44 replies to this topic

[ralphi]

Hi all,

I got on 20mg of this drug for panic attacks due to Lyme disease around November 2011. Stayed at 20mg since then.
My doctor wanted me to cross taper with Remeron, since I have had horrible nausea, also due to Lyme disease.
She wanted me to just do a quick 2-week cross taper, but I asked if I could do 4 weeks instead.

My first taper was 15mg Cymbalta and about 2 mg Remeron on Oct. 15. Did ok, had some mild nausea, diarrhea, anxiety days 2 and 3 but then levelled out. Second taper was 10/21 10mg Cymbalta and (about) 3.75mg Remeron, did great with that one. Third taper was 10/27 and was 5mg Cymbalta and around 5.5 mg Remeron. Withdrawal started day 3. Nausea, high anxiety, dizziness, fast heart rate, clammy, diarrhea, etc. Yesterday I increased the Cymbalta to 7.5mg but still feel awful today.

When will I start feeling better?

1) Can a delayed withdrawal response occur? I'm not sure what's going on here. Could it be that I decreased a higher *percentage* of the current dose
2) What do I do now? Wait it out? I've read about long-term consequences and want to avoid those at all costs.
3) I'm planning to add the rest of the Remeron on Wed. and slowly taper off the Cymbalta. What's the ideal tapering schedule? I'd like to get off this drug so I can resume Lyme treatment asap, but also want to avoid long-term issues. 7.5mg is 45 beads in my generic capsule. 5 mg is 30 beads.

Thanks in advance!!!

[fishinghat]

Welcome Rlphi

 

You did the right thing by going with the slower cross over.

 

To answer your questions;

 

"When will I start feeling better?"  I would say some where around day 3 or 4.

 

1) Not only can it but it usually does have a delayed response. Most Cymbalta withdrawal last several months past the last dose. Now with the cross tapering that type of long term effect should not occur but definitely possible for delayed effects.

2) I would wait it out until you stabilize on 7.5 mg Dose. Meanwhile keep adjusting your Remeron as you had scheduled. It should help with the Cymbalta side effects. Listen to your body and it will tell you when you feel strong enough to try and drop back to 5 mg on the Cymbalta. IF the Remeron does not fully control the Cymbalta withdrawal then you might ask you dr for either a benzo (addictive and I do not recommend unless a last resort), clonidine or hydroxyzine.

3) The best rate to start with is dropping 3 beads a day and see how you handle that. Be sure and stabilize at 7.5 mg first. If things go well then you can try dropping 4 beads a day. Again, listen to your body. If symptoms start to build then stay at your existing dose to stabile before dropping again.

 

I am going to look up some data on this type of cross over and will be back to post soon.

 

Hang in there I think your goals are rational and possible depending on how well Remeron handles the Cymbalta withdrawal symptoms.

[fishinghat]

Some extra info...

Remeron (also known as Mirtazapine), a noradrenergic and specific antidepressant, is very affective in treating many withdrawals. It takes one to two weeks to show significant benefits. It has shown to be more effective and/or just effective for depression and anxiety than ssris or snris. Its side effects and withdrawal is similar to ssri and snris.

[fishinghat]

I would imagine that TFL will come on here later and post about the withdrawal from Remeron and how severe it can be. Some daya down the road that may be a concern. Also I noticed that Remeron is often prescribed off label for sleep. I am assuming that you are taking this med at night as it can cause a lot of drowsiness.

[ralphi]

Thanks for all that valuable info, fishinghat!
I do have Ativan to take as needed, though I try not to take more than 1 mg per day. Have weaned off of it a few times in the past successfully. I think the way my liver works (or doesn't work, rather) gives it a longer half-life, which is actually a benefit when weaning off!

Yeah, I wasn't thrilled to get on another SNRI, but my chronic nausea was becoming untreatable with everything I threw at it (even cocktails of Ativan/Zofran/Phenergan, and synthetic m********).  Remeron has helped a great deal with sleep (also have some insomnia) and nausea so far. The goal is 7.5mg, which is considered subtherapeutic for anxiety/depression. If I still have lingering anxiety after getting off Cymbalta, I suppose I could go up on the Remeron. I do have a pharmacist friend who says she can compound into a liquid when the time comes to get off of it. 

By dropping 3 beads per day, do you mean 3 on the first day, 6 on second day, 9 on third day, etc?
Thanks again!  
Ralphi

M******* = pot, lol

[fishinghat]

Got the M reference Ralphi, lol

 

Yes, take out 3 beads the first day, 6 the second, etc.

 

The use of the liquid to come off the Remeron, when the time comes, is great!!

 

Sounds like you are well on the way. Keep us posted.

[gail]

Hi Ralphi,

Just wanted to welcome you to the forum. I know nothing about Remeron, but Fishinghat knows this stuff, he's the med. Man. Not the mad but the med...and he knows a lot.

[TryinginFL]

Welcome Ralphi!

 

 

I went cold turkey off of 60mg of C in Jan of 2014.  I knew nothing about withdrawal or this forum.  When I found my way here it was too late to go back on the poison and bead count slowly.  I spent one hell of a year...

 

You are definitely doing the right thing! 

 

I think I am being confused with someone else as I never took Remeron, but FH is the one with the info!

 

Please let us know how things are going - we're here for you!

 

 

Liz

[ralphi]

Thanks so much, everyone! It's SO comforting to know you are out there.

It's sad that we have to turn to the internet for advice, but being a chronic Lyme disease patient for 4 years, I've learned to appreciate others' experiences and advice a lot more than most doctors!
Added in the last bit of Remeron tonight, so 7.5mg Remeron and 7.5 Cymbalta. Will see how that goes for the next week or so--have house guests coming from Taiwain (!) in a week and want to be in as good a shape as possible to host them. Once they're gone and everything has levelled off a bit, will reduce as FH suggested. Should not take long, with only 45 pellets :-)

Also wanted to add that I got on this drug in 2011 as a brand name and was told nothing about withdrawal effects. Not sure I want to get into the legal part of it to get my $3 or whatever compensation is being offered, but I would like to be added to the list of folks who have suffered, so people know. Anybody know off the top of their head where I can sign something saying "me too"? Thanks again.

[TryinginFL]

Hi again Ralphi!

 

I have a dear friend who this past spring was trying to come off Remeron - She at first tried cold turkey, and she ended up in the psych ward for 5 days.  Really a mess.

 

When we talked, we commiserated that our withdrawal symptoms were very similar.  No motivation,  loss of memory and horrible anxiety, to name a few. Both of us were on a Benzo and questioned whether we would every return to normal.  She is still on some meds (not sure what right now) as I am now on Bupropion.  Some of us just need something - I had been off the C for approximately 17 months and couldn't seem to get it together.

 

We have a dear member, thismoment, who always said that it is the "quality of life" that matters - with or with out meds.  The object is not to say that "I am med-free".  How right he is.

[ralphi]

Thanks for that info, TryinginFL!

I am second-guessing my decision to get off the Cymbalta to begin with. Just finished day 5 of feeling super awful...day 2 after going back up to 7.5mg. Maybe I should increase the dose to the last amount that I felt ok? (10mg)? Trying to figure out if this is still withdrawal or whether I just need the med to function right now. My doctor is no help here; after my withdrawal reaction, she thinks I should stay on the 20mg WITH the 7.5 Remeron.

I got on Cymbalta, as I said, for panic attacks brought on my Lyme disease. Have done a lot of treatment between now and then, and panic attacks were all but nonexistent the past year or so. Maybe it was just the drug keeping them down, and not the treatment?

[fishinghat]

Don't panic yet ralphi!! It takes a few days to a week to stabilize. If you are not feeling better by then, you can consider going up more but I bet you will improve.

[ralphi]

Thanks FH! Is that usually a week after symptoms start or after discontinuing the med? I'm assuming it's the latter :-)
Has been 8 days since I got off the higher dose...sigh.

[fishinghat]

What I was referring to Ralphi was ....

"day 2 after going back up to 7.5mg. Maybe I should increase the dose to the last amount that I felt ok? (10mg)?"

 

In other words 2 days back up to 7.5 mg isn't enough time to get stable. Give it a week before considering going back to 10 mg.

[ralphi]

Ah, thank you! Makes sense. My brain isn't working as well as it should...go figure ;-)

[ralphi]

Feeling a little better today! Almost 5pm and have not had to take Ativan yet! I also have an appointment tomorrow with an NP, which I guess I don't really need now (hopefully) but it never hurts to get some moral support and a checkup...

[fishinghat]

Good

Another few days and you will be ready to start dropping again.

[ralphi]

45 beads to go! Will probably start with 1 bead per day, because I'm chicken now

[TryinginFL]

You're doing great, Ralphi!

 

Start with the 1 bead - you know that you can increase if you are doing well.

 

Hang in there!!

[fishinghat]

Sounds like a plan!!

[ralphi]

Haha, went to a new NP today who said to just quit the Cymbalta (and never, ever open the capsule), double my Remeron, and take as much Ativan as I wanted because it's not addictive. That was helpful.

[gail]

Oh my God! You sure he's a real doctor?

My hair is standing straight up! As much ativan as you need, oh boy! Not addictive? Wow, I can't believe that he's a doc.

Dr Hat will remidate to this, I am sure!

[ralphi]

Lol! She was an NP; the other doc in the group seems legit, but was out of town this week. At least now I know not to go to her again! Had a panic attack right there in the office while she interrogated me regarding my Lyme disease diagnosis.

[fishinghat]

Fire her that is for sure. A lot of idiots and morons in the medical field. I am very glad you are not going back to see her!! 

 

Only God knows how many drs (both medical and psych) that I have left over the years. Last year my primary retired and I went through 3 drs before I found one that is half way decent (so far).

 

Keep on keeping on ralphi. The light waits at the end of the tunnel.

[ralphi]

Thanks FH! The regular doctor left me a message saying to slow down the taper, that what I'm experiencing is normal and it will pass. Seems a little more sensible! And yeah, just because someone has the degree doesn't me he/she knows their stuff or will listen...

[gail]

Sorry, I guess NP must stand for Nurse practionner?

French speaking here, I don't know all the terms. But nut is the good adjective for your NP.

Thank God, your regular Dr seems better!

[TryinginFL]

Just had to stick my 2 cents in here...

 

What an idiot Dr.!!!  I really wish that we could put them on this crap for a year or so and then tell them to just stop

[ralphi]

For real! She said she used to work in a nursing home and put "all her patients on Vitamin R" (remeron). Wouldn't you hate to be in a facility under her care and have no other option ?! :-(

[gail]

My hair is still standing up straight!

[ralphi]

I know, right?! And yeah, NP is Nurse Practitioner.
Still feeling jittery in the mornings with diarrhea, but not full-on panic (except for yesterday when NP was grilling me). Brain zaps are much better.