7 replies to this topic

[agrace]

I’ll give background as quickly as possible - five yrs ago my MIL died suddenly of a massive stroke. She and my husband were very close, he took it very hard, but internalized all emotion, which was completely out of character for him - usually very emotive. About six months later we moved to a different state (to be closer to his dad) and he started a very high pressure sales job. About six months after that he started to have outbursts of anger, overreactions etc, enough to cause me to comment and worry that all the internalization was coming out other ways. He wouldn’t talk about her and if he did, he’d get very emotional and cut off the conversation as quickly as possible.

About six months after this started, he had a couple of blinding headaches, bad enough to cause him to seek emergent care. The doc found his blood pressure was sky high, and prescribed a med for it, also diagnosed him with anxiety and gave him a prescription for Zoloft and two weeks’ scrip for xanax.

Several months after that, he switched to a primary doc who continued the Zoloft and blood pressure med, until my husband complained that the Zoloft made him sleepless, after which he switched him to wellbutrin. The anxiety didn’t get better, only got worse, and my beer a night never drunk husband began also to drink bourbon in secret - over time it became a big issue between us.

This went on for a couple years, fast forward to last January or so, when the anxiety (his job pressure had also gotten increasingly worse over time) hit a point where I said, whoa, we need to talk to your doc about this. We went in together, described all the symptoms (anxiety, sleeplessness, agitation, overreactions, racing thoughts, inability to concentrate etc) and his doc promptly called it bipolar 2.

At first it was a great relief - we finally had some answers. He was switched from the Wellbutrin to Effexor, about which we knew NOTHING. First at 37.5 mg - the second night after starting it he was acting a bit odd - baring teeth, wild eyed etc, so we (my parents were there at the time) put him to bed and blamed it on mania. We knew so little, sigh. That was mid Feb of this year. So fast forward a couple weeks to his third dose increase to 150 mg when he had an episode I can only describe as psychotic - eyes rolling back, total loss of equilibrium, motor skills sluggish, banging head against wall, crying, rage, and memory loss of about an hour. We returned to the primary the next day, who was alarmed, pulled him back to 75 mg, added a mood stabilizer (after I read to HIM from the Effexor insert that for bipolar, antidepressants should always be prescribed with one!) and referred him to a pdoc.

Couple weeks later, he saw the pdoc for the first time, who confirmed the diagnosis, called him a rapid cycler, switched from Effexor to Cymbalta 60 mg, added back the wellbutrin at 300 mg, and gave him Seroquel.

Thus began two months of hell, during which he reacted poorly (physically, emotionally, sometimes psychotically) to every single prescribed drug - Risperdal, Seroquel, Lamictal, Depakote, plus the ongoing ADs, til finally the pdoc suggested lithium. Having read of the high maintenance needed for it, we both went whoa! Let’s talk about this a little more. In the meantime, during all this craziness, usually after I had coaxed/poured my poor altered husband into bed, I started reading all about ADs and how they can actually cause mania and anxiety and insomnia etc, and I began to wonder if maybe the ADs were causing the problem in the first place, or at least largely contributing. I also read that for bipolar diagnosis, the DSMIV requires that an episode of mania or hypomania be observed WITHOUT the presence of any meds, otherwise it might be a case of substance -induced mood disorder. This never happened for my husband - he was diagnosed while on Wellbutrin. We began to doubt the diagnosis then too.

We took all kinds of info to the pdoc - peer journal stuff, FDA stuff, about the adverse affects of ADs, to ask him about maybe stopping the ADs to see what might happen and he scoffed completely - called me a first year med student trying to treat my husband, told me that there is NO WAY the ADs could be causing all of it, that the episode with the Effexor was just mania, that I was in denial about my husband’s diagnosis (like I hadn’t embraced it from day one, thankful to have an answer), that I should basically get out of the way and let him do his job, that he didn't need to know my husband's whole history to diagnose him, and that he had been on the consulting board for Eli Lilly (GIANT red flag), therefore he knows exactly what it can and can’t do, and in fact, that all the stuff they put in inserts is bull - if it happened to a lab animal, it got put in there, but not because it actually can do those same bad things to people. He actually said we should ignore the bad side effects listed and just believe the good things. I kid you not - he said just that. I asked for clarification - he meant it.

So needless to say we were done with him. My husband asked what he should do to go off it and he said, just take your regular dose every other day and be done. Yeah right! Thankfully we had also been reading about weaning and knew better.

So that was at the end of May. For the next six weeks, my husband cut down on both ADs and finished the cymbalta first, hoping that the lingering wellbutrin would help to get over the worse drug. About a week in he started having the brain zaps, bad enough that he thought he might fall down. He got used to them though, and other withdrawal symptoms included profuse sweating, exhaustion, sleeplessness, tremors, violent nightmares etc. This happy package continued for about a month. In the meantime, he went to another pdoc who threw the bp diagnosis out - said he didn’t see depression at all and said also that SSRIs/ SNRIs aren’t good for some people and CAN cause all of the things he’d been experiencing. Rather, he thinks my husband has GAD and prescribed Remeron, and told him to just stop taking the wellbutrin, which at that point was down to 150 every third day.

I balked at the Remeron (I'm thinking, please no! Not another drug!) and it was weeks before he actually filled it - has been taking a very small dose for a week now. But I get ahead of myself. After that, he had two weeks where he felt good, and even said that he felt better than he’d felt in a couple years - he was sleeping better, no anxiety attacks, no agitation etc. Even the evil job was gone (he lost his job at the beginning of May - blessing in disguise as it turns out) and so were the brain zaps et al.

Then about 3 weeks ago - and this is the point of my post, finally - he started having issues again, but it was different and might I say worse. Sudden onset of slurred speech, altered face, sluggish motor skills, rage and/or crying jags, lashing out at me and our kids, confusion, altered perception of things around him, then crashing for hours, often waking up with little to no memory of the events preceding the crash. My first thought was that he was drinking copious amts of bourbon and this was what the result was, but after going back and forth over that one, I think I’ve effectively determined that isn’t the case. Besides, I’ve watched this develop in front of me when it just isn’t possible for alcohol to be a factor.

It usually happens when he is very tired, or when he hasn’t eaten for hours and hours. Oh - one more thing - during the 6 weeks or so when he was weaning, he was taking supplements - fish oil and B complex. They kind of went by the wayside when the wellbutrin stopped, probably to his detriment.

Anyway, the episodes got so bad that last Friday, after a morning’s fun of this stuff, I called his pdoc and, not getting him, made an appt with his primary doc. In the meantime, the pdoc called back, I described everything, he wanted to see him to schedule a complete neuro workup. I asked, should we keep the primary appt in the meantime? Yes, he said, doesn’t hurt to have him seen, do bloodwork etc. After a bizarre question about whether his childhood was happy (no joke), I hung up, and we went to the primary, who also recommended a CT scan, suggesting maybe he was having temporal lobe seizures.

So, he had a bunch of bloodwork (normal) and a CT scan (normal) and in the meantime I did more reading. Came across a list of withdrawal symptoms that was more comprehensive than others, excerpted from a book by a Dr Glenmullen, which included everything I was witnessing. And then, while my husband sat in the waiting room for his CT scan, guess what came back? The good old brain zaps. That kind of clinched it for me at least.

Backing up a bit - before we left the primary’s office, I asked him if any of this could be caused by continued withdrawal from the ads, and he said, I’d never say never, BUT, no way - two weeks they last, tops. Two weeks huh? I can’t wait to tell him the zaps are back.

All that to ask this - has anyone else experienced this kind of thing with discontinuation? Because this really sucks, for all of us, and I’m wondering if anyone has any anecdotal info to share about how long it might last before things even out, or what might alleviate the extreme stuff. I’m pretty desperate! Thanks in advance, and so sorry for the length.

[Attorney_Victim]

I wanted to applaud you for supporting your husband and trying so hard to help him! Many of us here have family members who don't understand our issues, so it's great that you are doing what you can to inform yourself. Your experiences with the drs sound pretty typical. Even most pdocs are not fully informed about what these drugs are capable of doing. Some people on this site have reported that their withdrawal symptoms lasted more than 2 months, so it is definitely possible that your husband's troubles are being caused by anti-depressant withdrawal. Somebody else on here might have more info for you. Please feel free to come here if you ever need any support.

[agrace]

First of all, I'm sorry your husband and all of you have been through this horror, it's just a crime that these doctors can get away with this type of treatment..... some SHOULD lose their license because of this treatment you have been given. Especially the "lilly" guy, what an arrogant fool.

I didn't even tell you the half of it. The things he said were absolutely amazing. He spoke to us like children (like it was all he could do to keep from patting me on the head and saying, there there, little girl), cited his own credentials half a dozen times, disregarded every bit of peer documentation we brought with us, including FDA warnings, drug inserts, and psych journal articles, and actually said he didn't care to or need to hear about any of Kurt's history before the first time he saw him, that his in-office observations were enough. I said something about substance induced mood disorder, how he was diagnosed with bipolar without removal of the wellbutrin, against the guidelines of his own field of medicine, and he said that substance induced mood disorder only applied to illegal drugs! As if the human body can tell the difference! Rather than alleviate our concerns, he utterly demeaned them. When we left my husband said, "Don't worry, he's a big jerk and we're never coming back." Which about caused me to burst into tears because I sat there growing more and more concerned that my husband would stick to his advice rather than our own discovery. When the pdoc said something about being on the consulting board for Cymbalta during its development, I about came out of my chair. I wanted so badly to ask "And are you still getting fees for promoting it?" but I didn't dare escalate the tension. Later my husband said that when the pdoc said that, he was saying silently to himself, "don't ask him, don't ask him!" He knows me too well.

Second, My withdrawls lasted over two MONTHS............ so you can start discounting the guy that said "two weeks tops" He doesn't have a clue either. What I would consider mania was part of my withdrawal, but my therapist, who is pretty good, said that they didn't last long enough to be considered BP mania..... I trusted that diagnosis for myself.

Thank you. I gotta say, I LOVE our primary doctor - he's a really great guy, but like so many of his peers, he really doesn't have much knowledge about how deadly this stuff can be - case in point, I have a friend with bp II who also takes Cymbalta and just told me something really interesting this morning - she and her husband spent all summer trying to figure out why she's been having tingling in her extremities - did all kinds of neuro tests until finally her family doc said, "hey, you know what, it might be from the Cymbalta." Yep, paresthesia. And her pdoc hadn't a clue. She's currently cutting back her dose. I am concerned that a couple decades from now we'll find out that modern antidepressants did a lot more harm than good.

Who ever switched your husband over to cymbalta missed a biggy too, I believe you said this was also the "lilly guy" !!! If he were BiPolar, Cymbalta should NEVER be used.... according to the FDA, not even with a mood stablizer in conjunction because cymbalta can cause manic reactions......... I think there is a clue there as to part of what has happend to your husband be he BP or not. I'm not saying he is...... I would lean to the side that all these meds caused your husband to get much worse instead of better.

Right, the one who switched him was the lilly guy. The one who insisted that there was no way the Cymbalta could do that to anyone, that we were seeing mania/rapid cycling. I was perfectly willing to embrace a bp diagnosis because it was something I could label and fight, something concrete to go at - info is power after all. But wow, five years ago he was a different guy. Add what we learned about ADs, and the fact that - forgive the crudeness of the phrase - all the "anti-crazy" drugs seemed to make him crazy - you wouldn't believe some of the evenings we had around here - he would get to the point where his face would change and he would just be "done" and if I didn't get him in bed fast, he'd be staggering, eyes rolling back, paranoid, teeth baring, pulling at his hair, crying - and this on the drugs - antipsychotics and anticonvulsants etc - that were supposed to be helping him stabilize! Hence, we started to get really suspicious about the original diagnosis. It was like the meds were poisoning him, and many nights I would ask, Dear God, what are we doing to him?? It was awful.

Thanks so much for the link, and for just being there, all of you - I don't have to say it because you know it but I will anyway - it is such a comfort to read about the struggles of others, especially when you're feeling so alone, when docs dismiss your concerns or seem less informed than the patients. What a blessing this site is! And hey, I'm no angel - I couldn't have gotten through the last six months without a whole lot of tearful prayer and the Psalms. So God gets the credit for my sticking through it. And the fact that I KNOW this isn't my husband - this guy who currently is cranky most of the time and sometimes really kind of flipped out - isn't the affectionate, loving, laughing one who has been my best friend for two decades. Oh and boy, have I been blessed with a wonderful girl best friend, who is a retired RN (she is on permanent disability because she has POTS - an autonomic disorder) and is more insightful than any doc we've dealt with! She's come over to talk him down more than once and I can't thank God enough for her.

But hey, for all of you - as you each go through your respective trials with discontinuation, remember this - your pain is not for nothing, because it gives hope and insight to the rest of us. THANK YOU!!!

Oh - one more thing - another odd recent symptom - numbness in hands and feet. :?:

Oh - Attorney-victim (love the screen name, hate that you have to use it!) - the above is in response to you too despite my quoting of Greybeard. Thanks for the post and confirmation - it's a real relief.

Again the long post! I admit I suffer from chronic diarrhea of the keyboard...

[Attorney_Victim]

Greybeard makes some very good suggestions about the additional tests you may want to have done. Especially, you should have your husband's Liver Enzyme level checked. Cymbalta has been proven to cause serious liver damage when alcohol is used. I don't mean to scare you, but just have it checked.

[agrace]

I re-read your post again and have a few questions if you don't mind just for clarification. Is your husband taking anything now? The Remeron?

Also, the two weeks when he felt great ...... taking anything? Seems that you said he had weaned off the cymbalta while still taking the wellbutin and then stopped that. Correct? Then there was a two week span before he started the remeron and everything came back........ Excuse me if I'm not getting the timing correct here........ I don't call it a withdrawal symptom anymore but I still have "brain fog" at times... :roll:

Here's the whole timeline, in a nutshell - early 2005-Feb 2008 on Zoloft followed by Wellbutrin. Then one month of Effexor, then two or so months of Cymbalta + Wellbutrin and half a dozen different mood stabilizers. That brings us to the end of May. Then, total discontinuation of mood stabilizers and about six weeks of weaning amid withdrawal symptoms (at the recommendation of my nurse friend, he stopped the Cymbalta first so its more severe withdrawal would be tempered by the remaining Wellbutrin), followed by two weeks of feeling really good. Then about a month ago, some serious irritability kicked in, we're talking daily and completely out of character, which was followed a week or so later by the onset of these "episodes," which occurred every day for a week at all times of the day. These tapered off to every so often and mostly when he was visibly very tired or hadn't eaten in some time - still ongoing, every other day or so. But the Remeron didn't start until a week ago last Friday, so he's only been on it for ten or so days.

Regardless of whether the Remeron is a factor, your explanation of how his brain is trying to rebalance is a really good one, and makes perfect sense. Gives me some comfort when I'm dealing with the nearly perpetual, quite severe irritability.

Also I don't know if it was specificly looked into with all the tests done but having his liver checked would be a good idea because alcohol and anti-depressants don't mix well. Also specific tests for insufficient amounts of vitamins D and B12, those two vitamins when low can also cause many of these symptoms and they are usually not checked during normal bloodwork.

He takes a B complex but I'll look into the D. And I've read frightening things about liver damage and especially Cymbalta, thankfully he was only on it for a couple months but he did drink more than usual (hiding bourbon on a semi-regular basis) for the entire time he was on the ADs. How fast can liver damage occur? It's ironic because I am convinced that the ADs are what caused the increase in alcohol consumption in the first place for two reasons - I've read that they can affect blood sugar, causing intense cravings for sugar and thereby alcohol problems in some people, and I sincerely believe that due to the agitation caused by the ADs, his body was looking for something to take the edge off, and for him, it became alcohol.

(Speaking of which - slightly off the subject - I was reading in my pill book about seroquel last night, and noticed something very interesting - seroquel has the exact OPPOSITE effect on serotonin and neurepinephrin as SNRI's do, so what on earth is the benefit of taking something to inhibit its reuptake if you're taking something at the other end of the day to accelerate it? Ironic isn't it.)

With regard to his irritability, I'm having a bad time at the moment (some days are worse than others for me as well as him) - I read other people's stories on this board, their posts about how their emotions are wildly fluctuating, they're ready to bite someone's head off, their husbands/wives/families comment on it and it's obviously understood by the poster that it actually is happening and all concerned know its out of character and caused by the withdrawal. Or a poster might comment how their family members are having a hard time understanding what they're going through, but again, the poster knows the outbursts of rage et al are caused by withdrawal. I'm in the reverse position and boy am I frustrated.

For several weeks running I feel like I've had to walk on eggshells most of the time (there are brief periods when he's "himself"), that the tiniest thing sets him off, that he has absolutely no patience for our kids, that he yells more than he speaks, talks to me sarcastically, disdainfully, is downright mean sometimes...it's like his irritability factor is flipped - like say a normal person is fine 80% of the time and cranky for whatever reason the other 20%, he's the opposite right now. But he doesn't think he is! He thinks that the rest of us are the ones with the problem, that I'm always trying to pick a fight with him - you wouldn't believe how often I've bitten my tongue and acquiesced so as to avoid confrontation - it's often easier to just go along with him because it's next to impossible to convince him otherwise.

How is it for you guys? Do you know the rage/emotional outbursts etc are over the top when you're having them and you just can't stop, or do you think it's normal while it's happening and then later you look back and think, wow, that was whacked? Or somewhere in between, a mixed bag of yes and no?

When I say reverse position I mean the following - rather than the discontinuation sufferer trying to make their families understand, I'm the one who "gets it" and am having a terrible time convincing him! But that's the way it always is with him and medical stuff, even though he is extremely intelligent and well-read about so many things. When he was first diagnosed bipolar, he wouldn't read a thing about it - just refused to deal with it at all. So I did the homework, and whenever I would try to share anything with him, he would sigh, roll his eyes etc. This continued throughout - I was the one reading about all the drugs he was taking, I was the one reading about antidepressants and compiling info, I was the one who started to suspect that the doctors didn't know everything and might have misdiagnosed him, I was the one reading about discontinuation syndrome. He never wants to know anything but rather chooses to avoid it completely. It's so incredibly frustrating. At the same time, he'll take a doctor's word for anything, which is why I was so scared he would side with his first pdoc who said that ADs can't cause all the problems the FDA et al said they could.

Even with these episodes - he wakes up hours later, knowing he lost time, gets frustrated over it, but doesn't want to talk about why it might be happening. He wants to know what happened that he doesn't remember, so I tell him about the rage and crying and loss of equilibrium and slurred speech, and he accuses me (not all the time, but frequently, depending on how irritable he is at the time) of making things up! He has no answer as to what my motivation for doing so might be, but he often won't accept what I'm telling him as the truth. Meanwhile, he is forced to acknowledge that having no memory of blocks of time is hardly normal, but shows very little interest in doing anything to figure it out. He doesn't deny it's likely discontinuation syndrome, but he won't actively participate in dealing with it or learning about how to alleviate it. Simple things like taking his supplements - he might get pissed off if I even bring it up. I suggest changing aspects of his diet and get out and exercise, for example, and he scoffs at me, but then when his psychotherapist brings up exercise as a means to alleviate excess stress and emotion, he laughs and says "have you been talking to my wife?" But then he comes home and doesn't do it anyway. Yesterday he actually impressed me by telling me he felt "off" and then subsequently his speech started to slur and his anger level ratcheted up over the next hour or so, but he wouldn't take a non-drowsy AH to try to head it off! Meanwhile, he'll take every psychotropic thing handed to him by anyone with letters after their name without ever reading the inserts that come with them! UGH!!!!!

I have suggested several times that he might do himself a bit of good to get on here and read what others have to say, and he nods, but won't do it. I value so much the advice you gave with regard to being careful indefinitely, learning to recognize when things slip a little, and how to best take care of oneself, but unfortunately, 95% of what I've learned goes unheeded. Sometimes I wish I were the one going through this, because I can't make him do anything and so far he's largely unwilling.

So a lot of the time lately I am at a loss, and definitely have my moments when I'm scared that permanent damage has been done and my husband is never coming back to me.

Here I go again with the long posts. Thanks for the bandwidth with which to vent, sigh.

[agrace]

Houdi - you're calling me a gem just when I'm thinking my last post sounded so selfish and whiny!

Thanks so much for your input. Your husband sounds a bit like mine these days. I'm convinced though (except in my lowest moments) that his anger is completely AD withdrawal and it will all eventually go by the wayside...sooner rather than later, please God!

Funny - as I sat here feeling sheepish about how much I complained in the last post, my husband called on his way home and we had a very nice conversation about his irritability, so I guess he gets it more than I gave him credit for.

[Attorney_Victim]

Agrace,
Even though you are not the one experiencing the withdrawal symptoms, it is affecting your whole family. You have every right to feel frustrated and angry...just as long as you can keep that anger and frustration directed at the situation, not your husband personally. Your husband's symptoms are more severe than others I've seen posted here, so I'm sure it is really hard on you.

When I went through the worst of my anger/frustration problems (first from what I think was Seratonin Syndrome - too much Cymbalta)...it took a long time (6 weeks?) for me to realize that it wasn't just my depression worsening. I knew I felt bad, and that I was being very short with people, but it took a while to realize how bad I was. I am about 6 weeks off Cymbalta (and 2 wks without Prozac), and I just now, within the past 2 days, feel "normal." My symptoms got better and better, but I am just now feeling a normal level of energy with my temperment back to normal. So, I would guess your husband may not realize what he is feeling since he seems to be so severely affected.

However, it doesn't sound like you will be able to educate him about his own problems. Just stay involved with his drs appts and hopefully he will get this figured out soon!

Hang in there!! I don't know anything about the Remerol you said he is taking, but I know the Prozac is what helped me. You may want to get him off of everything except something like a Prozac and see how he does, then he can come off that in a short while when he is stablized. Then he would be drug-free and you all could get a baseline to determine if he truly has any underlying mental illnesses (Bipolar or anything else).

I am very interested to know if any of his drs will figure out whether or not his problems are related to the anti-dep withdrawals or if there is some other problem going on. Keep us posted! We're here for support!

[winner]

Hey. Please reed my story "There is help for Cymbalta withdrawal symptoms and other...." I wrote it yesterday, 13th of September. This is the way, how my daughter and me found help to our real hell-life. Hope yo´ll get help too . This will take little time but not many monthes or years. After drugg-hell every little step to better feeling and normal life, is a real win. The help can come also very soon. People are different. You don´t have to believe to these therapies and still they can help. I got help also myself for many pains and some tramas from my past. I´m going to study these therapies because I want to heal and help people. Read about these terapies, there are addresses in my story. D0N´TGIVE UP - THERE IS STILL A LOT OF HOPE - AND NORMAL LIFE.