30 replies to this topic

[downtongirl]

I feel drunk...I have vertigo and am so tired.  4 days ago I also went back up to my normal dosage of trazadone of 100 mg.  I am not sure if I need to go to the clinic or not.  There is no way I can work like this.  I don't even feel comfortable driving.  I feel like I am in a transe.  Please help.

[thismoment]

DTG

 

Yes the Trazodone is an SARI, a hypnotic sleep-inducing drug. That's what's causing lt. And you shouldn't be driving. And yes you are in a trance. And no you can't work like this.

 

The best suggestion: Find a place where it's safe to sleep it off. Then reduce the Trazodone. Bring the doctor on board with your withdrawal plans if you haven't already done so.

[FiveNotions]

Hi DTG,

First, let's confirm your meds and doses and the changes you've recently made ....

based on your meds and what you've told us, you're dealing with anxiety and, I'm assuming depression? (If you've already posted this, I apologize for missing it.)

In your very first post on June 29th you said:

"It took me a year to taper off of Effexor by going onto buspar and Prozac. This is my second time being on Cymbalta. I hate medicines to say the least. I have had a few psychiatric hospitalizations after massive panic attacks. Last summer I reached what I believe to be klonopin tolerance. I have been in withdrawals for a year. I took my last klonopin on April 9th, 2014. I was put back on Cymbalta in late November 2013. I was also put on risperidone and gabapentin for anxiety in March and April of this year. I took my last dose of risperidone on May 30th and my last gabapentin on June 13th. My current medications are supposed to be 60 mg of Cymbalta and 50 mg of trazadone and 1 mg of estradiol."

You've been on Effexor, and got off by tapering/crossing over to buspar and Prozac.
You've been on Cymbalta before.
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You went back on Cymbalta 60 mg. in November 2013, I assume this was to replace the buspar and Prozac?
You were on klonopin for anxiety for a longer period of time, and have been getting off of it for a year, since spring of 2013....
You were put on risperidone for anxiety in March 2014
You were put on gabapentin for anxiety in April 2014
You are taking trazadone 50 mg
You are taking estradiol 1 mg.

You took your last klonopin on 4/9/2014, after, I assume based on your first post, tapering for about a year
You quit risperidone on 5/30/14
You quit gabapentin on 6/13/14
You reduced the Cymbalta from 60 to 30 mg on 6/28

Your phrasing leads me to assume that you may have quit the risperidone and gabapentin cold turke.

Each of these drugs, klonopin, risperidone and gabapentin have associated withdrawal syndromes, of varying length and severity. Getting off just one of them, much less all three, even if one tapers gradually, is massively disruptive to the CNS and hard on both the brain and the body.
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The large reduction in Cymbalta dose was the also the equivalent of quitting cold turkey and put you into hard withdrawal.
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You reinstated the Cymbalta at 60 mg. on 7/3

It will take a week to several weeks for the 60 mg Cymbalta dosage to kick back in, during which time you'll continue to have withdrawal/discontinuation effects due to your immediate drop from 60 to 30 mg.
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You increased the trazadone to 100 mg. on 7/3

This is double your prescribed daily dose of 50 mg.
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Is my understanding, summary, correct?

Have you discussed each of these changes, quitting the drugs, changing the doses (Cymbalta and trazadone, etc) with your doctor?

If so, can you see the massive changes you have, are, putting your CNS through?

Is it any wonder that you're experiencing anxiety, and having other withdrawal/discontinuation effects? And with so many drugs seemingly in the mix, how can you be sure which effect is related to which drug?
-----------------
I'm gettin' kinda' worried about you here,

[FiveNotions]

DTG, TM is correct....

Do. Not. Drive.
Do. Not. Work.
Do not take more trazodone!
Sleep it off.


I just checked, and there's a "MAJOR interaction" warning for the use of Cymbalta and trazodone simultaneously.... serotonin syndrome ! ! !

You've just gone back up to 60 mg. Cymbalta, and you've taken double (100 mg) of your recommended dose (50 mg) of trazodone ....

You're playing with fire here....

http://www.drugs.com...273-2228-0.html
"Talk to your doctor before using traZODone together with DULoxetine. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms while taking the medications."

[TryinginFL]

FN...

 

I found your last post of extreme interest!  My PCP had me on both Crapalta and Trazodone...   what was he thinking, or wasn't he?  I consider myself fortunate that I didn't have any serious problems.  (60 mg Cym and 50 mg Traz).  Maybe the dosages weren't high enough in his opinion, but it is with much relief that I am now off of both.

 

Yes, even this new PCP is an idiot   ....and he only saw me once while I was taking both meds!

[downtongirl]

what are the symptoms of serotonin syndrome?

[downtongirl]

I just looked up the treatment for serotonin syndrome and it said to discontinue the medicines you are taking....if I went to the doctor and he decided to do that I don't think I could handle it...how could they just stop the Cymbalta cold turkey on me and send me home

[thismoment]

DTG

 

". . . how could they just stop the Cymbalta cold turkey on me and send me home?"

 

It's because the doctors don't know any different- they are just overworked employees in the medical industry doing what they were believe is right with the limited knowledge they have.  They are not researchers, scientists, saints, bloggers, or internet surfers. They've got kids in schools and universities and many of them are on second spouses and second mortgages.

 

DTG you have to become your own medical advocate! That's what this forum is, and many others like it-- these are groups of self-advocates. Without groups like this we would be totally on our own, and you'd be thinking your condition was all your fault.

 

It's not your fault: your current drug-adled condition has been created by greedy bastards cooking expensive drugs that cannot be escaped. And these greedy bastards control government, media, and the physicians. That's why you need to be your own advocate or a member of an advocacy group like this.

 

And unless we stand up (at least a little) on our own two wobbly feet, we will be lost as a statistic. We need each other, and you need yourself to be as fierce and committed as you can be to push through this. 

 

Take care!!

[TryinginFL]

DTG...

 

Can you not discontinue the Trazodone?  Stay on the Cymbalta...

[FiveNotions]

DTG,

Why did you take a double dose of the Trazodone, 100 mg instead of 50 mg?

Did you quit the risperidone and gabapentin cold turkey?

Did you talk to your doc about any of this?

TM is correct, we have to be our own advocates....which includes researching and reading about each and every drug we take .... and researching the withdrawal effects and how to withdraw if we decide to do so...

Please take care of yourself!

[FiveNotions]

TFL, if I recall, you said somewhere here that your dosing schedule was to take the Cymbalta in the morning and the trazodone at night, for insomnia .... that would keep the drugs far enuf apart time-wise to reduce the risk of SS...

Also, 50 mg is a low dose (lowest?) of trazodone ....which is what's often prescribed for insomnia...

That's why I asked DTG why she doubled her recommended dose to 100mg....

also, her post seemed to indicate that she'd taken both the 60 mg Cymbalta and the 100 mg trazodone at the same time...

Here's an interesting Consumer Reports article about trazodone...it raises questions as to whther trazodone was ever very good as a depression treatment, and whether its "off label" use as a sleep aid has any benefit...

http://www.consumerr...ssant/index.htm

[TryinginFL]

FN...

 

Very interesting article!  I honestly don't remember what I may have said about the Cym and Traz dosing..6 months ago seems like 6 years somehow...

 

I do remember having 30mg Cym with RX to take twice daily but that may have been when I first started it...seems as if I was on Trazodone forever, though.  I just remember having a shxxload of pills lined up every night and I was so into getting off of everything I could!  I'm afraid the Alprazolam will remain a crutch for a long time to come...

[FiveNotions]

TFL, truly doesn't matter for you about the trazodone, as you've gotten off that now...as for the alprazolam, that's not worth worrying about now ... when the time comes, you'll be able to get off of it...you've got a pretty "atypical" response to it, your doses are high or frequent, and it'll be pretty straight forward to set up a weaning plan...also, I think valium can be used as a "cross over" while you reduce the alprazolam....

nah, youe current issue is whether or not to get that ipod for the plane trip(s)!

[fishinghat]

what are the symptoms of serotonin syndrome?

 

They are as follows;

 

Signs and symptoms[edit]

Symptom onset is usually rapid, often occurring within minutes. Serotonin syndrome encompasses a wide range of clinical findings. Mild symptoms may only consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), as well as overresponsive reflexes.^[1] Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia; a temperature as high as 40 °C (104 °F) is common in moderate intoxication. The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs. Mental status changes include hypervigilance and agitation.^[1] Severe symptoms include severe increases in heart rate and blood pressure that may lead to shock. Temperature may rise to above 41.1 °C (106.0 °F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation; these effects usually arising as a consequence of hyperthermia.^[1][3]

The symptoms are often described as a clinical triad of abnormalities:^[1][5]

• Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
• Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
• Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

 

The 104 to 106 temp is a give away that you have serotonin syndrome.

[downtongirl]

Ok fivenotions gonna try and answer some of your questions....

 

1.  Stopped klonopin after a taper on April 9th

2.  Stopped .5 mg 1 x a day of risperidone after 8 weeks on May 31st

3.  Reduced 100 mg of trazadone to 50 mg on May 30th

4.  Dr. increased Cymbalta to 90 mg on May 30th

5.  Decreased Cymbalta back to 60 mg on June 7th due to fatigue

6.  Stopped 300 mg of gabapentin after 6 weeks of use for anxiety on June 13th

7.  June 17th decreased Cymbalta to 30 mg

8.  June 20th went back up to 60 mg of Cymbalta due to withdrawals

9.  June 28th tried to go back down to 30 mg of Cymbalta

10. July 3rd had to go back up to 60 mg of Cymbalta and 100 mg of Trazadone due to lack of sleep and withdrawals

 

I take the trazadone for sleep.  I have for several years.  I know I should not play around with my meds and I have really screwed up and I regret it big time but I have been telling my doctors for almost a year that I think the medicines are doing more harm than they are good and I want off.  I have been telling my current psychiatrist that the Cymbalta makes me very anxious for a while after I take it each day.  He has told me to stop playing doctor but his solution is adding more medicine not taking it away.  I appreciate all of your help. 

[downtongirl]

I know it is just frustrating how they will start someone on a psychiatric medicine or stop them on a psychiatric medicine in the hospital after a few days to a week or so and then send them home.  That is not enough time for them to really see how the medicine is going to affect them but I know hospitals have very limited space and most hospitals don't see people trying to adjust or get off of these medicines as a priority.  It's a shame.

[downtongirl]

I am supposed to go back to see my doctor Wednesday any suggestions as to what I should say to him?

[thismoment]

DTG

 

"(Doctors and). . . hospitals don't see people trying to adjust or get off of these medicines as a priority.  It's a shame."

 

Absolutely right, and it will take some years for this to happen- it's all too new! This epidemic only began about 25 years ago, and considering that the power group is well-established in industry, government, the media, and indeed within the psyche of the culture (take a pill and be happy), it will have to get a lot worse before it gets better. 

 

Fluoxetine (Prozac) was approved in 1987 and Duloxetine (Cymbalta) in 2004. It's all very recent, and all the first-time users that didn't die in car crashes or kill themselves are still alive today. They (and we) represent the only Long-Term SSRI/SNRI users that have ever lived; we're still inside that experiment!

[thismoment]

DTG

 

Ask the doctor if he's having a nice day. Ask him what he would do if he were you; I'm serious- you need an ally.

 

You need to go on a 6-month-long vacation- a beautiful and safe retreat where you have compassionate caregivers around the clock. There will be a balanced diet of clean food and plenty of water. You will have daily access to a therapist, a yoga instructor, a dietician, a Mindfulness Meditation instructor, and group discussions. There are no drugs.

 

These places exist. 

[FiveNotions]

How many times have you been hospitalized, and when? Was it for panic attacks each time?

Are you saying that that's when some of these meds were added? Was your regular doc involved in the hospitalizations?

Subject big time to what FH and TM think, I suggest you need to tell the doc at your appointment is that you feel you're on too many medicines, you'd like to get off of as many of them as possible, esp. the Cymbalta, but first you want to get back to being stable and then from that place of stability you want to make a reasoned decision and plan on how to proceed.

I also suggest that you need write down and give to the doc (keeping a copy for yourself) a chronology of the meds and doses you've been taking, showing the changes you've made on your own, as well as what was done wrt meds in the hospitalizations and by your doc in office visits.... you can use the info from this thread, in fact....

And, my last suggestion is that you be firm and insistent on this with your doc....be your own advocate....

[downtongirl]

Yes that would be nice but I don't have access to that kind of money

[downtongirl]

Fivenotions...everything you suggested is good and reasonable.  My doctor suggested at my last appointment that I let someone else take over my care because I want to make too many changes so I am afraid this week he will fire me as a patient. 

 

I have been in the psych hospitals before and yes they were all the result of major panic attacks.  I have much more problems of panic/anxiety than depression although I think my depression is a result of my panic/anxiety.  My last hospitalization was back in the winter just before I started seeing my current psychiatrist.  I was having so much anxiety that he added the risperidone for anxiety.  It worked pretty well at first.  I did not want to go on it because I had researched the side effects but I did buckle to the advice of my doctor.  The gabapentin had been suggested by a dr. while in the hospital in the winter and was suggested also by my current psychiatrist in late winter.  I had gone to see a neurologist about face numbness and pain and he wrote a script for gabapentin.  I took one dose at night and while it made me relaxed I was just uncomfortable adding yet another medication so I did not take it again untilI had a massive panic attack in late April.  I took one and kept on taking it at 300 mg 2 x a day even though the neurologist had prescribed it at 300 mg 3 times a day but I knew that would be too sedating so I just kept it to morning and night time.  I told my psychiatrist I was taking it and he was ok with it.  I hope that cleared up your questions.

[FiveNotions]

Ah, that last info helps a lot, DTG....

Well, your current doc may be a jackass, but right now he's the only jackass you've got, so to speak...

So, why not try to avoid having him "fire you" .... and just explain to him (I'm sure you've already done this at least once) yet again ... calmly and firmly .... that:

Getting the panic and depression under control and yourself back to being stable and healthy is your number one priority.

You understand completely his concern and frustration about all the changes you've tried to make on your own....and you won't do this again.

It's just that you're so very very concerned, and frightened, at how many different medicines you seem to have ended up on, and you're frightened of ending up in the hospital again....

This fear and concern about the meds is making your underlying anxiety and depression issue worse.

You want him to help you sort out all the meds and doses/dosing schedules in such a way that you can get off of as many as possible, and stay on just the one or two meds, and at the lowest possible doses, that work the best for you.

Tell him (if this is correct), that it's the Cymbalta that you're the most worried about, because you think you feel worse on it and it's not helping....and that's why you tried to get off it on your own.

Ask him if there are alternatives to treat anxiety that have fewer side effects while taking them and fewer withdrawal issues. (Clonidine, hydroxyzine, a different benzo, etc.

Tell him you want to remove just one med from your "cocktail" at a time... slowly weaning off, not rapidly, so you and he can carefully monitor how you respond...

Ask him which med he thinks you should wean off of first, and to give you a plan for how to do it.
---------
Then, when you come home from the doc, research the shit out of the drug he's suggested weaning first, focusing on its withdrawal/discontinuation effects....and check in here to see what we all know about it and can share/suggest....

Compare what the doc suggests as a plan for weaning off the drug with your research and what you learn here....

Either he'll have suggested something that corresponds with your research/our experience, or he'll have suggested something that seems off-base....

Depending on which of the outcomes you arrive at, you'll be able to figure out what to do next....

[downtongirl]

That sounds like a good plan five notions.  I'll give it a try.  I don't think he believes in withdrawals because at my last appointment I told him I thought I had protracted withdrawals from the klonopin and he said he did not believe in that.  I have a feeling any withdrawal side effect I bring up to him he will not believe me.  You are right he is the only jack ass I have.

[FiveNotions]

Another thought, DTG, is that you start keeping a journal of all this info...TM suggested this to someone else on another thread here recently....it's something I used to do, then stopped, and am now doing again because of the Knox Ricksen legal case I'm participating in...

[FiveNotions]

I know, DTG...most docs just don't acknowledge extended or hard withdrawals/discontinuations...for Cymbalta or most other drugs...I was venting/ranting elsewhere here about that recently...

Either TM or FH, or maybe both, suggested I just not force that issue with my own jackass...not try to convince them this exists, etc....but to sorta just use the doc to my best advantage...

Another possibility to consider is to replace the Cymbalta with a different ssri...for example, you've already been on Prozac...did that help?

[downtongirl]

Yes it did help for a while...It looks like on this forum that people have also used Lexapro, celexa, and Zoloft when tapering off of Cymbalta.  Did you use another medicine to taper off or did you do the bead counting?

[FiveNotions]

No, DTG... I quit cold turkey...60 mg a day for 7-8 years...down to zero in one day...12/4/2013.... I'd lost my health insurance, ended up on Medicaid, went to a neighborhood Medicaid clinic... the doc there put me on the generic Cymbalta...I took just one generic capsule and got violently ill ... I immediately called and left an emergency message (or 2 or 3, memory is still messed up) for the doc..he never called me, and the clinic told me to just go to the ER....So, I went cold turkey on my own, alone ...except for one friend who checked on me a couple times a week...

Cold turkey Cymbalta withdrawal was hell...

And I came through it, I survived...in large part because I found this forum...and the wonderful people here really did save my life....

[downtongirl]

Wow!  Sorry to hear about that ordeal fivenotions.  That was horrible treatment of you.  Were you able to work after you went c/t?

[FiveNotions]

I had left my last job (librarian) last June. I'd intended to take a few months off, travel, read, relax...then get another job and be back at work around December or so... well, withdrawal hit, and blessedly I wasn't working so I've been able to have the time to get through this...so no, I haven't worked since last June...and I really haven't felt able to do so...yet...