mg) and do not a direct switch from 20-0, like my psychiatrist suggested.

 

What do you think?

Thanks a lot and greetz from Germany!

 

Welcome LaVana.

Your English is just as good as mine and I grew up here. lol

That looks like a good plan. Many here have done the same type of switch and schedule. There are two ways to switch. One is a slow cross-over like you describe. The other is a direct cross-over like your dr wanted. Many drs don't like the slow cross-over as you will be on two antidepressants at the same time and they worry about serotonin syndrome. Given your low dose of Cymbalta it should not be an issue.

Remember one thing, it takes Zoloft around 4 to 6 weeks to kick in so you may go through a pretty difficult time until you have been on it long enough.

Hi LaVana and welkommen!!

 

I think the week, then 3 days might be a bit to erratic given your response to missing one dose. I think you need to take this more steady. You are one a very low dose of duloxetine so there will be no problem with serotonin syndrome. If you did not have issues with 60mg duloxetine, then this will not be a problem for you.

 

I suggest the following as a slight change to your plan;

 

- 20mg duloxetine + 12,5mg sertraline for 3 days  one week

- then 10mg 15mg duloxetine + 12,5mg sertraline for one week

- then 10mg duloxetine + 25mg sertraline for one week

- then 5mg duloxtine + 25mg sertraline for two weeks

- then 0mg 5mg duloxetine + 50mg sertraline for two weeks

- then 50mg sertraline

 

Here you will go slower at the end of the taper, and at the end of 8 weeks, the sertraline should we working quite well, so the levels should balance out. Dropping 20-0 is NOT a good idea - you are right not to do this!

 

Also as you are changing drug classes from SSNI to SSRI, you should expect to feel some withdrawal related to adrenaline, so you might feel weak, shaking and sweating, but this will be perfectly normal. Our eBook which you can download here from the site will explain a lot.

 

....and your English is zehr gud! I used to speak some German, but I forgotten most!!

 

IUN

Hello guys ;-)

 

Many thanks to your exactly information! I will try the "slight-change-plan" of IUN, because I also thought about the step to 15mg duloxetine.

This evening I start with adding 12,5mg sertraline.

 

I will give you some updates during the switching process. Wish me luck...I´m very concerned about it

 

Have a nice weekend!

LeVana

Best wishes and keep us posted.

Still a question: is it ok to stay longer (3-4 weeks) at every step or is it too dangerous?

thx :-)

Once you start dropping the Cymbalta you will probably start getting some withdrawal that will get worse with time because the Zoloft has not fully kicked in yet so it is best not to delay too long. If you drop to slow you have to suffer to much withdrawal before you get relief, if you increase your new antidepressant too fast your body does not have enough time to adjust and you are more likely to get side effects. Most drs and research articles use one or two weeks between each step such as IUN outlined.

Hello fishinghat,

 

ah, ok, sounds logical to me. You´re pretty smart ^^

Thanks!

Thanks for your lovely words LeVana...

 

...and I wish you the very best of luck in your switch. Please ask any other questions if you need further help. 

 

IUN

Yesterday I took my first dosage of 12,5mg sertraline. I permanent feel difficulty in breathing and shortness of breath. Is that a normal side effect?

Not unusual. We have another current member that has this issue as well. This is from adrenaline buildup due to the withdrawal. Do plenty of deep breathing exercises until it passes.

So you meant it's too much adrenaline because of combination dulox+serta?
I thought it's a generally side effect of sertra.

Sorry for questioning ^^

No Cymbalta controls serotonin and norepinephrine. As you drop the dosage of Cymbalta both the serotonin and norepinephrine increase. You body then converts the extra norepinephrine to adrenaline. This excess adrenaline causes the breathing issues as well as anxiety, higher pulse, etc.

I don't want to overwhelm you but incase you are curious the faster shallower breathing allows carbon dioxide to buildup in the lungs and blood, this makes the blood more acidic which in turn reduces the amount of oxygen that the blood will carry. This leads to further breathing issues. This is called respiratory acidosis.

Hi LeVana

It's me who has the shallow breathing problem at the moment. I am weaning off Cymbalta and am down to 26 beads. I feel like I can't take a deep breath in and it's like I'm gasping for air, although I can breathe. Is that what it's like for you?

It is scary but I am trying to ignore it. I keep telling myself it is only temporary and will pass. Deep breathing exercises do help.

Good luck with your switch.

Polly

LeVana.

 

This is what I said might happen because you are switching from SNRI to SSRI. These problems can be expected, but I know they are not very nice. We have all been through many stages of withdrawal so we can empathise with you on your journey.

 

The eBook explains a lot of what Hat and I are explaining to you - you can download it here;

 

https://www.cymbalta...tion-the-ebook/

 

There is a lot of information which will help you and lots of stories and help from other members on the forum. 

 

You will feel uncomfortable for a while, but please continue to ask any questions as there are answers here waiting for you!!

 

IUN

Thanks for your answers!

I dropped duloxetin in oct 2018 for the last time. The difficulty with breathing appeared only since yesterday (after I took sertra). Dulox is still at 20mg. With this med I never had breathing probs.

As far as known, sertra can cause bronchospasm as side effect. That's why I'm concerned.

@Polly Good luck to you, too. Take a deep breath :-)

CU

@IUN: thanks for your ebook-link. I will try to read :-)

Maybe, I have some problems to understand all your information from English to German...try my best!

Maybe, I have some problems to understand all your information from English to German...try my best!

 

If you have any problems - please ask - bronchospasm is between 1-10%, so a possibility. Do you have wheezing/whistling when you breath all the air out of your lungs?

So you haven't started dropping the Cymbalta yet? The breathing issues would not likely be from Cymbalta withdrawal them. The FDA website says that 3.8% of those tak9ng sertraline complain of breathing difficulties with 2/3 being female. This makes me concerned that it is a side effect of the sertraline. Many sertraline side effects fade after a week or two. If this does not it may be time to see the dr again.

Yes exactly, wheezy sounds while exhaling and a strange pressure at my chest. Since yesterday :-/

No, not dropped yet. I only added sertra.
The first step of dropping dulox was planned for next week.

OK - then as Hat has said - if this does not stop within 2 weeks, it will be time to go to the Doctor and re-think the medication. Hopefully it will clear in a few days...

 

Please let us know.

 

Wishing you well.

Hello everyone,

 

I stopped sertraline because of the breathing probs. The chest pressure was horrible and I felt like suffocating (don´t know if its translated correctly). After stopping this med (I took 3x 12,5mg) I had very hard nausea and headache for two days.

 

So my plan has changed ^^. I try to taper off duloxetine...with slow steps. It´s really necessary because of the eye side effects (disorder of accomodation, "mouches volantes", paralysis of eye muscles and so on)

 

enjoy your week :-)

Hi LeVana

I am glad you have stopped taking the Sertraline, so hopefully you will start to feel better.

I have had the same symptoms with breathing whilst on Cymbalta and it's got worse whilst I have been weaning off. Please be careful and do it slowly. Good luck with your taper.

Polly

Hi LeVana,

 

It sounds like you are doing the right thing by quiting - this does not sound right. As Polly said, reducing the Duloxetine needs to be done slowly. If you would like to discuss anything relating to how to do this, please let us know...

 

IUN

It will take a couple days for it to flush out of your system. It will be interesting to see what happens. Keep us posted.

Just for the record, I had to stop sert... I got the worst tinnitus within a few days and it was unbearable - this coming from a tinnitus sufferer already.. it was THAT bad.

 

That was another cold turkey error on my part. I took it for 10 days and stopped without taper and ended up in the ER with a load of pills in my hands. For sure wasn't me.... very scary times.