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#1 zivcha

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Posted 04 April 2016 - 06:59 AM

hello all,
i am new here but on SNRIs for 11 years and on cymbalta for 6 years. i have been diagnosed with mild depression, GAD, social phobia and OCD. for some time now (maybe 3 years) i have been trying to quit cymbalta so im going between 60 mg to 30 mg and back. i sleep very bad, have tachycardia almost constantly and i guess i also suffer from an obsesive perceprion regarding school and work (all exist also when on 60 mg). things have got really bad the last year and a half since i could not decide wethear or not i want to continue to an advanced degree or advance my student job to full time at a high tech company. i then decided to continue with school but regreted it after a year and quit school, got my job back only to regret once again after 6 month. so i quit the job. now i finally decided (and im happy till further due) to continue with school and will renew my studies at october. during the last year i moved in and out of 2 apartments due to OCD reasons (im used to having my bed placed in the corner of the room - but it was not possible in both of the rooms so i had to leave).
my psychietrist is aware of the situation and suggested that i will change to brinthellix. i agreed. now im on 30 mg of cymbalta and moving to 20 mg.
my family is...well..they are good people but they cannot be supportive. my mother also suffers from depression. she and i had a big fight over something she said. so i cant stay at home any longer. i have some money i saved but dont know how i can support myself financialy for 3 years with school being so demanding.
i managed to find a nice place with 2 other flatmates at around my age (28) but i dont know if its such a good idea to enter a new apartment with people i dont know and then start the withdrawing process. i dont want them to see me crying or whatever and im afraid that this new situation will not be supportive enough for me when trying to change medications.
the other option is to pay double and have a small place of my own. i will do that and will of ofcourse get into higher debt.
i must say that logically i know that it is more important to set up a comfortable environment for withdrawal and its something worth paying for and even increase debt/loans.
SO - my question comes down to this:
which will be a more supportive environment for changing medication (cymbalta to brinthellix ) - in a flat having my own room with 2 other studnets in the apartment or perhaps in a smaller apartment alone?
thanks a lot in advance!

#2 fishinghat

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Posted 04 April 2016 - 08:29 AM

Welcome Zivcha

 

That is a tough question to answer. It really depends on the two friends and how patient and supportive they are. It also depends on how well you do when being alone. Some (like me) don't need people around all the time but others suffer if they don't have people around. I am sorry I couldn't give you a clear cut answer but I hope this helps some.

 

God Bless


#3 zivcha

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Posted 10 April 2016 - 09:12 AM

thank you fishinghat for your answer!
regarding the racing heart at night and the lack of sleep due to that reason - can you or anyone who reads this recomend a drug or a supplement?
and - is there something that can help with the amxiety that follows the withdrawal process?
thanks

#4 fishinghat

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Posted 10 April 2016 - 09:47 AM

zivcha

 

Best supplement for the heart issues and is chelated magnesium. There are other forms of magnesium that work but they can be hard on the stomach. It is not expensive and most of my drs recommend starting at 100 mg one a day for 4 or 5 days and if that is not enough they go to 100 mg twice per day. Then, if needed, up to 300 mg per day. Usually it takes around 300 mg and after 2 or 3 days you start seeing the relief.

 

What to take for anxiety during withdrawal. We have all tried to deal with that at some point. A brief outline of my opinion is below.

 

Presrciption

Addictive/Withdrawal

Ativan (lorazepam) or any other benzo. Addictive, you develop tolerance to it in a few weeks and the dose needs to be raised. I wouldn't recommend unless no other choice.

 

Withdrawal

An AD like Zoloft, Lexapro or Prozac. Many have went this route. It not only helps the withdrawal but is easier to wean off of. So you go on one of the three for several months (to give your body a chance to recover from the lack of Cymbalta and then you start weaning off the new AD.

 

Not Addictive/No Withdrawal

Clonidine or hydroxyzine. Start up slow because they can make you a little sleepy at first. They will also lower blood pressure some. Of the two Clonidine is the most recommended for anxiety unless there is severe sleep issues then the drs often go with hydroxyzine.

 

Over the counter

No Withdrawal but Tolerance

Benadryl - Many have success with 50 mg of Benadryl which contains diphenhydramine, an antihistamine, like the over the counter sleep aide. Some sleep aides use different anti-histamines as well. The work decent for most on anxiety but you build up tolerance over time and in a couple weeks it has no effect. If you stop taking it for a few weeks it will once again work for a while.

 

Natural

Some have good success with Melatonin, a chemical that your body produces to help us get sleepy at night.

There are also many other herbal/natural products which can be beneficial BUT many of them can have serious interactions with prescription meds and should be used very carefully.

 

As with any medicine, prescription or not, remember the old 'teaspoon/teacup rule'. Start with a small amount first and then build up the dosage slowly. This way if you are going to have a reaction it is less likely to hit you like a brick.

 

I am sure many of the others have suggestions as well and will be chipping in.


#5 zivcha

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Posted 11 April 2016 - 05:10 AM

thank you very much fishinghat...this information is vital for me.
as for the magnesium - what do you mean by magnesium chelate? magnusium glycerate or other? thanks

#6 zivcha

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Posted 11 April 2016 - 05:51 AM

and also - when you say 100 mg a day - you mean 100 mg of magnesium or 100 mg of the magnesium chelate? (as there is less than 100 mg of magnesium in 100 mg of magnesium chelate)
thanks!

#7 fishinghat

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Posted 11 April 2016 - 08:40 AM

Good point Zivcha. I am talking about 100 mg pf magnesium taken in the amino acid chelated form. 'other forms' include magnesium oxide, mag. sterate, etc which can be hard on the stomach.


#8 zivcha

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Posted 11 April 2016 - 09:05 AM

ok thanks! and which amino acid to buy as a chelate? i saw glycine but im sure there are others...is it even important?

#9 fishinghat

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Posted 11 April 2016 - 10:49 AM

Not important really. Nothing like a little extra amino acid in the diet.  lol


#10 zivcha

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Posted 11 April 2016 - 11:01 AM

thank you

#11 kmrekl217

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Posted 11 April 2016 - 07:42 PM

Zivcha,

Are you also going to therapy as you work through this? Most universities offer free or pro-rated counseling. 


#12 zivcha

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Posted 12 April 2016 - 06:44 AM

im going to therapy, yes. thank you for asking.
i hope things will get better...

#13 fishinghat

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Posted 12 April 2016 - 08:52 AM

Time and patience


#14 kmrekl217

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Posted 12 April 2016 - 09:24 PM

im going to therapy, yes. thank you for asking.
i hope things will get better...

Great!

I think having roommates around can be really nice. You can retreat from them when you need time to yourself, but you're not alone.


#15 zivcha

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Posted 13 April 2016 - 01:42 AM

i hope so. im moving to the new place next week. i will update.

#16 zivcha

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Posted 19 May 2016 - 06:13 AM

Hi all,

yesterday i went down from 30 mg to 25 of cymbalta. i decided that until reaching 20 mgs, i will reduce 5 mgs each month. then i will start the classic bead counting.

i must say - i dont sleep. again - its my cardiovascular system that causes me to a very poor sleep. I want to start taking chlonidine. I scheduled an appointment with my psychiatrist in two weeks time. i have to find those bio sensors to help me monitor my BP at night. not easy for me to find these at times like this (OCD - every bio sensor i find seems to be not accurate enough).

 

 

13 years ago (when I was 16) I went through this trial and error process. I went through a lot of anti depressants and reacted to none. and then was put on venlafaxine (after a year and a half of trying to find the right medication) which I responded to. a few years later I went cold turkey on venlafaxine, had SEVERE withdrawal symptoms and year out of hell. then was put on cymbalta and here I am.

 

these are the meds I took during this trail and error process which did not help:

Prozac

Cipramil

Cipralex

Zoloft

Reboxetine

 

I wanted to ask: do you have any recomendations on a good anti-depressant drug or combination to take instead of cymbalta for patients (like me) who are do not respond to SSRI? 

I wanted to ask if you have any recomendations on a good anti-depressant to take instead of cymbalta for patients (like me) who are do not respond to SSRI? 


#17 fishinghat

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Posted 19 May 2016 - 08:21 AM

Hi Zivcha
 
That is an excellent question. Unluckily there is no clear cut answer at this time. Mostly drs choose one based on there experience and instincts. Not real scientific. What works for one may not work for the next 5!! There are efforts underway to develop tests to determine which AD would work best for an individual based on DNA and/or medical history. A couple of these are discussed below.

http://www.medscape....warticle/842533
http://www.besthealt...cription-drugs/

 

As far as I am concerned, well, I really don't have an answer for you except don't give up.
 


#18 zivcha

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Posted 19 May 2016 - 11:37 AM

thank you fishinghat


#19 fishinghat

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Posted 19 May 2016 - 01:41 PM

Well I made a mistake. I decided to do some searching of the medical journals on how a dr should make a decision on which AD to try for their patients. A lot of articles (50 to 100?0 which normally say a lot but have little meaning. They are filled with 'but', maybes and ontheotherhand' type comments.
 
I did find a few interesting ones that I have listed below.

https://www.ncbi.nlm...pubmed/25163042
Effectiveness of a smartphone app for guiding antidepressant drug selection.

https://www.ncbi.nlm.../pubmed/9805208
Choosing appropriate antidepressant therapy in the elderly. A risk-benefit assessment of available agents.

https://www.ncbi.nlm...les/PMC2965366/
Biomarkers to Predict Antidepressant Response

https://www.ncbi.nlm...les/PMC3194084/
Functional Biomarkers of Depression: Diagnosis, Treatment, and Pathophysiology

https://www.ncbi.nlm...les/PMC1371627/
Which antidepressant?

https://www.ncbi.nlm...les/PMC2786903/
Update and Critique of Natural Remedies as Antidepressant Treatments


#20 zivcha

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Posted 01 June 2016 - 09:53 AM

wow. thanks alot!

i hope my dr is aware of those researches


#21 zivcha

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Posted 02 June 2016 - 04:20 PM

i think this work basically says that there is no conclusive guidline or set of choices for patients who are not responsive to SSRI as first line treatment:

 

http://www.ncbi.nlm....books/NBK97406/

 

(perhaps there are more updated studies)


#22 fishinghat

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Posted 02 June 2016 - 05:58 PM

Zivcha, you pretty much got it. There is two research projects going on now to develop a protocol but who knows when that will be done.


#23 zivcha

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Posted 03 June 2016 - 12:33 PM

man what a bummer.

just got back from my dr. he recommendef that i will stop with the cymbalta (currently im on 25 mg) and move straight to fluvoxamine (25 -> 50 -> 100. few days in 25 and then in 50). he thinks that i must take another AD to be less obssesive\perfectionalist.

he didnt want to give me clonidine. said it will make me too sleepy and that it will not help. after i told him i have read about it and i think it will be good for me (especially for my anxiety night bursts), he gave me clonidine 0.025 mg. he said to start at one a day and move up to 2 in the morning and 2 in the evening.

 

i dont think that changing from c to fluvoxamine sharply is a good idea. you people agree?

and regardign clonidine - even if ill take 2X2 a day of 0.025 clonidine, its sums up to 0.1 mg a day - which i think it might still not be a therapuatic dosage for me. what do you people think?


#24 zivcha

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Posted 03 June 2016 - 12:39 PM

i must say that maybe im quite obssesed with a few stuff but as far as i see it - its partialy also because of the discontinuation. and the stuff that bothers me the most are the palpitations and sweating during the night!


#25 fishinghat

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Posted 03 June 2016 - 05:00 PM

Well Zivcha
 
First of all I believe there is a change over taper from Cymbalta to fluvoxamine but I will check on that but I think your dr is a little fast on his feet. You can suffer a lot of withdrawal before the 4 to 6 weeks for fluvoxamine to kick in.

 

On the other hand I do agree with his clonidine approach. It does lower blood pressure so go on it slow and come off it slow. My dose is only 0.1 mg/day (0.05 in the AM and the same at bedtime). That is an average therapeutic dose for anxiety/panic.It does a good job for me. If your bp doesn't drop significantly they can put you on more later.

 

I like that second post. We are not trying to develop a perfect mental health. It is only natural to be a little compulsive, anxious, depressed or whatever. We just don't want to be consumed by it. If you feel that your level of OCD is tolerable and just part of who you are then don't worry about it.


#26 fishinghat

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Posted 03 June 2016 - 05:14 PM

There is a cross over taper when the patient is on higher dosage than you but I am more concerned that it takes 2 to 3 weeks for the fluvoxamine to begin to kick in and 4 to 6 weeks to reach full effect. It is worth noting that he is going from the minimum effective dose of 30 on C to the minimum effective dose of 100 fluvoxamine. Many do a change like this and about half way through the change the withdrawal symptoms disappear yet the patient will continue to increase the dose up to the drs recommended dose. I have always chosen to maintain my dosage when I reach a comfort level. Usually that turns out to be sufficient and the less I pump in my body the better. Anyway, just my opinion. Not an MD but makes sense to me.


#27 zivcha

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Posted 06 June 2016 - 02:09 PM

fishinghat,

thank you so much for your answer. a question: what do you mean by "cross over taper"?

 

I decided tp continue with tapering C and for the meanwhile, not to take the fluvoxamine. ive been on medication for 10 years. i would like to see if i can do without them. Ive been very anxious for the last one and a half years but perhaps it is also because i was on C. i mean, can it be possible that low dosage of cymbalta causes anxiety?


#28 fishinghat

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Posted 06 June 2016 - 02:43 PM

A cross over taper or sometimes called cross taper is to slowly come off one ssri/snri while slowly building concentration up on the new ssri/snri. In the case of a patient being on a low dosage the drs sometimes just switch directly.

 

I would say that the anxiety at 20 mg of Cymbalta may be from decreasing the Cymbalta (withdrawal). My suggestion would to be to hold at the dosage you are now at on the Cymbalta until things clear up and then continue dropping. Slow is the word. very slow.


#29 zivcha

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Posted 06 June 2016 - 02:57 PM

ive been on 30 for a year and a half. was even on 60 for a month during that time. things dont get clear up for me....insimnia, heart beats, anxiety, hard on the social part, lack of sleep...

i really dont know what to do :(


#30 zivcha

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Posted 06 June 2016 - 03:31 PM

just thought of something:

ive been on 30 mg from october 14 to september 15. then increased it for 60 mg for a month maybe. then tapered back to 30. february 16 to april 16 im on 30 mg and then started tapering off. currently im somewhere between 25 to 20.

ALL of that time - i suffer from insimnia, heart beats, anxiety, lack of sleep and other goodies.

maybe i need to admit it - i cannot do it without ADs. I mean - a year and a half should have been enough time to overcome the withdrawal symtoms that were caused by going from 60 to 30. maybe im just not responding to the C any longer and that what im feeling is actualy part of my anxiety disorder.

 

if this is correct, maybe i do need to start with the fluvoxamine.

just thinking out loud :)





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