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Weaning of Cymbalta & Replacing


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#1 s.r.

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Posted 02 July 2008 - 03:45 PM

Hello All,

I've posted in another area regarding my Cymbalta withdrawal disaster and in doing so came to the realization that there's a scenario, which allows for the vast reduction of withdrawal symptoms. Please keep in mind my experience was unique to me, my situation, and the specifics detailed below, but if you find yourself in a similar one this could be a great help. Talk to your Dr. Oh, and when I say Dr. I mean psychiatrist. I am extremely uneasy w/ the practice of GPs, etc. prescribing psychiatric meds. I you have psychiatric issues go to a psychiatrist. Don't like the one you went to, go to another, and do so until you find someone you do! Exception being Cymbalta prsecribed for the treatment of other illnesses and then go to a specialist in that field.

Specifics for me are Bipolar Type II. Additionally, GAD (generalized anxiety disorder). I take Lamictal for mood stabilizer and the Cymbalta (120mg) for anxiety and depressive episodes.

In 12/06 I was switching from Effexor XR to Cymbalta. From what I understand they're both of the SNRI class. In my case the Effexor XR had to be replaced like for like. Changes in what was considered "nonformulary" medication by my health insurance company, and thus covered at a much higher copay tier, was the impetus for the change!!! :evil:

Why my Cymbalta isn't being replaced is something I'm working on w/ the Dr., but I can tell you I think it's the major difference this time and a big mistake.

Here's the dosage schedule I followed:

Daily Effexor XR dosage was 300mg. (2- 150 mg capsules taken in the morning) Take my SNRI in the morning. Had been taking Effexor XR in some form and dose since around 1994ish.

Week 1: Effexor XR - 300mg / Cymbalta 30mg

Week 2: Effexor XR - 225mg / Cymbalta 60mg

Week 3: Effexor XR - 150mg / Cymbalta 60mg

Week 4: Effexor XR - 75mg / Cymbalta 60mg

Week 5: Effexor XR - discontinued / Cymbalta 60mg

Week 6: Cymbalta 90mg

Additionally, I had the option to add 37.5 mg of Effexor XR to my daily dosage if the drop from one week to the next was too great, but didn't need to.

My Cymbalta dosage reached 120 mg. Although, I can't say at what period of time after the 7th week. I do know I've been taking that amount for at least 1 year).

I don't recall and can't find having written anything down about bad withdrawals or found a bookmark on my browser along the lines of EffexorXRwithdrawals.com. I'm sure I experienced some symptoms, but for sure I didn't have withdrawal symptoms of the severity I'm having now. I can't claim none at all as I can't remember. I'd probably have to have my Dr. check my chart. But as I mentioned above not replacing it w/ another SNRI/antidepressant seems to have been the key to withdrawals developing.

For those of us that have to replace an SNRI w/ another (or very possibly another class of antidepressant) the slow decrease of one and the low dosage introduction and gradual increase of other is a very good idea.


Having researched Cymbalta recently I did notice in the Eli Lily medication info (http://www.cymbalta.com) it does very clearly report that doses above 60mg showed no increaed efficacy in treatment. Does make me wonder why I was taking the amount I was.

If you were taking above 60mg and definitely 120mg per day like me, could you reply to my post and also include the illness Cymbalta was being used to treat.

Thanks

#2 schmb01

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Posted 02 July 2008 - 09:37 PM

I too switched from Effexor XR to Cymbalta, because I began experiencing withdrawal symptoms, brain zaps, while taking Effexor. I was switched straight over to Cymbalta mg for mg. I have mild depression and a chronic medical condition called intracranial hypertension, so I have severe headaches, neck and shoulder pain. Initially, for about 9 months, the brain zaps stopped, but then started again, so my dose was upped to 90 mg. I took that for about 3 months, and then realized that my depression worsened considerably, I had no relief from the pain at all while on Cymbalta, and I was basically becoming house bound. That was when I decided to stop taking it.

#3 s.r.

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Posted 03 July 2008 - 01:31 PM

Thanks for your reply.

So I understand; you experienced Cymbalta-like withdrawal symptoms while on Effexor XR including, but not limited to "brain zaps"? When you switched from Effexor XR to Cymbalta you just switched; one day Effexor XR the next day Cymbalta at the same dosage, correct? Did you have any withdrawal or symptoms doing it that way?

When you say you stopped taking Cymbalta you just stopped cold from 90 mg? Any withdrawal? Is so, what did you experience?

#4 kimbers

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Posted 03 July 2008 - 05:01 PM

Hi all,

I have been taking Cymbalta and Lithium for many years now (been taking differend med's for 11 years e.g. Prozac, Effexor XL, etc). I have decided to come aff all my med's as my husband and I want to try for a child and I would prefer to be completely free of medication. I am very annoyed with my psych. as I am only now down to a quarter of my lithium (was on 800mg, now on 200) and am doing very well. :D

But today he said he didnt want to see me any more and I can go it alone, I can go to my GP if I need any help or advice. I have yet to come off lithium completely then face coming off Cymbalta with no help at all (remembering here I have been seeing him and on medication for 11 years). I am taking 120 of Cymbalta and as he didnt give me any advice etc, on what to expect coming off Cymbalta I decided to look it up, the reason for which I am on this site now.

;) I am totally devistated at what I have been reading. So far 95% of what I have read on people coming off this medication is REALLY BAD. I am actually getting freightened now. I really want to do this but now am dreading what might happen. I have been (and so has my husband and family) really proud of me so far, I have been doing so good. I am 28 years old and before now never saw a future without medication. However, I am determined to at least try it not just for the sake of a child (that I wish to have :D ) but for myself too as I feel I have come through so much in the last few years. The last thing I want to do is go back on medication because I cant cope with the withdrawl symptions. I cant imagine having to pop happy pills in the morning not because I need the help but because I cant come off them.

I think its an absolute disgrace that my doctor didnt warn me about this. Actually its an absolute disgrace that my psych. has treated me this way im so shocked and angry, I kind of feel abandoned. I know im not alone and my family have been a great support, but for feck sake if you cant do or dont like your job, then get another one - life's too short - MY LIFE'S TOO SHORT!!!!!!!!!!! :evil:

Sorry for going on but im anxious, scared and worried now. If anyone can advise me on what step I should take next I would be grateful of your input. Remembering I will and have been doing all I can up until now to fight the fight, Im winning so far and not intending to loose (but I am also a realist and know that I might).

Good luck to all of you in the same boat or even similar

Kimbers xx

#5 Laurie

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Posted 03 July 2008 - 06:26 PM

Kimbers - my first concern is that it appears your psychiatrist has discharged you - what is the reason behind that? If this is the case, he must, by law, provide emergency care to you for the next 30 days until you are able to establish care with another provider, otherwise it's abandonment. I wouldn't "go it alone" or rely on a GP or even an Internist - they are not educated enough about these medications. Secondly, if you and your husband are considering having children, make an appointment with the OB/GYN you are going to be establishing care with, take a list of your medications with you, and discuss the risks, etc. of becoming pregnant while on these meds. He/She has a vast knowledge of what is safe and what is not. I work in a large OB/GYN practice and we see these patients all the time. You can be on certain medications for depression and other ailments while pregnant and they can monitor you during the pregnancy. I really urge you to set up an appointment. We call them "pre-conception" appointments, and patients are encouraged to come with a list of questions to these appointments, as well as their meds and any concerns they may have about meds they've taken in the past. I'm sorry you're going through this, and I hope you find the answers you need soon.

#6 s.r.

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Posted 03 July 2008 - 06:36 PM

Kimbers,
I'm blown away by your psychiatrists attitude.
First thing I'd say is get a new psychiatrist, one you can work w/. The other sounds like a complete disgrace. Don't forget you always have the right to file a complaint w/ your state's medical board of examiners and other licensing agencies.

If you live in a metropolitan there'll be many to choose from and if you don't have to have a referral to see a specialist, even better. Shop around. As far as I'm concerned when I go to any Dr. first time, I'm evaluating them as much as they're evaluating my medical situation. Don't like them, don't go back. Empower yourself.

Also, thought for your specific situation you might go at it by looking for an OB/GYN who specializes in dealing w/ situations like yours. You'll need one anyway so why not one who can treat both.

Look for local resources that rate Drs. Check out professional medical organizations and see whose names come up for your area. Ask people you know for references. Take your insurance's list of covered providers (psychiatrists and OB/GYN) and research each of them for areas of specialization. Can't find anyone close by, then expand your search area.

Great to hear you family is supportive, now a supportive, qualified, experienced Dr. is what's needed.

To speak specifically to your Cymbalta withdrawal concerns, of which are legitimate, I like everyone else here is really looking for answers. One good idea I would've like to have known about when I started to taper off came from a link Greybeard posted.
http://www.antidepre...s.com/taper.htm
Hope the link works right. I've never posted one before.
In this article the author describes lowering the SSRI (Cymabalt's a SNRI, but the same may apply) far more slowly than I would imagine any of us on this site have or did. Worth a try knowing how we did didn't work.

I'd be interested to know how many people discontinue Cymbalta w/o the withdrawal symptoms we've experienced. Hard to get a complete picture of the situation.

Hope something in here gives some help to you.

Oh, and if you're talking to a Dr. you're considering, for God's sake shoot straight and tell them about these concerns regarding Cymbalta & others and if the Dr. says they've never heard of this happening I'd run a FECKIN' mile!!!!!!!


FYI- My diagnosis Bi Polar Type II. I take Lamictal 200mg, for a mood stabilizer.



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