New To Forums, Preparing Wean For The Second Time

I have been taking 60mg Cymbalta for depression for over 10 years and have wanted to wean from it for about a year. I also take 50 mg Trazodone for help with sleep issues (waking up every hour or two during the night), which helps that. My reasons for wanting to wean from the C are as noted.

• Feel emotionless
• I've had ringing in my ears & shortness of breath with no explanation after pulmonary & heart issues were ruled out.
• I have difficulty remembering things.
• Feel like I'm in a fog most of the time.

I tried unsuccessfully about a year ago, but partially because I learned that my provider PNC (psychiatric nurse practitioner) was not in-network (even though I was told that they were) so my out of pocket would have been very high. His recommendation for weaning was to decrease as noted below:

• Decrease to 50 mg (1 20mg tablet & 1 30mg tablet) (I can't remember for how long each time (maybe 3 weeks), but whole process was less than 3 months.)
• Then to 40 mg (2 20mg tablets)
• Then to 30 mg
• Then to 20 mg
• Then stop the C

At some point during the above, I was to add 20 mg Prozac

I believe the difficulty began when I stopped taking the C and was so miserable that I decided it was better to continue with the C given that I had to find a new provider. I'm now seeing 2nd new provider because the other one quit the practice. I turned 65 years old and now have Medicare so the original provider may be in-network now.

I have been doing research over the last few days and am trying to figure out the best approach for weaning. I have an appointment with my PCP tomorrow Thursday, June 28 and psychiatric nurse practitioner on Friday, June 5th. Below are some of my questions.

• Do I continue with my current provider (not sure what her take on weaning might be, but plan to discuss it with her)?
• If she's not had experience/amenable to working with me, should I return to the original PNP? I've only seen her once and saw the other PNP twice, given that we recently became full time residents of Arizona.
• Do I wean as noted above, count beads (sounds painful) or count beads when I get to a lower dose?
• If I plan to travel for about 3 months over the summer (triple digit temps here already), should I wait until I come back to start the process?
• I read a post and there was something about an ebook, which I couldn't find. Any suggestions?
• Should I be concerned about another depressive episode after weaning? If so, are there any safe anti depressive medication?

I've discussed this with my family and friends who will be my main support system, and they are very supportive. 

Thanks in advance for your reply.

Welcome taretha

many people have no issue weaning off the Cymbalta at all (lucky people) But other have a terrible time. Normally we recommend bead counting. If you open one of your capsules you will find around 300 small beads of Cymbalta inside, I normally recommend to remove 1 to 3 additional beads a day with pauses whenever symptoms hit. This can take 3 to 8 months or more to wean. I would strongly recommend a look at our ebook (first thread under Medical Support section. It includes detailed descriptions of how to bead count, medical research, what members have tried and much more. The idea in weaning very slowly is to reduce the severity of the emotional episodes during weaning but yes you can expect some depressive episodes if that is what you experienced before. I weaned off over a 3 month period and had 9months of severe withdrawal before I started to feel better, If I had it to do over I would wean off over a 1 or 2 year period.

I would wait until you come back from your trip before starting because once the symptoms start they tend to last and also high temps would add additional stress to a weary body if it was in withdrawal.

P.S. There is no such thing as a safe antidepressant, Oh how I wish there was. Serotonin is used throughout our body in nearly all systems. Anything that would control the serotonin would have significant effects on all systems.

Thank you for your response. 

Regarding my travel, the high temps are the reason we leave this area for the summer. Does that change your opinion about the time frame for starting the process?

I did not see a Medical Support Section. Can you be more specific about where I might find it. I'm relatively computer literate, but for some reason having trouble finding the book.

Thanks again.

Welcome Taretha...

Hat has covered the bases here and agree totally - particularly with the waiting for your return to begin the drop. Whilst the early days are usually the better, there is unfortunately no knowing, so a few weeks will do no harm to bide your time while you can enjoy your break.

Regarding the bead count, as I often say to many you need to be aware of the difference one bead can make when you are at different points in your taper. One bead when you have 100 of the little buggers is a mere 1% drop, but when you get to 10 beads, it becomes a 10% drop... and then 2 is a 50% drop, and this is why we always say to put the brakes on as you get closer to day zero. Often users will reduce quite happily to between 30-50% of their original dose before counting beads, but if you have the opportunity to do so, slower will always make things easier.

Hope you find the eBook useful - which reminds me, I need to finish off the bi-annual update!

IUN

I started reading the book and find it helpful. I also counted the beads in 1 of my 60 mg capsules. There were 610 beads. Yowsa, that’s a lotta beads to count.

Any thoughts on the following?

1. Using a scale vs counting beads?
2. Appropriate reduction amount/% and for how long does one stay at that level until the next reduction?

I’m determined to do this and want to do it with knowledge to support my goal so I appreciate the support and knowledge of this group..

Weighting or counting/that is the question indeed. There is a detailed description about this in the ebook. At the higher doses it normally does not matter. Once you get down to the lower dose...well that is a different situation. A reasonably priced scale has a hard time weighting 5 or 6 beads but if you go to bead counting there is variation in size of the beads to consider. Your guess is as good as ours on which is better. Read that section in the ebook and see what you think. I believe that the update to the book that IUN is currently working on has some additional information in it as well.

Hi Taretha!

Wanted to welcome you as well. I said this to another member and want to say it again, I'm always so pleased to see people find this forum BEFORE or at least during their taper so they are able to be armed with sufficient information on what to expect. Like FH said some people get off these drugs without any problem, a lot of people have some issues but not for too long, and then there are some of us who have a miserable and very long recovery for whatever reason. Unfortunately because the third scenario is rarer, it feels like a lot of doctors have no experience with prolonged withdrawal. 

For the reduction, the ebook recommends taking a few extra beads out every day. But I think what's hard about that is that since the capsules have somewhat varying amounts of beads, you wouldn't know how much to take out of each one. So ideally you'd want to open a few capsules, count the beads and figure out what the average number is, and then REFILL each capsule with that amount MINUS however many beads. This is a Sisyphean task tbh especially if you have 600 beads to deal with so I feel like weighing is probably ok from 60 to 30mg unless you're super sensitive (you'll probably find out if you are very quickly). You could maybe try a 10% reduction for your taper and hold for a week and see how that goes. When you start seeing stronger withdrawal symptoms that are bothersome you could slow down to maybe like 5% reductions from there. And then maybe around the 20 or 15mg mark you can switch to bead counting so you can do things even slower if you need to? 

Also regardless of which doctor you decide to go with, you should always remember you can get a second opinion on this forum. I've asked FH and IUN a billion questions over the course of my recovery from a nasty withdrawal. They've both seen a lot of people come through this forum with all sorts of stories. 

• Bead Counting

The third choice, bead counting, is where you open the cymbalta capsule each day and remove a few beads, usually 2 or 3 (1%). So the first day you remove 3 beads, the next day 6 beads, the next 9 beads etc. This provides for a slow steady withdrawal. If symptoms get to bad you just hold at that dosage for a while until you stabilize. Then start dropping again. Be aware that for most the last few beads give the worse withdrawal. Be prepared to slow down when you get to the very end. Now this is just an example. Some can only remove 1 bead a day and others 7 or 8 beads a day. You will have to play with it a little bit to find what works for you. This doesn't mean you won't have withdrawal but it will be lighter and you will have some control over it.

Scuffy1209 - Just wanted to reiterate really helpful info i found on a forum here -- I discovered that Lupin brand generic cymbalta is actually filled wtih tiny 5mg minipills instead of hundreds of little grains of "cymablta sand"

Maybeceejay - My 30mg capsule had 56 beads, and my 60mg capsule had roughly 88 beads (some flew away and I think I lost count once). my box of 60mgs are Tixol and my box of 30mgs are Cymbalta. For those that don't know Andepra AN is the name for Cymbalta in Australia.

mamma1st - The manufacturer of her current bottle is Ajanta Pharma. I opened up one of the capsules earlier and there were 70 beads inside.

Ayla65 - Mum's Cymgen here in South Africa come in capsules (blue and green) and have 569 tiny white balls (of poison) in each capsule.

Gardenlady - I counted beads in my Teva brand 60 mg capsules and they all had varying numbers. The average was 315 beads.

Noush - There are 50 ish beads less in the capsules I got this month, than the ones that I got last month! If I wasn't bead counting, to make sure my beads stay the same, I would've dropped 50 beads (approx 8mg) in one go, without even knowing it!

FH - Eli Lilley had 6 different manufacturing facilities the last time I researched it. Each facility must follow the patent but it only specifies a range of sizes so some facilities produce smaller beads than others.

FH - This is the first time I have seen such a large variation in bead count with the same manufacturer but what concerns me is how often does this happen? Is it just a matter that one batch comes from one facility and the next batch comes from a different facility OR does the number of beads differ from one day to the next. When I talked to Eli Lilly a couple of years ago they said they fill the capsules by weight. That is fine BUT we know some beads in the capsule will be slightly smaller than others. Larger beads will have more medicine per mg of bead because size of the bead is geometric in relation to weight.

Tips

KFL -Someone told me that they put their beads in the freezer and that stopped static cling, but do that after opening the capsules and putting the beads in a different container. I found that the capsules were difficult to open if they had been stored in the freezer.

FH - I personally agree with your decision to take 1/2 the dose in the AM and 1/2 in the PM to keep a stable blood serum level.

You have already tried 1 bead a day so I would recommend going to 1 bead a week for one week and if no symptoms then 1 bead every 3 days for a week, then 1 bead every 2 days for a week until you find her limit and then back off a little. Also the last 5 mg is by far the hardest so plan on 1 bead a week or even less if she is sensitive to the withdrawal.

Juli - Put the pills on a black t-shirt and use a toothpick to separate into piles of ten.

https://www.ncbi.nlm...pubmed/30850328

Tapering of SSRI treatment to mitigate withdrawal symptoms.

Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms. Other types of medication associated with withdrawal, such as benzodiazepenes, are tapered to reduce their biological effect at receptors by fixed amounts to minimise withdrawal symptoms. These dose reductions are done with exponential tapering programmes that reach very small doses. This method could have relevance for tapering of SSRIs. We examined the PET imaging data of serotonin transporter occupancy by SSRIs and found that hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums, in line with tapering regimens for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised.

How long to stabilize after updosing?

The following research shows how fast the body responds to reinstating a ssri/snri shortly after withdrawal.

https://www.ncbi.nlm...pubmed/10958258

The SSRI discontinuation syndrome.

SSRI reinstatement leads to resolution within 48 h.

https://www.ncbi.nlm...pubmed/12008858

Selective serotonin reuptake inhibitor discontinuation syndrome: a review.

These self-limiting symptoms resolve on reintroduction of the drug and cannot be explained as a remanifestation of the original disorder.

https://www.ncbi.nlm...pubmed/11347722

Antidepressant discontinuation syndromes.

Severe cases can be treated symptomatically or the antidepressant can be reinstated before being gradually withdrawn. Reinstatement usually leads to symptom resolution within 24 hours. Some individuals require very conservative tapering schedules to prevent the re-emergence of symptoms.

FH - We recently had a discussion on one of the threads the other day about how long to stabilize after updosing. The following research shows how fast the body responds to reinstating a ssri/snri shortly after withdrawal.

Eli Lilley Patent Information on the manufacturing of Cymbalta.

https://patentimages...1/US5508276.pdf

1996 patient of Cymbalta pellets by Eli Lilley.

This document is a very detailed description of how Eli Lilley makes the little "pellets" (what we call beads).

Clarification - In this patent it states that Eli Lilley uses small "beads" of starch and sucrose for the center of each pellet. The pellet id then coated with Cymbalta and then enteric coating. What Eli Lilley calls a pellet is what we refer tp as a bead.

"A preferred core for the pellet is prepared by applying a duloxetine-containing layer to an inert bead. Such inert beads are conventionally used in pharmaceutical science, and are readily purchased in all industrial countries. The most preferred bead is one prepared from starch and sucrose, for use in confectionery as well as in pharmaceutical manufacturing."

"In general, pellets can be as small as 0.1 mm, or as large as 2 mm. Preferred beads are from about 0.3 to about 0.8 mm, in order to provide finished pellets in the desired preferred size range of from about 0.5 to about 1.5 mm in diameter."

Note - So this means that some beads are 3 times bigger than other beads.

This is the section from the eBook Hat was speaking about (and is the up-to-date version). Have a read....

IUN

What is going on again?  Has the server been changed?

I no longer receive any posts from this forum anywhere...

Liz

Not been changed as far as I am aware, but Ken has made other changes here and there, but for the better...

No idea why you are not getting notifications though - are you getting notifications about messages or new topics?

I am getting no notifications whatever - a few months back they were all going to Spam but now I get nothing at all.

What's up??

Liz