401 replies to this topic

[Xanazul]

Hi every one. I've been for two years on 60 mg cymbalta with almost no side effects. It worked OK (along with therapy and the improving of my life circumstances) to pull me out of both a terrible depression and an extreme anxiety. I was not depressed or anxious any more, so last september I decided that was time to live by myself again plus I was longing for the recovery of my sexual life wich cymbalta took enterely away, and went from 60 to 30 along 4 weeks: Blood pressure raised moderately+intense sweting (I am 61, menopausia 6 years ago with no symptoms)+ once in a while breath shortness and chest pain+body aches.
In february I started to wean off from 30 mg: Hypertension crisis+intense chest pain (feeling as if going to have a heart attack)+more sweting+body aches all over+feeling like fever+moments of intense painful sadness or panic. But, however hellish as this is, what scares me to death is if the possibility that this is depression and anxiety coming back. Someone had the same experience and is OK now? Hope please!!!

[xman]

Anytime you have CP, sweating and shortness of breath you need to go to your nearest ER, if alone call 911. Don't mess around with this-you can sort out the Cymbalta issue later!

[fishinghat]

Xman is absolutely right. You get that checked out and come back and we will all chip in to help with the Cymbalta.

[Xanazul]

Thank you very much for your warnings. I am a physician myself (but also an academic that is used to look for answers) and I've already taken care of the "measurable" part of the symptoms. ECG, Echo, effort test, plus all BP tests done, including Holter for both blood pressure and ECG and urinary metanephrines (adrenaline and noradrenaline metabolites). Everything OK but for a very small increase in normetanephrine which can not be explained other than by extreme stress or CYMBALTA!

[fishinghat]

That is great to hear Dr. X.  Welcome to the site. Except for the chest pains, none of the other symptoms surprise me. Here is some info to consider.

 

OPTIONS

There are three ways to do it. Cold Turkey, swapping meds and bead counting.

I don’t recommend cold turkey unless there is no choice. The cold turkey withdrawal can be quite severe and usually lasts longer. With swapping meds you lower your dose of cymbalta over a 2 or 3 week level to zero and at the same time go on a different ssri with a lot less severe withdrawal, say zoloft, lexapro or prozac. Once you make the switch you slowly come off the new ssri. Very slowly. The third choice, bead counting, is where you open the cymbalta capsule each day and remove a few beads, usually 2 or 3. So the first day you remove 3 beads, the next day 6 beads, the next 9 beads etc. This provides for a slow steady withdrawal. If symptoms get to bad you just hold at that dosage for a while until you stabilize. Then start dropping again. Be aware that for most the last few beads give the worse withdrawal. Be prepared to slow down when you get to the very end. Now this is just an example. Some can only remove 1 bead a day and others 7 or 8 beads a day. You will have to play with it a little bit to find what works for you. This doesn't mean you won't have withdrawal but it will be lighter and you will have some control over it.

 

DURATION OF WITHDRAWAL

 

The first 3 or 4 weeks of withdrawal are usually the worse with some slow, and I mean slow improvements. By the 8th to 12th week usually see signs of good days followed by bad days but at least there is light at the end of the tunnel. Now that is the average. I have known people who actually quit cold turkey without a symptom. And others where the withdrawal last 6 months to over a year but these are rare. Research says between 30 to 80% of people do not experience withdrawal while other research shows that around 7% experience withdrawal of 6 months or more.

 

I hope this info helps. Let us know what we can do for you and feel free to come on site any time and just vent. Nothing more therapeutic than complaining!!  lol

 

 

[Xanazul]

I am afraid to late for counting beads. My last 30 mg pill was march 3. However I am very interested in: how frequent is high BP ocurring and also the frequency of any kind of chest disconfort. The reason is, the symptoms I am experiencing as well as many others I've learned in this forum, may be very easily explained as adrenergic crisis. Now there are only to measurable signs for these crisis (well three to tell the thruth), increased blood preassure and increased levels of adrenaline and noradrenaline metabolites in urine. I've the two of them and I am wondering if measuring both variables would not be a good way to prove the nature of the withdrawal effects (in fact it will be a very indisputable way to prove it). Also, this will open the door for the use of adrenergic blockers (which I am beguinning to tryi myself) to attenuate the withdrawal symptoms.

[fishinghat]

I suffered from a chronic adrenergic state for many years due to my work. I have had good success with both beta-blockers (atenolol) and alpha-agonists (clonidine). Both have helped significantly over the years but moderate success with my  withdrawal. There are many articles linked on the section Cymbalta in the News". In the last year there has been 3 papers released that show ssri/snri cause the dendrites in the hippocampus and amygdala to be greatly altered. They become mushroom shaped and it is believed that this is a response to better facilitate the bonding of the ssri/snri to the neuroreceptors. This and other research has shown a subsequent increase in extracellular glutamate. Imagine what would happen with the removal of the ssri/snri. The glutamate would then have better access to the neuroreceptors.  The primary circuits affected were the fear circuits in the hippocampus and the panic, anxiety and mood circuits in the amygdala. While that would explain much with the withdrawal symptoms It does not suggest a therapy, at least to me. The suggestions by the researchers is to go back on a ssri/snri. A suggestion that is really not a good one to the many that have trouble dealing with such meds.

 

I look forward to hearing how your efforts with the adrenergic meds turn out. Please keep us posted. And best wishes.

[fishinghat]

I did a search through the old entries here and found 21 previous entries concerning chest pain/tightness/discomfort. I have NOT been able to find any prior references to cardiac arrhythmias which I would anticipate with a cardiac related issue.

[Wagtail]

Xanazui , welcome to our nightmare. I too am experiencing the return of depression , anxiety & fear & am desperate to know if it's from the withdrawing from Cymbalta or if it's my original condition returning .
Any information from your findings will be imperative to those of us who are suffering without any help from a doctor .
Please keep us informed of your progress.
I pray for your good health ..

[thismoment]

Dr X

It IS depression and anxiety coming back and it is real, but why is it here now? It's either the original condition or it's withdrawal. Remember, your brain will do and say anything to convince you to take that capsule of Cymbalta.

If a particular symptom resonates with you, don't be surprised if your mind utilizes that symptom to motivate you to pop the pill. That's addiction and withdrawal- your brain needs you to be on the drug.

Take care.

[gail]

Fishinghat, I have read and reread your explanation on glutamate, Could you , in a few words, tell me what is glutamate? If I understand right, this is the culprit causing fear, panic and anxiety. Am I right?

[fishinghat]

Gail, glutamate is a neurotransmitter just like serotonin, adrenaline, dopamine,.....

 

In fact glutamate is the most common neurotransmitter. Each transmitter reacts with certain nerve cells to produce a signal to the brain for a certain response. Some make us feel pain, others sadness, fear, happiness, etc. Glutamate is an 'excitatory' neurotransmitter. It is common in the brain BUT the majority of it is stored in cells until needed. One of the effect of ssri/snri is to increase glutamate OUTSIDE the cells where it can react with the nerves. Another effect of ssri/snri is to increase the number of neuroreceptors.  When taking an ssri/snri they tie up these nerve cells and the glutamate produces little problems. But once the ssri/snri is removed (withdrawal) they are no longer bonding to the nerves and the glutamate has a clear shot at these open neuroreceptors.  Chaos.

 

Will these nerves repair themselves? No one knows. Our history shows almost no healing of the affected areas after trauma (say a car accident). But this is different. There needs to be a lot more research before we can figure out how to deal with this.

 

Sorry, not really a short answer. If you have any other questions ley me know.

[gail]

Oh my! read and reread again, simply said, it means that the glutamate is free to do whatever it wants to do, create panic, fear, unease or any other symptom that is quite unbearable , withdrawal would be caused by this mostly. Am I right?

 

If so, what can we do to limit the shit it's doing to us? And most of all, are doctors aware of this?

 

And what is a beta blocker, can it help?

 

And will this glutamate calm down by it's own in due time if you take nothing for it ? thanks for informations, this is real interesting.

[fishinghat]

You are right. Once the ssri or snri is out of the way glutamate can move in and create havoc.

 

This would strongly add to the withdrawal, yes.

 

The only way to limit the effect is to avoid taking ssri/snri in the first place. Once you start on them then the changes start taking place in the brain and there is no way I have heard of to control glutamate.

 

No, most dr are not aware of this. This has all come out in the last 12 to 14 months and most drs simply don't have the time to read the hundreds of research articles  that are published each month..

 

There are two receptors that will react with adrenaline, the alpha and the beta receptor. A beta-blocker stops adrenaline from attaching to the beta site. In other words it blocks the use of some adrenaline. Mostly beta blockers is useful in our body and is not easily absorbed in the brain.

 

Will it work? If this research is true then it will not affect the glutamate problem. BUT what else is going on in our body. With withdrawal we become very stressed, especially if fear is present. Fear causes an increase in adrenaline and the beta blockers would help that issue. As you can see it is a very complicated issue. This does npt even consider the other neurotransmitters like serotonin and many others.

[Tbird]

Okay.  So are we messed up for life then?  I mean I am taking Cymbalta due to Fibromyalgia, Depression, and Anxiety Disorders.  On top of the illnesses I have, the withdrawals and all that stuff that was mentioned by you all, will it only make what we have worst now?  Have we screwed up our bodies from taking Cymbalta and have made our other illnesses worst?  Confused o..O.

[xman]

Dazed glazed and confused, is how I feel most of the time of late. I am approximately 9 weeks from cold turkey r/t crapalta and have had a sustained head ache, trouble concentration (for you docs out there ACLS tomorrow), sweating/ hot flashes not r/t menopause, and yes I confess to chest pain. It has been episodic and I do not have any other risk factors. I attribute it to crapalta. Since the neurotransmitters are trying to recruit or compensate, I am hypothesizing that I will continue to feel this way for awhile.

 

Anyone who has not reported to the FDA or your country's Drug regulatory agency (or at least to Lilly ) should think about doing so in order to bring about change.

[fishinghat]

Now this is just my opinion but....we have had many conversations on this site about how long the withdrawal lasts and I have seen it go from 2 months to 2 years. But I have noticed a pattern The majority (70%?) of the people on this site who still have symptoms after 6 months or more are over 50. Last night I got on the FDA website and looked at the trends for reported side effects. They run pretty consistant that about 30% of the reports are from 20 to 50 years in age. And about 70% are 50 or older. If the side effects are that obviously linked to age then why not the withdrawal effects too.

 

Have we screwed up our bodies, simply yes BUT ...I would suggest that the younger you are the more likely you are to recover. Research shows that full damage to the nerves takes up to 2 months so I would say those people would probably heal. For us with the long term problems and are over 50 I would suggest that 2 to 3 years to heal just based on what I have seen on this site. Now all of this is just an educated guess but there does seem to be a pattern.

[Wagtail]

Now this is just my opinion but....we have had many conversations on this site about how long the withdrawal lasts and I have seen it go from 2 months to 2 years. But I have noticed a pattern The majority (70%?) of the people on this site who still have symptoms after 6 months or more are over 50. Last night I got on the FDA website and looked at the trends for reported side effects. They run pretty consistant that about 30% of the reports are from 20 to 50 years in age. And about 70% are 50 or older. If the side effects are that obviously linked to age then why not the withdrawal effects too.
 
Have we screwed up our bodies, simply yes BUT ...I would suggest that the younger you are the more likely you are to recover. Research shows that full damage to the nerves takes up to 2 months so I would say those people would probably heal. For us with the long term problems and are over 50 I would suggest that 2 to 3 years to heal just based on what I have seen on this site. Now all of this is just an educated guess but there does seem to be a pattern.

That makes sense to me , & Im one of the 70%.
I'm happy to think that the younger of us may not have ruined their lives by taking the CRAPALTA.

[gail]

^{Geez, what a mess}

[gail]

My computor is is withdrawal, back when it calms down.

[FiveNotions]

Fishinghat and Dr X,

Another question about glutamate..... I thought that if the brain is functioning properly (and mine surely isn't), the chaos of glutamate is balanced by the calming effect of GABA.....sort of like nature's benzodiazepines ..... I thought it acts on the same receptors....?

"GABA and glutamate: the balancing act of the nervous system"
http://neuroendoimmu...nervous-system/

I've recently started taking small (100 mg or a bit less) of GABA when I start to feel anxiety coming on...maybe I'm just enjoying the placebo effect? but it seems to help me a lot...... (Please don't try this without researching it for yourself, and if you do try it, start with tiny doses...it's strong stuff and some people have adverse reactions to it.)

Fascinating discussion!

[fishinghat]

In general you are right. The research shows a 4 to 10 fold increase in extracellular glutamate but no comments on changes (if any) in GABA levels. I can't wait for this research to run its course and fill in a lot of the banks. It has been shown hat the Calcium channels have been altered as well by ssri. So what. What is the net affect of this?

[fishinghat]

Well, well, look at what I found. A research article, that if I read correctly shows that 75% of the time that the hippocampus is exposed to antidepressants the gaba activity is drastically reduced.

 

http://www.jneurosci...2/47/16616.long

 

That is just one article so I am going to do some more digging.

[fishinghat]

Well I found more.

 

http://www.antidepressantsfacts.com/SSRIs-not-selective-GABA.htm

Anti-D raised gaba

http://www.ncbi.nlm.nih.gov/pubmed/15451391

Anti-D lowered gaba

http://ajp.psychiatryonline.org/article.aspx?articleid=175472

Anti-D raised gaba

 

There are more contradictory articles out there but this illustrates that the researchers are confused. By the way, if you actually read these, the cerebral cortex is where the hippocampus is found.

[FiveNotions]

Excellent article, FH.....

And, Fishinghat, in another recent thread where we were discussing GABA you pointed out that a GABA supplement in and of itself won't cross the blood brain barrier.....and that's when you mention using phenibut or picamilon.....

https://www.cymbalta...rier#entry38654

My own experience however seems to be different....the GABA supplement I've been taking, even if it doesn't cross the BBB, has a noticeably calming anxiolytics effect..... As I said above, perhaps it's placebo....but, I'm fine with whatever convinces my brain to chill out....

[fishinghat]

You know the old saying...If it works don't fix it.  I would be curious to know if it is an emotional calming or a physical calming (slower heart rate, BP, etc.) As far as not crossing the bbb, that is the researchers words and there has been a lot of work done on it. As a biologist it is very interesting but God knows we are just scrapping the top of all the chemical operations n the brain.

[Xanazul]

Good evening. For those of you interested in glutamatergic synapses and its role in mood changes/anxiety, as well as their possibilities as targets for new antidepressants this is the simpliest, more comprehensive review I was able to find in PubMed with open access: http://www.ncbi.nlm....nihms318867.pdf
As you may read it is becoming quite clear that Glutamatergic or GABAnergic rather than monoaminergic synapses are the important ones in the circuitry involved in emotional reactions. Also there are growing evidences that both in ssri/snri effects are mediated through changes in the glutamatergic/GANAnergic system rather than through direct effects on monoaminergic receptors.
FiveNotions: talking GABA will not do anything other than placebo effects to you, it could not posible do it. For neurotransmitters to do their job, they have to be synthetized in the presynaptic membrane, delivered at the adequate times (that are measured in a milisecond scale) and amounts and thereafter interact with the appropriare receptor at the postsynaptic membrane. For these and many other reasons that would be too long to enumerate I believe that is useless to take GABA (as useless as taking serotonine.
As for me my BP is under control with beta and alpha blockers and the remaining symptoms I guess that unbearable as they are, I will just have wait until brain plasticity (not as good as if I was 30, but existing nevertheless) does its job.

[Xanazul]

PS: I am writing from Spain, so please do not pay much attention to the multiple misspelings. My automatic text corrector is in spanish
:-P

[fishinghat]

Don't feel bad for your English. I am writing mine in English from America and have more misspellings than you. lol

[FiveNotions]

Well, Xanazul, with all due respect to you as a doctor, if it's just a placebo effect, that is fine with me . . . far preferable to taking Cymbalta, which came close to destroying me. ;-)

Fishinghat, in response to your question about GABA and physical effects like bp, etc.... yes, I believe it has helped both bp and pulse to further normalize ...I've also been able to stop using Lunesta for insomnia .... and the physical effects of anxiety/panic like shaking, diaphragm spasms, etc. are nicely under control....

I can't prove it of course, perhaps it's also just the placebo effect ... but again, if so, I'm content with that ...

I base this on the following .... not scientific, not doctor-approved, but my own experience and observation ....

Before Cymbalta, my bp ran about 110/70 and pulse 68-72 .... on the low side, but felt just fine and no concerns from my docs.

Cymbalta caused me to have hypertension and tachycardia .... by the time I was put on meds for these issues, my average bp was 170/120 and pulse was 100-110 or so.... (I specifically asked my gp if this could be a side effect of Cymbalta, and was laughed at.)

So, when I quit Cymbalta I kept taking the heart meds, not knowing that without Cymbalta my bp and pulse would come down.

As a result, I went into a tailspin... hypotension and bradychardia .... e.g., 100/60 bp and 54 pulse .... fainting became a regular activity....

That's when I started my own research, learned about the side effects of the poison and found this website.

I immediately stopped the heart meds. (Yeah, I know ... dumb and dangerous.) Within a week my bp dropped to an average of 150/100 and pulse to 76-80....

By about 2 months off Cymbalta, I was averaging bp of 130/80 and pulse of 72-74....

Since I've been taking GABA my bp is back down to 110/70 or a bit higher and my pulse is running around 68-72 again ....

Edited by FiveNotions, 12 April 2014 - 03:15 PM.