14 replies to this topic

[Junior]

aaaarrrrrrrrrrgggggggggghhhhhhhhhhhh
I was typing a long response and managed to lose it all


Hi Concerned Husband

The gist of what I was saying is that it is best to wean off one drug at a time. These drugs chemically alter the way the brain works and it needs to heal slowly. I am not a Dr but my recommendation would be to stabilise your wife on the 30mg of Cymbalta for at least 3 weeks before reducing the dose further. The general recommendation I've heard is to reduce by no more than 10% at a time and to wait 3-6 weeks for wdl symptoms to subside before reducing further.

I'd be disinclined to add Prozac to the mix. Your wife is already on quite a cocktail. Adding something more now will only prolong the healing process.

You might find this forum helpful http://www.paxilprog...display.php?f=7 they have a very sophisticated understanding of SSRI/SNRI withdrawal.

Hope that helps
Junior

[Junior]

Forgot to add that a talking therapist would be good right now. If your wife has GAD and social anxiety, those issues will still be there when she eventually gets off all this medication. CBT and other therapies can give her the tools to learn to live with them. This is probably more beneficial than medication although I must admit that I have depression and GAD and i'm still on 20mg of Aropax / Paxil as it has helped me enormously.

Good luck
Junior

[MaureenV]

Thanks, I'll check out that forum.

Cymbalta withdrawal is the most dangerous thing I've ever seen, while Prozac she's gotten off of before, comparatively easily, and presumably can again at a low dose. If it can make the Cymbalta process -any- safer then I'm all for it.

As for stabilization, she's been having a lot of troubles at 30 so far, and it's hard to tell what's withdrawal and what's 'side effects' (I have no idea what the main effects are even supposed to look like, through all of those). How can one tell if she's simply not stabilized yet or if this drug is just poison to her? If it's the latter, we simply don't have 3-6 weeks. It was a terror to behold at 60, even through all the valium.

It's very confusing that the withdrawal and ordinary bad effects of Cymbalta are so similar, except when the brain zaps are around.

I can't really add much because of the large number of drugs involved excecpt this:

1) After having to change from Lexapro due to severe nightmares, I changed to Cymbalta and had great difficulty getting off, thus finding this site. Realizing I still needed 'something' I suggested Prozac to my GP who was reluctant due to withdrawal problems.

When I commented that compared with Cymbalta I believed the percentage of people having a problem getting off Prozac was lower, and that not a single Cymbalta 'survivor' Prozac user had had a problem, she was happy for me to try. I started on only 5mg, and even at that dose felt startlingly awake, and had insomnia badly the first night, then less over the following week. (It wasn't an unpleasant insomnia, just not sleepy.) I've also had what I would call 'agitation', but at a low level. There was absolutely no anxiety or insomnia present when I started the prozac - I was actually sleeping quite soundly. This IS one of the noted side effects, so to be honest, if you add that to the mix, how on earth would you know what was causing what?

Those who've successfully added prozac (many people)have generally not been taking such a cocktail of drugs.

2. In Australia we have a professional 'consulting chemist' if you like, who actually goes through people's drugs and works out what all of the interactions etc are likely to be. I can't remember if this is a specialist doctor or specialist chemist. I found out about this via the husband of a friend who has type 2 diabetes plus heart and blood pressure stuff. Each specialist couldn't be sure whether or not it was 'their' drugs, or the drugs from another area which were causing the problem. It worked wonders for him, but they found out about it accidentally.

3. you sound concerneed that your doctor is 'following you', but unfortunately he doesn't have much choice: he can either pretend he knows what's good for her (which many do) or admit that he's flying blind (at least he's honest). At least you have someone who's prepared to work WITH you rather than just issue instructions. Perhaps you could ask him about the specialist who looks at all the drugs.

4. The brain zaps seem to be the big difference between side effects and withdrawal effects for MOST people on Cymbalta. That doesn't necessarily apply to your wife. Did she have any brain zaps AT ALL on the 60mg dose? If not, I'd use that as a guide as to whether the 30mg is the problem, or whether the problem is still not being stabilized on 30mg.

5. Those who are destined to suffer the most from Cymbalta withdrawal often find that the worst of the withdrawal symptoms don't even appear until nearly a week is up. It may just be co-incidence that you chose the 'hit the fan' day to take out seven beads. Don't get me wrong, I'm not saying seven beads don't matter; I made my final drop at 1mg, 9 beads, (after being stabilized on 1mg) and suffered (very mild) withdrawal symptoms for nearly three weeks. They were trivial (in comparison) but the point is, my body noticed the difference, but the other point is, it's also a matter of percentages. It's hard to imagine that the seven beads where what was causing today's problems given you were only 4 - 5 days out from a significant drop.

6. This is all conjecture, but I hope it helps.

regards, Maureen.



p.s. she's a lucky woman - you sound so supportive, whatever she says about your cleaning.

[Junior]

Thanks, I'll check out that forum.

Cymbalta withdrawal is the most dangerous thing I've ever seen, while Prozac she's gotten off of before, comparatively easily, and presumably can again at a low dose. If it can make the Cymbalta process -any- safer then I'm all for it.

As for stabilization, she's been having a lot of troubles at 30 so far, and it's hard to tell what's withdrawal and what's 'side effects' (I have no idea what the main effects are even supposed to look like, through all of those). How can one tell if she's simply not stabilized yet or if this drug is just poison to her? If it's the latter, we simply don't have 3-6 weeks. It was a terror to behold at 60, even through all the valium.

It's very confusing that the withdrawal and ordinary bad effects of Cymbalta are so similar, except when the brain zaps are around.

Prozac has a longer half life than most (all?) modern a/ds which is why it is the easiest of them all to get off. Of the SSRI's, Paxil seems to cause the most probs while both SNRIs (effexor and cymbalta) are difficult to get off.

In terms of stable v side effects, going on what info you've given me, it sounds like the weaning process has been too fast and that your wife is suffering wdl. The only way to tell for sure is to 'updose' and wait to see if the effects settle. Many have had to do this in the past so it is not a 'failure'. These are powerful drugs and one has to do what one has to do. If updosing works, it should only take a few days for things to settle.

Was 60mg the maximum dose your wife has been on? How long was she on that? What were the side effects? Sorry to ask a million questions but the more info I have, the better I can advise you.

Keep in touch
Junior

[Junior]

Paxil withdrawal I've seen too--for her it happens instantly, so we had trouble whenever she forgot a dose. Paxil was her first SSRI, before Celexa, and lasted a couple of years before pooping out. Cymbalta withdrawal seems to occur just as fast for her. We've never had delayed brain zaps or anything--they happen within hours of the dose change when they happen (which they did quite a bit at 60-to-40, and I think just a little at 40-to-30). I've been asking her about brain zaps frequently yesterday and today, since we started bead removal, but she hasn't had any in a long while. We made an attempt to take her from 30 to 20 last weekend that failed miserably but there were no brain zaps then either, just dangerously wild mood swings.

She was on 60 for just a couple days and the side effects were extreme akathisia: hostility, speediness, shortly thereafter despair etc. Exactly the same as withdrawal except no brain zaps, and same as the 30 mg side effects except much worse. She's only been on Cymbalta for about six weeks, during most of which we've been trying to reduce. She was upped to 60 at about a week in, if I remember right.

After previous downdoses that succeeded or, like last week's, that failed she seemed back to normal after 2-3 days of restored dose. Things seem to happen a little faster for her. I have suspicions that the side effects are themselves withdrawal, considering the short half life. Cymbalta's going to be looked back on as the Halcion of the '00s, isn't it.

Wellbutrin was no good for her either, but it was a breeze to come off it--the problem with Effexor and Cymbalta would seem to be their action on serotonin.

Hi Concerned Husband

Just one more question.. did your wife go straight from Celexa to Cymbalta? I'm asking because there could be a combination of withdrawal effects from that, and start up effects from the Cymbalta. Also, your wife might be like me and might not need the norepinephrine 'lift'.

Getting back to the up and downdosing... there is no doubt that dropping the dose of Cymbalta is causing a whole set of problems for your wife. For people as sensitive to this process as her, the only solution is to go VERY VERY slowly. I've heard of people reducing by 1mg a month. I know that means it is going to be a LONG LONG road, but it might be the best one.

To give you an idea - and I'm nowhere near as sensitive to this as some - I switched from Paxil to Lexapro a year ago.. stayed on that for @4 months but stopped it due to suicidal ideation among other things... switched to Cymbalta which messed up my sleep pattern and my GI tract.. went c/t from 60mg after only 19 days and suffered BAD wdl. I was forced to go back on 40mg of Paxil (my original dose) to stabilise. I'm now on 20mg and will stay at this dose for a while - my job future is unknown as i'm 5 months into a 6 month contract, so I don't want to mess with my medication until that is sorted - before reducing further. I'm stable but still suffer from the occasional bad night's sleep - like last night - where I wake every hour... so I'm not fully over the drama yet.

Some people find natural supplements very helpful. Some don't. Everyone is different. But it helps to speak to people on boards like this to get ideas and for support. Your wife is lucky to have someone as supportive as you.

Kind regards
Junior

[Junior]

Thank you, Junior. No, Celexa was out of my wife's system for three weeks or more before Cymbalta was started. Prozac, however, was not--I think we stopped her on that at about the same time we started Cymbalta. So there's probably still trace amounts of Prozac kicking around now, c. 6 weeks later. She definitely doesn't need a lift--she was never depressed. When not being kicked around by these drugs, anyway.

My wife has suicidal ideation on higher doses of Cymbalta (that at least is gone, at c. 30), but never had it from Paxil or Celexa until they started pooping out. Paxil and Celexa were remarkably good for her while they lasted--I hear some people liable to SSRI poopout just switch to a new one every 6-12 months?

Best of luck getting off 20 mg, and well done reducing to the point where you just have occasional insomnia. What was your side effect profile like at 30?

And do you happen to know whether people whose brain chemistry rejects Cymbalta commonly have trouble with Lexapro also? I.e. is that a common theme you've heard, or does it seem random?

Hi again

It is not the time it takes for an a/d to be out the system that is the issue - as many drs mistakenly believe - it is how long it takes for the brain to return to its pre-med way of functioning. Switching - as I found out - only confuses the brain / issue.

In terms of SNRI's (effexor and cymbalta) v SSRI's (paxil, prozac, celexa, lexapro)- it varies widely. My personal belief is that some do better on an SNRI while others are better off on an SSRI but there are differences even within the same class of drugs. Lexapro basically sent me nuts (!) while I respond really well to Paxil. The bottom line is that everyone's neurochemistry is a little different and that trial and error is really the only way to find out what works. I know someone who tried several different a/ds - including an old MAO - before settling on Prozac.

My concern for your wife is - much like Tracy has said - that there is layering. That Celexa made certain changes which were still in the process of being undone when she was put on Cymbalta. Tracy is also right in that benzodiazepines like Valium, usually work on the dopamine production .. so by taking Cymbalta and Valium, serotonin, norepinephrine and dopamine are all being chemically altered. (Interestingly, these are the three most implicated in mental illness). On top of this, because of the changes the drugs are making, the brain is trying to find the 'right' levels of other neurotransmitters in order to find its new equilibrium.

It really is best to wean off ONE drug at a time. Several people have said to get off a/ds first as the benzo wdl is harder. As I've said before, it is not going to be an easy road for you and your wife but it is the best one if you want to get her well. Talk therapy can also be useful, even now. It will certainly be beneficial when she begins to heal and she will need the psychological tools to cope without medication.

Kind Regards
Junior

[Junior]

Your welcome 'hubby'

Unfortunately there is no right or wrong way when it comes to tapering off medications. It is often a case of trial and error. I know that Cymbalta is proving to be one of the harder a/ds to come off.

I don't really know how to guide you here, I'm sorry. The info I've given you is what I've heard elsewhere. I think I told you about the Paxil Progress forum? Maybe ask them. Their moderators have a more sophisticated understanding (from a few years of being mods) than I do.

If you do decide to stop at 20mg of Cymbalta, just make sure your wife is stable before tackling the valium issue. That might mean waiting a couple of months. I know that is frustrating for both of you but you have to keep thinking of the long-term.

With the Celexa and tolerance, some people find they can go back on their old med successfully, others find it no longer works for them. Again, it's trial and error. I'm currently on my original med (Paxil) but I know it's not working as well as in the past. I'm at 20mg and I plan to stay there for a while because my long-term job future is uncertain (although I just found out I will be there for at least another 8 weeks - was originally on a 6 month contract) and I don't want to mess too much if I'm going to be looking for another job.

Keep in touch
Junior

[Junior]

PS - 8 days on a reduced dose is not long. The depressive symptoms may well have passed if you'd waited. They might not have either - but remember,the brain takes time to readjust to being without its previous level of medication. Depressive symptoms are common and often pass.

For the record, I find I don't notice anything for 2-3 weeks when I do a drop.

[MaureenV]

Thank you again for your advice, Junior.

Since this thread opened she was put onto 20 mg Prozac. At the same time we removed 7 beads a day for 8 days (so, down to 30 mg minus 56 beads), during which she was doing quite well, but then some depression symptoms crept back in. We reinstated her at 30 mg minus 49 beads (25 mg, basically) and have had her on that for a few days. She's still rocky, but there have been some stressful events happening. I haven't seen anything as bad as during the large dosage drops so far.

I'm anxious to get this process going again so we can then address the Valium. The Prozac we might ultimately stay with, though personally I'd like to try Celexa again. It worked so well until tolerance built.

Do you think there might be something to halting at 20 mg--assuming we can even reach that--and switching to tapering her off of Valium?

If I can stick my bib in ... Given the range of drugs you're dealing with, wouldn't it be better to do a little drop of no more than 10% then hold that dose until all side effects have passed? The way it's being done now, given the way Cymbalta withdrawal effects hit different people at different times, means you don't know which actual dose reduction is causing the problem. The first one? The last one?

It's because you don't know which dose reduction is triggering the problems you may have to start again at 30mg.

The advantage of doing drop/stop is that you very quickly get an indication of how quickly the withdrawal effects kick in for that person and how long it takes for the withdrawal effects to pass for that person.

regards, Maureen.

[Junior]

I see what you're saying. Should one drop by 10% of the original dose (60 mg, so 6) or of the present one (25 mg, so 2.5), by the way?

And how much clearance should one give, after all withdrawal symptoms seem to be gone, before trying to drop again? A couple days?

She's had two problem days recently, today included, on both of which she woke 2-3 hours later than normal and therefore took the drugs a bit later, so I wasn't sure if it might be that instead of withdrawal.

And thank you, Maureen! I'm finding this input crucial. I feel completely helpless when her eyes go a certain way and I know we're going to have another Cymbalta night.

I understand the 10% drop should be taken from the current dose, not the original one.

I think the recommended time of stability before dropping again is about a week. Not 100% sure though.

With taking the drug later, who knows? Some people are extremely sensitive to things like that. I never had a problem when I missed a dose of Paxil but many people do.

[MaureenV]

I understand the 10% drop should be taken from the current dose, not the original one.

I think the recommended time of stability before dropping again is about a week. Not 100% sure though.

With taking the drug later, who knows? Some people are extremely sensitive to things like that. I never had a problem when I missed a dose of Paxil but many people do.

I'll second Junior on that one. From my experience, the dose drop is related to the CURRENT dose, not the original dose. You may well get the same withdrawal effects dropping from 6mg to 5mg, as you do going from 60mg to 50mg. I say MAY, because it's all so individual.

Because my withdrawal was relatively simple (no other anti-d, anxiety or sleeping drugs at all) I did my next drop within a day of the symptoms disappearing, because for me it was quite consistent.

Because you can get 20mg capsules in the US, it may be worthwhile taking a longer pause at that point (at least a week) just to be sure that she's o.k. to do the next drop.

Glad all of our experiences can be of assistance!


regards, Maureen.

[Junior]

My wife's withdrawal is too severe and I need to reinstate a higher dose, but I don't know how much higher to go. Is there any firm guideline on this? Alternatively, are there any specific names of knowledgable paxilprogress people that you recall?

Yes, Scotty and L. Crawford are both very good. But you will find that many there have a wealth of information, borne from a variety of experiences.

With reinstating, you might need to updose 2-3 times before you find the right dose but your wife shouldn't need any higher a dose than what she was on before. Just be wary of updosing in large doses as it can bring further problems. I find that out the hard way as I increased my Paxil from 20mg to 40mg in one go (I was desperate for sleep!) and it sensitised my nervous system, to the point where it felt jittery. It settled but in hindsight I realise I should have gone from 20 to 30 and then to 40.

Regards
Junior

[DonnaBS]

Hi Concerned husband, I too am a concerned spouse. My husband was on cymbalta for 6 months and has been on depression medication for about 2 years now. He has been very strange on this depression medicine and all of a sudden got very distant, no longer wanted to have sex, had no sex drive whatso ever, started sleeping on the sofa and has this weird distant look about him. Last weekend he stopped taking cymbalta and got so angry at me - He was so mean and told me he wanted me to stay away from him and didnt love me in 5 years ever since we built and moved into our dream home. I dont believe it because we had great years here but he fell into depression after an incident with a neighbor accusing him of hitting him and he was so hurt and had to fight it in court. All the other neighbors were so supportive of him but it just did something to his head. He started seeing a psychiatrist and then lost his sex drive. He told me that he was only here for the kids which is so weird because he never spends any time with them either. I have been compassionate and helpful for all this time but it is wearing me down. I dont know if it is the withdrawl from cymbalta or what has happened to him. He is so angry and that he really seems to hate me for trying to help me at this stage. I dont know what to do - I really dont - I do not recognize this man at all anymore. What has happened to him? He wont wean off the cymbalta , I called his psy yesterday and he was very unhelpful - He dismissed me and told me that Chris would have to call him himself. He wont call him and says he doesnt want to. I asked him today if he wanted me to go get him his medication and he was so angry and said No he doesnt want anything. What will I do? He is on a rampage and looking for apartments and when I told him that he is blaming me he gets so angry. I remember he used to turn angry like this when he was drinking and he has been a recovering alcoholic for about 7 years now. This is my husband of 19 years. I think maybe I am the one who is going mad because I keep quesitoning myself and questioning whether this is really him or the cymbalta. SOmeone please help.

[hothelen]

Hi, Junior!

I was at prozac for 3 years, started from 20mg, after year it was 40mg. I have nightmares and panic attacks from that drug. But my doctor not give me replacement. I posted my prozac review with my side effects of that drug.

Is anyone know any natural replacement to prozac? Is St John Wort work well or not? I listen what it not enough strong.

Best Regards,
Helen

[happyzapynot]

Hi, Junior!

I was at prozac for 3 years, started from 20mg, after year it was 40mg. I have nightmares and panic attacks from that drug. But my doctor not give me replacement. I posted my prozac review with my side effects of that drug.

Is anyone know any natural replacement to prozac? Is St John Wort work well or not? I listen what it not enough strong.

Best Regards,
Helen

Helen, St. JohnsWort alone may not be enough. Check out the product below. I'm not endorsing it because I have't tried it yet.
http://www.nativerem...tml#ingredients