27 replies to this topic

[AaronSD]

I'm on day 8 of weaning process.  Dropped from 60 mg a day to 30 on day 1 and continued for 6 days.  Picked up a script for 20's today and will see how 20 mg a day goes.  Anyone out there find 20 a day theraputic?  The recommended dose for all indications is 60 based on Drugs.com info.

[thismoment]

AaronSD hi.

 

After you dropped straight from 60 mg to 30 mg, what (if any) W/D side effects occurred during those 6 days?

 

If you now drop to 20 mg, you will have dropped 66% in a week, which is really steep! 

 

Hopefully you will be one of the lucky ones who has few (or no) withdrawal side effects.

 

However, should you get 'discontinuation syndrome' (side effects from withdrawal), consider returning to a higher dosage until you stabilize, and then taper off at a slower pace.

 

Let's say you are stable (withdrawal symptoms are bearable and not intensifying) at 30 mg, then slowly reduce at a constant rate to zero. If I had to do it again, I would reduce at the rate of +1%  per day-- Day 1- 1%; Day 2- 2%; Day 3- 3% etc. If the W/D symptoms get too rough, stop the tapering for a few days to get stable, then resume the countdown. Yes, that takes 100 days.

 

I did it at a rate of +2.3% per day and really had a tough time.  That's why I recommend the +1% per day taper.

 

Best wishes!

[AaronSD]

Well...in the first few days at 30 mg I had a crummy spot develop in my afternoons - for about 3 hours I was feeling sort of an empty mental hole develop with accompanying spaciness and low energy.  I masked that by taking 5 extra mg of ritalin just before that time of day.  Toward the end of the first week I was noticing increased back pain at work (have a computer job) and headachiness for a few hours in the afternoon.  I knew I had a lot of tension in my back, but I suspect cymbalta was masking the pain it was causing.  The headache may actually be caused by the ritalin as it occurrs during the time when the concentration should be at its peak.  This too was probably masked by the analgesic effect of cymbalta.  I was on cymbalta both when I started taking the ritalin and started the computer job.  I am lowering the ritalin tomorrow and will see if I still develop a headache in the afternoon.  Other than an increase in pain, I have been getting really tired at night when the ritalin is wearing off.  This may be good if it lasts because I have been depending on sleeping pills for awhile (trazodone or lunesta as needed).  On the positive side, I have noticed an increase in energy, which I somewhat expected as cymbalta was mildly sedating, and an increase in good moods and not too much of an increase in bad moods.  I suspect some of the mood lifting effect of the ritalin was masked by the cymbalta.  I also take latuda (20 mg daily) which is a powerful mood stabilizer.  If I wasn't on that, I am sure my mood would be noticeably lower and less stable based on my first experience coming off cymbalta in 2008.

 

I plan to stay on 20 mg daily for a week and continue for a month if there are no serious side effect issues.  At that point I plan to stop taking it and see how that goes.  If side effects get to be too much to handle, I will go back to 30 mg (higher if necessary) and try a gradual decrease...maybe 10% a week.

[thismoment]

AaronSD hi again.

 

With the mix of Cymbalta, Latuda and Ritalin, the action (and interaction) of the medications makes it impossible to sort out what drug is doing what. I don't think it's helpful to speculate about how these drugs interact, and how to manage one by medicating with another.

 

If I were taking these 3 medications and wanted to wean off, I would do it one-at-a-time. The order in which to discontinue would be a question for the physician. 

 

Go slow and taper off in a linear fashion (not in steps).

 

Best wishes!

[AaronSD]

AaronSD hi again.

 

With the mix of Cymbalta, Latuda and Ritalin, the action (and interaction) of the medications makes it impossible to sort out what drug is doing what. I don't think it's helpful to speculate about how these drugs interact, and how to manage one by medicating with another.

 

If I were taking these 3 medications and wanted to wean off, I would do it one-at-a-time. The order in which to discontinue would be a question for the physician. 

 

Go slow and taper off in a linear fashion (not in steps).

 

Best wishes!

You're right about making assumptions about drug interactions...I have no clear way of proving them right or wrong.  My science background has made me prone to hypothesize and experiment though.  Adding 5 mg ritalin did help with low energy on day 2...it's a powerful stimulant after all.  The presence of latuda could help with mood stability during withdrawal, since adding it to the mix did increase mood stability initially; but, I was already on 60 mg cymbalta when I started latuda, so the added mood stability may have been due to some sort of combination effect...synergism...who knows?  Once I'm completely off cymbalta and side-effect free for about a month, I should have a better idea of what was doing what.

 

My psychiatrist OK'd attempting to discontinue the cymbalta, approved my rapid step down plan and gave me a script for 20's which I'm now taking (on day 2 of that dose today).  He recommended taking as much time as I feel I need for the weaning process.  I told him about this forum.  He said this type of forum provides a skewed perspective because most of the participants are reporting adverse effects.  In his practice, he said he's found cymbalta to be an effective and well tolerated antidepressant.

 

Today is day 9 of my rapid step-down plan and I feel OK.

[equuswoman]

I'm glad for the ppl who are on this med and it has helped. However it is a forum of ppl who for the most part are coming off Cymbalta and are experiencing adverse w/d symptoms. Some are able to discontinue the Cymbalta without horrible w/d. I was not one of them. Aaron I hope you have an uneventful weaning process. Please let us know how you are doing. TheEquusWoman..♥

[thismoment]

AaronSD

 

I wish you total success with your plan!! Please keep us posted on how it is going.

 

And your psychiatrist is right, Cymbalta is often effective and well-tolerated, but only marginally better than placebos. Placebos, however, don't physically damage the brain, requiring the patient to stay on the drug at higher dosages to keep the enhanced symptoms at bay. Many (including me) who are totally off the drug, have residual symptoms that are permanent, and that's damage to the brain. 

 

Sooner or later most Cymbalta users will come to sites like this to ponder how life might have been, and perhaps how it still could be if they can escape the drug. There are websites for other similar drugs.

 

The long-term effects of these drugs is just becoming known; Prozac was the first SSRI to be marketed, and that was 1988- relatively recently, and the first test-patients are still living.

 

And yes, this is indeed a skewed perspective, but so is everything in life: it's how we stay alive, how we judge what's safe for ourselves and for our children; a skewed perspective is in our DNA- just like your psychiatrist's skewed perspective, which, perhaps, is about preserving his lifestyle.

 

We Cymbalta survivors need to be each other's advocate in our desire for caring and responsible healthcare.

 

Consider this: These doctors hand out drugs in an effort to make symptoms go away (not diseases)!  But the symptoms progress and escalate, and you come back to the doctor and you get bigger pills, different pills, more pills. That's lazy and irresponsible medicine.

 

Just my opinion.

[AaronSD]

Hi thismoment,

 

Regarding my motivation for mentioning my psychiatrist's view of this and similar forums as being "skewed" toward the negative side of med experiences...I didn't mean to say that is my position or that this is a "bad" site.  I too have suffered negative effects from taking this and other psych meds and have a degree of skepticism regarding pharma's efficacy claims.  I mentioned it to give some support to the idea that not everyone has a difficult withdrawal experience and to thus support my attempt to try a rapid step-down approach. 

 

You're right, these drugs certainly don't cure, but they can be a big help to those suffering from major depression.  Some studies have shown little benefit vs placebo for those suffering from mild to moderate depression.  If you are seriously depressed, however, anti-depressants can help quite a bit.  It stands to reason that there are individuals out there that have isoforms of enzymes involved in the synthesis of neurotransmitters with a degree of "abnormal" activity toward their substrates thus making them more moody that the norm or more suseptible to getting stuck in low mood states.  An anitdepressant or mood stabilizer might help such an individual quite a bit.  I can't prove it, but I believe I may have something going on genetically that makes me chronically low in energy and suseptible to low mood states.  I have been that way all my life and have had a lot of psychotherapy and still have had those issues.  The medications never made me happy, though, but they did help with overall energy levels and cognitive function. 

 

I believe antidepressants are over-prescribed because people are taking them in many cases because they're not happy.  I was happier after starting antidepressant therapy because they helped me function at a higher level and I was thus less frustrated, angry and hopeless about my predicament.  True and lasting happiness, in my opintion, will never be found in a drug or anything else in this material world we live in.  Real, true happiness is a condition of our spirit or soul.  It's immaterial.  I believe our true nature is a spiritual  essence  that we know in our material life by the content of our thoughts and the motivations of our hearts.  Because of the limitations inherent in material existence, we will never fully discover the true nature of a human being or of our selves until we enter into a purely spiritual existence after the death of the body. 

 

This is an existence purely of the heart and mind (at least as far as I have come to understand and believe).  The knowledge that gives us the tools we need to grow spiritually, that is in heart and thought, comes from the essential teachings of the great religions.  The helpful insights and tools we get out of psychotherapy are doubtless derived to a degree from the essence of the spiritual teachings that religions have given us over the millenia.  Therapists are like secular priests in a sense.  So, becoming truly happy in this life entirely depends, I believe, on spiritual education and transformation, not on making your flesh "happy" with pills, drugs, food, sex, shopping, toys, gadgets, etc.  The more you internalize the truth that a human being's true nature is not material but spiritual and eternal, that spiritual existence is actually the only real, true and permanent existence, and that this material life is just an initial, short introduction to reality, the more detached you will be from the unpleasantness of life in flesh.  We get the power we need to discover and internalize spiritual truths, grow out of our unhapiness and discover our true natures by learning to love God, the source of all Truth.  The love of God is actually the fundamental motivating and transformative force that gives the ability to discover the secret of true and lasting happiness.  Without that you're stuck with your flesh, which is in a gradual process of decay once your body reaches maturity. 

 

So, yes, antidepressants are probably overprescribed and little better than placebo for many, but they may be truly helpful for individuals that have a genetic "abnormality" in their nervous system, that have been overwhelmed by physical/emotional stress, or that have brain damage. 

[thismoment]

Hello AaronSD.

 

Your post is profoundly personal and heartfelt. And while our epistemologies are virtually opposite, I thank you for sharing your views and beliefs.

 

I will not follow up because I think the bandwidth of this site has surreptitiously become dominated by subjects unrelated to withdrawal from Cymbalta. I must confess that I am largely to blame, and therefore I apologize for introducing extraneous material that clearly doesn't help. 

 

So I will file away the philosophy, abscond with the abstractions and meditate elsewhere about the metaphysical. I shall endeavour to self-correct.

[AaronSD]

Update:

 

Yesterday, on day 3 of 20 mg a day (down from 30 mg a day - step down from 60 mg starting) I felt my overall energy level decrease and had to increase my ritalin from 45 mg to 55 mg to keep my performance up at work.  Fortunately I take IR ritalin tabs and can increase or decrease the dose in small amounts as needed.  My mood also seemed a bit unstable in the evening but the latuda (20 mg), magnesium (400 mg) and trazodone (25 mg) I take before bed calmed me down and I slept well.  I am also much more tired at night once the ritalin starts to wear off.  Before decreasing cymbalta, I was going to bed at 3-4 am (get home from work at 12 am) but I'm now tired enough to sleep at 1 am when I was previously too jazzed up from the ritalin to sleep (ritalin has a 2 hr half life).  The increase in fatigue is magnified by the fact that I had to take 5 mg ritalin near the end of my shift last night, for the first time ever, to keep my energy level up, making my bedtime ritalin concentration 50% higher than usual.  If I can make it through 1 week on 20 mg, I will contunue for a month then stop.  If not, I will go back to 30 mg, stay there for a few weeks then try 20 mg again.

[thismoment]

Hi Aaron SD.

 

You are doing some complex juggling! With that many balls in the air at once, it may be inevitable that you lose sight of one or two. Please be careful.

 

"If I can make it through 1 week on 20 mg, I will continue for a month then stop. If not, I will go back to 30 mg, stay there for a few weeks than try 20 mg again."

 

These plans are abrupt steps. Have you considered a linear taper by bead-counting?

[AaronSD]

Thank you for your concern thismoment.  I will change to linear tapering if I can't deal with the withdrawal effects on 20 mg.  Adding 10 mg ritalin is like adding an extra shot of espresso to a Starbuck's venti americano (comes with 4 shots).  Now that I'm pretty much caffeine free, I'm not concerned about the extra ritalin.  Using medication(s) to deal with withdrawal effects of Rx or illegal (heroin for example) drugs is not uncommon, but I haven't added anything new to the mix since starting my step down plan. 

[AaronSD]

Update: Day 7 on 20 mg

 

Dropping from 30 mg to 20 was harder than from 60 mg to 30.  The ritalin has been holding me up energywise but I'm maxed out on it...will have to stay at 20 mg until I feel well enough to drop further.  The good and bad so far:

 

Good:

No brain zaps

No nausea

Mood OK (a bit less stable though)

Day 7 is better than day 3

 

Bad:

Increased fatigue

Feel kind of crummy overall

Overeating to compensate for feeling crummy

[thismoment]

AaronSD- your level off at 20 mg is a good plan. That crummy feeling should diminish after level-off. You sleeping okay? For me, the brain-zaps, flu-like and concussion-like symptoms, and vertigo came down around the 15 mg level.

 

Be well.

[AaronSD]

thismoment - Yes, I am sleeping well, but depend on sleeping pills to get a full night's rest (trazodone or lunesta).  I hope to decrease the ritalin back pre-wean levels, as I feel better, before decreasing cymbalta again so I have something to treat fatigue with.  I'm at my max ritalin dose now.

[AaronSD]

Update: Day 7 on 20 mg

 

Dropping from 30 mg to 20 was harder than from 60 mg to 30.  The ritalin has been holding me up energywise but I'm maxed out on it...will have to stay at 20 mg until I feel well enough to drop further.  The good and bad so far:

 

Good:

No brain zaps

No nausea

Mood OK (a bit less stable though)

Day 7 is better than day 3

 

Bad:

Increased fatigue

Feel kind of crummy overall

Overeating to compensate for feeling crummy

 

Update: Day 19 of weaning - day 2 of 0 mg

 

Recap: 3 years on 60 mg, 7 days on 30 mg, 10 days on 20 mg, 2 days on 0 mg

 

The crummy feeling that starts on day 2 of a new lower dose lasts about 5 days.  By day 7 on 20 mg I was feeling good and by day 10 I decided it was time to try 0 mg.  Today is day 2 of no cymbalta.  The crummy feeling is here again but not as bad as the last two dose changes.  This may be the end of cymbalta for me.  The only lasting effect so far is an increase in sadness or sorrowful emotions resulting from unpleasant life circumstances/experiences.  On cymbalta I would feel frustration and anger from the same things but not much sadness.  So I guess I am feeling life more, but unfortunately I don't have a lot of pleasantness in my life right now.  Hopefully, I am strong enough now, stronger than I was three years ago when I started taking cymbalta again, and will not need its numbing effect to keep going day to day. 

[AaronSD]

Update Day 26 of weaning - day 9 of 0 mg

 

Recap: 3 years on 60 mg, 7 days on 30 mg, 10 days on 20 mg, 9 days on 0 mg

 

The increase in saddness I was feeling on day 2 at 0 mg only lasted a couple of days.  On day 3, I experienced a new sensation in the evening, when the Ritalin was wearing off, that reminded me of weaning off Effexor...it felt like I was entering into the "nerve zap zone" but without having an actual zap...a hard to describe uneasiness in my nervous system.  When I dropped from 60 mg to 30 and from 30 to 20, I felt more tired at night, but on 0 mg I was feeling more awake and restless at night.  I had to increase my dose of trazodone at night to be able to sleep.  Interestingly, when I start my daily Ritalin, in the morning, the nerve uneasiness goes away.  The uneasiness/restlessness in the evenings has gradually decreased from day 4 through today.

[thismoment]

AaronSD

 

What a fascinating process! Have you stopped all antipsychotics? 

[equuswoman]

Update Day 26 of weaning - day 9 of 0 mg
 
Recap: 3 years on 60 mg, 7 days on 30 mg, 10 days on 20 mg, 9 days on 0 mg
 
The increase in saddness I was feeling on day 2 at 0 mg only lasted a couple of days.  On day 3, I experienced a new sensation in the evening, when the ritalin was wearing off, that reminded me of weaning off Effexor...it felt like I was entering into the "nerve zap zone" but without having an actual zap...a hard to describe uneasiness in my nervous system.  When I dropped from 60 mg to 30 and from 30 to 20, I felt more tired at night, but on 0 mg I was feeling more awake and restless at night.  I had to increase my dose of trazodone at night to be able to sleep.  Interestingly, when I start my daily ritalin, in the morning, the nerve uneasiness goes away.  The uneasiness/restlessness in the evenings has gradually decreased from day 4 through today.

wishing you the best. Glad to hear from you! TheEquusWoman♥

[AaronSD]

AaronSD

 

What a fascinating process! Have you stopped all antipsychotics? 

 No, I still take 20 mg Latuda a day.  I haven't changed my Latuda dose since starting to wean off Cymbalta.  Once I feel Cymbalta withdrawal effects are gone, I plan to attempt to decrease Latuda and eventually replace it with a different class of medication.  The atypical antipsychotics have had a negative effect on my blood sugar and lipids.  I had to start taking diabetes meds and a powerful statin after being on an antipsychotic for a couple of years.

[fishinghat]

You should start getting breaks in things soon. Hang in there Aaron. Happy New Year.

[AaronSD]

You should start getting breaks in things soon. Hang in there Aaron. Happy New Year.

  Thanks fishinghat...Happy New Year

[thismoment]

AaronSD

 

Clearly, you are maneuvering your way through this! Good work! Happy New Year!

[AaronSD]

AaronSD

 

Clearly, you are maneuvering your way through this! Good work! Happy New Year!

Thank you thismoment...Happy New Year

[AaronSD]

Update Day 38 of weaning - day 21 of 0 mg

 

Recap: 3 years on 60 mg, 7 days on 30 mg, 10 days on 20 mg, 21 days on 0 mg

 

The uneasy/restless "nerve zap zone" feeling has gone away and I now feel reasonably stable.  I'm not sure when the normalization occurred because my mother was seriously inured in a car accident a week and a half ago and I have been busy handling her affairs.  This was a stressfull time both emotionally and physically but I managed to handle it without the support of Cymbalta.  One more week and I will consider myself free of this medication.

 

[Carleeta]

Aaron sounds like an extremely stressful time for you. I'm sorry to hear about your mom. Hoping all will be well for her. You conquered many a stressful thing through all of this. Extremely proud you plowed through the financial affairs as well. Wishing you great luck and success on your journey. Keep us posted...Smile a big smile.

[AaronSD]

Aaron sounds like an extremely stressful time for you. I'm sorry to hear about your mom. Hoping all will be well for her. You conquered many a stressful thing through all of this. Extremely proud you plowed through the financial affairs as well. Wishing you great luck and success on your journey. Keep us posted...Smile a big smile.

 

Thank you Carleeta...your support is much appreciated.

[Carleeta]

Thank you Carleeta...your support is much appreciated.

YOU Are Very welcome..The more you see what you've accomplished through such a difficult time, the more someone notices, appreciates your strength and love, the more it makes me want to praise that person. In turn my hopes are your recognizing your own strength! Once again..Great job..