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Help With Daughter


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#1 srv112266

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Posted 20 January 2016 - 03:34 PM

Hello all.....my wife and I are struggling with our 15 year old daughter....She has depression / anxiety .....prescribed Seroquel, and Cymbalta with Klopnopin as needed (lately needs it often).  When she was first prescribed Seroquel, we saw a relatively quick improvement, however she still had anxiety....so as Psychiatrists often do, they wanted to try another drug (Cymbalta) in conjunction with the Seroquel.  She has regressed very badly, and after reading about Cymbalta, we have decided to get her off of it.  Wife read about the skipping a day method, which we are doing, but she is a total train wreck (both physically and mentally). 

 

Any guidance on helping a teenager would be greatly appreciated.  She is on 20 mg of Cymbalta currently on an every other day routine.  At her current dosage can anyone give any guidance on the following:

 

1.  how man beads should we start for the weaning process, and what progression should we try?

2.  what would a realstic expectation be to start seeing any improvement?

3.  any supplements we should try to help alleviate the withdraw side effects?

 

Currently, she is very suicidal, very hard to wake up in the morning, and really in a place that she just can't function very well at all.  Your help is greatly appreciated.

 

 


#2 lady2882Nancy

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Posted 20 January 2016 - 03:47 PM

Hello srv

 

The first thing you need to do is to put her back on the 20 mg every day to get her stable again. The going every second day only works for antidepressants that have a long half life of more than 24 hours. Cymbalta's half life is only 12 hours so every second day the poor girl is going into withdraws.

Eli Lilly is the company that makes this medication and they recommend a gradual lowering of the dose and recommends you do not increase the length of time between doses.

If she is feeling suicidal then you may want to talk to her doctor about doing a cross taper onto another antidepressant to ease the side effects. If you decide to do that make sure you specify that you want one with a long half life so that it will be easier for her to stop later if that is what you or she wants.

 

If you have just decided that you just want to get her off all antidepressants then the first thing you need to do is to take one of these capsules apart and find out how many beads are in each capsule. This way you can figure out how many beads are in a mg of medication. You do not want to decrease more than she can handle. To start once she is stable again she should be able to handle a 1 mg reduction about every 3 or 4 days. Once you get down to only 5 mg left you will probably have to go slower.

 

Supplements - Vitamins B & C, Omega 3 3000mg per day, make sure she drinks lots of water so she stays well hydrated

 

Cymbalta made me suicidal too and I know a few others who had that problem. Let her know you love her and will help her no matter what and get talking to that doctor who put her on this medication and make sure that doctor know what has happened.

 

Whatever you decide to do, if you have any other questions just let us know and we will be more than happy to help.

 

Take care

 

Nancy


#3 srv112266

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Posted 20 January 2016 - 03:57 PM

Thank you lady very much for your help....It looks like on my screen that possibly some of your reply was cut off.  This was the last two sentences...maybe I missed something:  "To start once she is stable again she should be able to handle a 1 mg reduction about every 3 or 4 days. Once you get down to only"  Maybe the last sentence was cut off.  Please advise if there was more information that is missing.

 

Also, if she has been skipping every other day, how long would we expect to get her stable by getting her back on the 20 mg every day?

 

Thanks again....really hoping we can help her.


#4 srv112266

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Posted 20 January 2016 - 03:59 PM

Oops....the rest of the reply now shows up....thank you Lady!

 

Will proceed as directed, and re-post updates as them come along, or any questions we may have.

 

Thanks again.


#5 fishinghat

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Posted 20 January 2016 - 04:57 PM

Lady Nancy is 100% correct. For  her sake get her back on the 20 mg. A word of caution. The withdrawal will get worse before it gets better. Once completely off all those nerve cells have to learn to function all over again so the heart of the withdrawal will last about 8 to 12 weeks after coming off and then slowly, and I mean slowly, get better. If you start on the 1% drop every 3 or 4 days and after a couple weeks aren't having any problems then you might try to go a LITTLE faster. If things get too bad just stay at your dose or go back up a little bit until you are stable and then start dropping again.

 

Having said that, there are some who have much less problems than that but you can't bet on it.


#6 srv112266

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Posted 20 January 2016 - 05:05 PM

fishinghat - thank you very much for your reply / help.  Can you help me with explaining what you mean with " Once completely off all those nerve cells have to learn to function all over again so the heart of the withdrawal will last about 8 to 12 weeks after coming off "  I have not researched (likely should have) what effect this drug has to nerve cells....are you talking about nerve cells (like receptors in the brain)? - or some other type of nerve?

 

Thanks again for everyone's help. 


#7 srv112266

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Posted 20 January 2016 - 05:38 PM

OK - I looked and should have already realized, that is the function of the drug (block nerve receptors), and is also why it is used for pain management.  I am guessing since while taking these, those nerve receptors that get blocked, get turned back on when you go off of this drug.  This must be part of the difficulty of withdrawing from the drug.


#8 fishinghat

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Posted 20 January 2016 - 07:43 PM

You are right, and more than that SVR. The drug not only ties up the synapses in the hippocampus and amygdala in the brain but also inhibit the reuse of serotonin, a neurotransmitter). It has been demonstrated that while on the drug these drugs (ssri or snri) the binding spots on the synapses actually change shape to accommadate the drug. Once the drug has been removed from the system then the brain must relearn how to regulate the production of serotonin, the enzyme used to reuptake (reuse) the serotonin and also to 'heal' back into the normal shape for the receptors. Tests on other drugs have shown that this process is a steady improvement over a 2 year period and is expected to be the same for Cymbalta.

 

It sucks. That is why many drs say once you are on an antidepressant you will always be in an antidepressant. Many on this site and other sites have proven this wrong but it is very difficult and requires much patience, time and suffering.


#9 fishinghat

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Posted 20 January 2016 - 07:45 PM

I just wanted to add that with your daughters age, small dose and short use period many of these changes are in there infancy now and it will be easier for her body to readjust.


#10 srv112266

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Posted 20 January 2016 - 08:04 PM

Thanks for the detailed information.  A couple of things.  Today my wife had an appointment with her psych to discuss our problems.  I had emailed my wife a paper from www.fda.gov where they had a paper "Cymbalta Discontinuation Syndrome" to see what she thought and / or suggested we did.  Amazingly, she said she had never heard of that before, and suggested we try the cycling of "on a day off a day for a short period, then off 100%".  Question: is this that common that prescribing Dr.'s are this misinformed? 


#11 fishinghat

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Posted 20 January 2016 - 08:13 PM

Extremely common. Originally the company trained drs that there wasn't any withdrawal just some light flu like symptoms. A couple of lawsuits later, and FDA study and a couple memos as part of the testimony and the company was forced to include the statements that you saw on the FDA website (also in their inserts with the drug). However, the court did NOT rule that drs were to be retrained. It has been one of our jobs here to retrain the drs by supplying that FDA statement, the inserts or other research to address 'overconfident' in their knowledge if you know what I mean.

 

Part of the original training was that when these symptoms occur after discontinuation it was just a return of previous symptoms and they need to go back on Cymbalta. Money


#12 lady2882Nancy

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Posted 20 January 2016 - 10:48 PM

You always explain all of that so much better than I do fishinghat so I was really hoping you would jump in here.

 

I am out of practice with this and just know what I know. In another month it will be 3 years since I started my journey off.


#13 fishinghat

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Posted 21 January 2016 - 08:46 AM

Oh Lady Nancy. Don't sell yourself short. You put things in such simple to understand and straight forward manner. I get to detailed sometimes (sometimes? Most of the time). This site is much better off with your contribution.

 

God bless you my freind.


#14 srv112266

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Posted 21 January 2016 - 10:39 AM

Thank you so much to those who have responded to this post. I am Mrs SRV112266 and couldn't be more grateful for your help with our daughter. There is no feeling worse than watching your child suffer. Last night she was literally hallucinating. (is that normal ?) My husband has already given you the details so I wont repeat them but would like to share with you the plan we have outlined based on your feedback.‚Äč We put her back on her 20mg dose this morning at 9am and plan to give her that dose every day at 9am for a week. At that point we will see how she is doing and with this forums feedback decide if we should continue for another week at 20 Mg or start the process of counting beads and decreasing her by 1% every 3 days as she can tolerate it.  It also sounds like there are supplements that will help her along the way and we will get her those ASAP as well.  Any other advice you can offer will be most appreciated. I'm extremely frustrated. Just yesterday I sat in front of her Psyc who said she knew "nothing" about problems with Cymbalta withdrawal and suggested we do the skip a day method ! Absolutely terrifying.


#15 fishinghat

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Posted 21 January 2016 - 12:13 PM

I understand your frustration 'mrs srv112266'. The medical field, esp psych needs MUCH better training. It is not completely the drs fault. With over 300 medical articles published every week and the limited time drs have to read they become behind the times very rapidly. That is one reason I usually take in some of the most recent research (important points highlighted) on any specific subject we are dealing with. It helps the drs get up to date, gives him the knowledge that I didn't just dream up this information and gives us something to center our discussion around. With the latest information in hand I can also ask more intelligent questions as well.

 

The hallucinations are frequent in adolescents. Once she stabilizes she should be able to wean slowly enough to avoid those.

 

Many of us on here are praying for your daughter. Tell her to stay strong it will get better.


#16 silverseed72

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Posted 21 January 2016 - 01:12 PM

Part of the original training was that when these symptoms occur after discontinuation it was just a return of previous symptoms and they need to go back on Cymbalta. Money

 

That hits the nail on the head. When I was off of it the first time, I had brain zaps and fog which was unlike anything I ever experienced before cymbalta.


#17 brzghoff

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Posted 21 January 2016 - 02:28 PM

mr and mrs SRV112266

 

wow. i am so sorry to hear about what your daughter and subsequently what you are going through. psychoactive drugs for teens and younger seems to me to be a crime. especially when something doesn't work doctors just want to throw another med at the problem - instead of at least switching/trying something else instead of adding on.

 

you are getting good advice here, i just wanted to add my support. when it happens to adults, its bad enough, when it happens to children it is heartbreaking and makes me furious. 

 

i haven't noticed that you've mentioned this, but is your daughter getting therapy? i highly recommend it, as do many others on this forum. especially effective is Cognitive behavioral therapy from a therapist who specializes in that form of counseling. it takes time. there is no silver bullet, but if your daughter is open to working with a therapist and working on the skills and "tools" taught, CBT can be as effective as meds. often meds are used together with therapy. i would guess in her case that would be important since she is having such a difficult time. in tough to treat cases it often takes meds to get a patient to the point where they have the capacity to benefit from therapy. in many cases, the patient can wean off the meds as they improve with therapy, but the therapy must continue afterwards, at least for awhile (6 months or more). what drives me nuts is when doctors want to use meds as a first line of treatment, before even suggesting therapy. 

 

all the best and please, please keep us posted! 


#18 brzghoff

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Posted 21 January 2016 - 02:32 PM

You always explain all of that so much better than I do fishinghat so I was really hoping you would jump in here.

 

I am out of practice with this and just know what I know. In another month it will be 3 years since I started my journey off.

 

 ladynancy,

 

you are one of the life savers on this forum! you have often been a much needed voice of reason for us all!


#19 srv112266

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Posted 09 March 2016 - 04:49 PM

Hello

Mrs SRV112266 here.  Its been awhile since we posted here. Our daughrter has now been back on 20mg of Cymbalta for about a month and we are ready to begin bringing her off of it.  When I opened the first pill I found many different size granules.  I also found each pill does not have the same number of granules.  How do I go about reducing the med for her ?  Should I get a gram scale and weight it ? Any suggestions would be most appreciated.

Blessings


#20 fishinghat

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Posted 09 March 2016 - 04:58 PM

You hit the nail on the head Mrs srv. Just weight out the beads is a couple capsules and figure out the average weight of the beads inside. Reduce the weight by about 1% a day and you will be in the right neighborhood. If she is only on the 20 mg then you will probably be able to wean faster than that I would suggest starting at 1% a day and if you are doing well after a week or two then you can try a little faster.





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