3 replies to this topic

[Susan]

I was just wondering if you were still taking Cymbalta? Thanking you for posting. I too, had/have a lot of these effects, from Cymbalta. It has been five weeks today at 0mgs of Cymbalta. I still feel so miserable. Body aches, itching, rage, depression, and intense anxiety. To name a few of the most problematic for me still.

[chula17]

What else can we do to stop them?
How do we make doctors aware of this if there is nothing they can test?
This is so frustrating, I went back on Cymbalta so that I could work and function, after only 8 days of being off of it. And I've only been taking it for 3 months. I can only imagine what you are going through.

[Norther]

Hello, I went to your website to read about your cymbalta nightmare, and then saw your weaning regime + supplements. If you aren't already aware of the following, I hope this may be of interest:

1. B vitamins - in withdrawal, a lot of folk find they can cause extra agitation/anxiety, although there are exceptions.
2. Taking more than one serotonergic drug heightens the risk of serotonin syndrome. If you head over to drugs.com and stick 5htp, cymbalta, and St John's Wort into their drugs' interactions checker, you will find 3 major drug-drug interaction warnings. 5htp and St John's Wort affect serotonin, as does cymbalta, so each warning relates to serotonin syndrome. Also to be considered is that cymbalta has interfered with serotonin, and now two further compounds are being ingested which also affect serotonin.
3. If you find you are badly affected by withdrawal as you head further on down the doses, then you may be getting cumulative effects from the previous drops due to the small stabilising time at each dose drop. Be especially aware of suddenly feeling 'better' with energy surges - welcome to the wonderful world of withdrawal mania/hypomania, often followed by a big crash shortly afterwards. It's more commonly noted in those that withdraw swiftly/cold turkey.
4. Generally, with both the SSRIs and the SNRIs (cymbalta), withdrawal can become more severe at the lower doses. Lots of people can get down to 37.5mg Effexor (SNRI), for example, without too many difficulties, then all heck breaks loose. It's something to be actively aware of, and monitor closely.

If you are a fast metaboliser then your body's been in physiological chaos for months. The scenario you've endured is more commonly seen in Effexor users (half-life 5 hrs), who are usually unaware that the reason they feel so awful towards the end of each day is that they've just headed into cold turkey withdrawal. Again. The brain zaps are the classic tell-tale, since they only seem to occur into two scenarios: poop-out and withdrawal.

Your symptoms fall into the standard groupings seen for both SSRI/SNRI side-effects and SSRI/SNRI withdrawal: movement disorders (tics, twitches, jaw dystonias and dyskinesias, bruxism), cognitive problems, mood swings, gut/nausea problems, breathing problems, headaches, eye and ear problems, weight gain, lethargy/apathy, joint/muscle pain, itching, 'flu', tinnitus... together this mix of symptoms is a CLASSIC presentation of an SSRI/SNRI adverse reaction, or severe SSRI/SNRI withdrawal. You read about it, over and over again. Weight problems, sensory changes, gut issues, movement problems, sexual dyfunction (usually), musculo-skeletal problems, cognitive problems, new/changed psychiatric issues (generally mood swings/irritability/aggression/anxiety/depression).

Did your eye problems include photosensitivity? And did you find that you were restless with a desire to pace about, or keep moving (that's before you fell asleep again - I know all about that one!), or a general sense of motor restlessness? If the answer to the latter is 'yes', then have a read up about akathisia (try Healy's definition in the Wiki for starters), which appears commonly associated with all the SSRIs and SNRIs (it was noted early-on in the SSRI Prozac trials, but the term swiftly disappeared from official use), but rarely recognised in clinical practice.

If you are taking any cough/cold medicines, read the label to ensure that dextromethorphan is NOT an ingredient. Dextromethorphan is another one to avoid due to a major drug-drug interaction warning.

[Norther]

Hello,

80-85% of doctors are unaware of Serotonin syndrome, which is caused by an excess of serotonin in the body. Serotonin syndrome can be a result of taking a single serotonin boosting drug (rarely), but more usually it is a result of taking two or more serotonin boosting drugs in combination.

This patient leaflet will give you the basics: http://www.patient.c...owdoc/40024932/

Any google search on "serotonin syndrome" will bring up many like documents. Have a read through a few?

5HTP, as a precursor to serotonin, will boost serotonin levels... here is one individual's experience of combining a serotonergic antidepressant (Prozac) with 5 HTP : http://leda.lycaeum.org/?ID=6583

So two of your supplements were effectively increasing serotonin, in addition to the cymbalta itself - that makes three serotonin boosters taken simultaneously, increasing the risk of serotonin syndrome.

The separate issue, is taking supplements to aid the depression and anxiety caused by the drug/drug withdrawal. Cymbalta has affected the serotonergic system, the serotonin-dopamine connection means that it has also affected the body's dopamine levels (dropping them, which is possibly why so many people end up with parkinsonism-like symptoms, and movement disorders, again, pretty standard for the SSRIs/SNRIs once you know what you are looking for, and what questions to ask), and together the knock-on effects go through the body affecting hormones, eyes, ears etc a systemic effect - of which you have had first-hand experience. St John's Wort can be considered a natural SSRI; 5HTP will boost serotonin... thus they would be expected to mimic, to whatever degree, various actions of the Cymbalta. To heal from the Cymbalta might seem to indicate not stressing the same systems, or avoiding supplements that act in a similar manner...? That is one for the individual to read and research, and make their own decision about. However do be very aware of serotonin syndrome, for your own safety... which is why I also mentioned checking cold medicines for the ingredient dextromethorphan.

I found this document, after-the-fact, and the advice within echoed many of the conclusions I reached through trial-and-error with my own antidepressant withdrawal nightmare, which was survived in complete ignorance and probably more than a little luck: http://www.antidepre...om/reaction.htm

My best helpers were:

1. Stay away from stimuli, as far as possible, especially light and noise. Your system is in hypersensitive mode. I wore sunglasses, and had ear protectors on, long before I knew about any of the hypersensitivity effects.

2. If your body needs sleep - then sleep. It is in physiological chaos, and letting you know all about it.

3. Good diet - stay away from the processed stuff. Many folk now display post-drug/withdrawal food sensitivities, or have various digestive upsets - flatulence is an oft encountered one, remember, most of the serotonin the drug acted on is in your gut - so a decent diet, staying away from the added chemicals is a sensible move. However, there are the typical craving that may hit (you may have had them on-drug, too), and I simply gave my body what it was screaming out for, when these hit... usually high sugar, high fat rubbish... it may be a by-product of the blood sugar effects going on.

I'm afraid the suicidal nasties are part and parcel of the drug's effects and withdrawal effects. That's been known about since the start of the SSRI/SNRI saga, but carefully swept under the carpet. Those docs who did investigate the fact, rather than the promulgated marketing info, brought forth the truth... but they have risked a great deal to do so. The facts are out there, but you have to look to find them.

For example, duloxetine (Cymbalta) has the distinction of: 'the rate of suicidal acts in duloxetine open trials for stress induced urinary incontinence is at present 14 times the expected rate from the normal population' Prof. David Healy, letter to the MHRA (drug regulatory body). Hardly unexpected, SSRIs and SNRIs have been inducing depression, anxiety, panic attacks, acute suicidality and worse in individuals who did not present with these symptoms, for years and years. So in an SNRI Cymbalta test on healthy volunteers with bladder problems, it would be only natural that they would suffer the same psychiatric effects as everyone else.

How do you manage the suicidal nasties. Well, you have one major advantage that I did not - you KNOW this is down to the drug. If you can implant that fact, in concrete, then you have a huge weapon at your disposal. When the anxiety/depressive surges hit, mentally step back, say 'yes' that's withdrawal, it's not 'me' it's the blinkin' drug and I think I'll go and have a lie down until I feel a bit better (or have a cuppa, or tune it out, try and bat it away and ignore it, dwelling on the suicidal nasties cannot help). Fast tapering seems anecdotally to increase these effects. However if you are a fast metaboliser then you have the added problem of going into withdrawal before the 24hrs is up. Usually, Cymbalta's half-life of 12 hours means the typical onset of withdrawal after a dose drop is seen on Day 2-3. Glenmullen's tapers look at roughly a month per dose drop to stabilise out, others look to reduce at no more than 10% of the current dose at each drop level (e.g. 120mg Cymbalta, 108mg Cymbalta, 97mg etc). Again, it's something for the individual to research, so that going in, they are armed with the facts. Always keep in mind that it is NOT about getting the drug out of the system, the drug has made many changes to the body, some of them structural, it is about trying to allow the body a chance to adapt back, to be able to function without the presence of x mgs of the drug.

Sometimes people take benzos whilst in withdrawal. The drawback... it can take a little as 10 days to become dependent upon them, paradoxical effects include increases in agitation and anxiety, then you have to wean off, plus there is the post-benzo anxiety and depression rebound. One to discuss thoroughly with a doctor who is fully aware of the benzo issue - and have a read through the highly respected 'The Ashton Manual' yourself, in advance... http://www.benzo.org...anual/index.htm

Back when you were on 120mg of Cymbalta, the fact that you started to have zaps whilst still taking the daily dose may have indicated the onset of poop-out. Cymbalta does (anecdotally) seem to poop-out faster than Effexor; if you read about various people's experiences, you find accounts of people noting Cymbalta 'stopped working' within months of the first dose, resulting in dose uppages, drug switchings and addings, or various weaning attempts. When your drug dose was halved, that gave you a massive dose drop and landed you in severe withdrawal. All SSRI/SNRI dose changes (up OR down) are supposed to be carefully monitored, because ANY dose change has the potential to precipate severe reactions either via withdrawal or dose-related side-effects.Then, as you know, when you were accidentally given the 120mg back again, it took you out of withdrawal.