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How/when Should I Begin With Tapering?


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#1 Howtostoppropperly

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Posted 26 August 2016 - 06:41 AM

Hello,

I'v been on paxil 20mg for almost 15 years and afterwards 10mg the last 3 years. Beginning of this year I had a severe depression for 4 months. In my opinion I had a poop out of paxil but the doctors did not want to confirm this. My psy subscribed me cymbalta 30 mg and increased it to 60 mg in July this year. At 30mg I was pretty okay but on 60mg I do have terrible side effects. (itching skin, cold sweats, cold body temperature, tinnitus).

 

My psy advised me to take 60mg and 30mg each every other day for a month and after this period on 30mg.

I've read to much terrible things on the internet I don't have much confidence/ have a lot of fear that it could be wors then it already is... I surely don't want to get in relapse. Do I need to take some vitamines or magnesium. 

 

Please help me out guys!

 

Many thanks in advance

 

Dieter


#2 fishinghat

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Posted 26 August 2016 - 08:58 AM

Welcome HTSP.  You are right. It would make things worse. The alternating days idea is a terrible one. Cymbalta has a 12 hour half life. By doing the every other day routine it jacks your blood levels up, it lowers over the nest two days before it jacks your blood levels back up again. You are doomed to repeat your withdrawal over and over again.

 

You would probably be better off doing bead counting, Open a capsule and count the beads. Remove about 1% of the beads a day to achieve a slow even taper. If things get too bad then stay at your level until things stabilize then start reducing again.  Hang in there and be patient.


#3 Howtostoppropperly

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Posted 26 August 2016 - 03:17 PM

Hi fishinghat, can you help me out in giving me a proper plan to wean off please? I'm only on 60mg for 7 weeks now so to 30mg, should not take that long I think?

#4 fishinghat

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Posted 26 August 2016 - 05:21 PM

"Open a (60 mg) capsule and count the beads. Remove about 1% of the beads a day to achieve a slow even taper. If things get too bad then stay at your level until things stabilize then start reducing again. Hang in there and be patient."

 

We have had some members that have been so sensitive it took then a year to wean off at 60mg. Not that is an exception to the norm but 3 or 4 months would be typical. Be aware that when you get down to the last 5% you need to slow down as things can get ugly fast.


#5 Howtostoppropperly

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Posted 27 August 2016 - 04:47 AM

do I need to count each capsule then? :(

#6 fishinghat

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Posted 27 August 2016 - 08:00 AM

Not usually. Check the number of beads in 4 or 5 capsules and if they are similar then just go with the average. We did have one member recently that did find a 10%+/- difference between capsules.


#7 Howtostoppropperly

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Posted 27 August 2016 - 10:19 AM

many thanks man!
do you recommend to add magnesium and/or vitamines during this process?

#8 fishinghat

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Posted 27 August 2016 - 12:36 PM

Normally I would recommend 3000 mg of Omega 3 (The EPA/DHA variety), 500 mg vit C and stay well hydrated. As far as the magnesium is concerned I would look at my last blood test and if you are in the lower half of normal or lower than I would add from 100 to 300 mg of amino acid chelated magnesium. This is readily absorbed and easier on the stomach. If you start the Mg then be sure to have your blood levels checked every 6 mths.


#9 Howtostoppropperly

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Posted 28 August 2016 - 05:03 AM

and these quantities can/may be taken together with the Cymbalta or should I wait untill my c level is lower?

#10 fishinghat

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Posted 28 August 2016 - 08:34 AM

They can be taken with the Cymbalta. You must however be sure these supplements are compatible with your other medicine.


#11 Howtostoppropperly

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Posted 28 August 2016 - 08:40 AM

I only use inderal 20mg

#12 fishinghat

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Posted 28 August 2016 - 08:45 AM

Inderal lowers BP as does omega 3 so start the Omega 3 slowly and monitor bp as you increase dosage. There is also a good drug compatibility program on Drugd.com. You might check it as well.


#13 gail

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Posted 28 August 2016 - 01:10 PM

Hello Howto,

Should you decide to take Omega, choose one with high EPA. Like 500mg or so. EPA high dosage is recommended for anxiety. I hope that you feel better, if not, there is always a tomorrow!

#14 Howtostoppropperly

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Posted 28 August 2016 - 02:08 PM

I've ordered life extension super omega 3 tablets with 700 EPA and 500 DHA and Life extension vitamine C 1000mg. should I add Magnesium?

#15 gail

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Posted 28 August 2016 - 03:17 PM

A lot of EPA, good, I would go with 2 a day. No more.

Magnesium is the specialty of Fisherman, I will let him reply.

#16 fishinghat

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Posted 28 August 2016 - 03:41 PM

Gail, that is the dose for 2 tablets on the Life Ext. Omega 3. I am suppose to work up to 4 tablets a day but I am taking it for a different reason.

 

The magnesium depends on your latest blood test. If your magnesium is toward the lower end of normal or below then I would definitely consider taking some. Be sure and check your calcium levels every 6 months. When the magnesium build up in the body it will lower your calcium levels.


#17 gail

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Posted 28 August 2016 - 04:48 PM

Fisherman,

How much EPA and DHA in your tablets?

I am referring to Lady Nancy's post in which she mentioned dosage of 500 or520 mg of EPA per capsules to be taken twice or three times a day. I based my purchase on this number.
1000mg fish oil per capsule. Daily usage suggested is 2000mg fish oil.

Lightning and thunder here, so posting now.

#18 fishinghat

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Posted 28 August 2016 - 05:23 PM

A growing body of literature suggests that higher intakes of α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) may afford some degree of protection against coronary disease. Because the physiological potency of EPA and DHA is much greater than that of ALA, it is not possible to estimate one AMDR for all omega-3 fatty acids.
The American Heart Association has set up dietary recommendations for EPA and DHA due to their cardiovascular benefits: Individuals with no history of coronary heart disease or myocardial infarction should consume oily fish or fish oils two times per week; those having been diagnosed with coronary heart disease after infarction should consume 1 g EPA and DHA per day from oily fish or supplements; those wishing to lower blood triglycerides should consume 2–4 g of EPA and DHA per day in the form of supplements. To reduce anxiety the current recommendation is 2,000 to 3,000mg/day of EPA/DHA.

Omega 3 is a polyunsaturated fatty acid. Humans have a limited ability to synthesize omega-3 fatty acid. The ability to make the longer-chain omega-3 fatty acids may also be impaired in aging. The most widely available dietary source of EPA and DHA (types of omega-3) is cold water oily fish, such as salmon, herring, mackerel, anchovies, and sardines. Oils from these fish have a profile of around seven times as much omega-3 as omega-6. Other oily fish, such as tuna, also contain Omega-3 in somewhat lesser amounts. Consumers of oily fish should be aware of the potential presence of heavy metals and fat-soluble pollutants like PCBs and dioxins, which are known to accumulate up the food chain.

https://www.ncbi.nlm...pubmed/25732379
Not effective. 2800 mg/day
https://www.ncbi.nlm...pubmed/24191918
Successful against anxiety.
https://www.ncbi.nlm...pubmed/21784145
Effective, 2,500 mg/day.
https://www.ncbi.nlm...pubmed/21666750
Effective

Note – There are numerous studies that show people with normal levels of Omega 3 are less effected by stress and exhibit less anxiety.

 

More to follow....


#19 fishinghat

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Posted 28 August 2016 - 05:28 PM

Whatever dose you use, EPA should represent about 60% of the total Omega 3 intake. Most of the studies have found that EPA supplementation has more beneficial effects on mental health disorders than DHA supplementation.

DHA is, of course, still valuable. It helps keep your heart healthy and contributes to the functioning of your immune system. American Heart Association recommends that you get at least 250 mgs of DHA per day, so keep that in mind when choosing your supplement.

Always start at the lower end of the recommended dose. This would mean starting with 1000 mg of EPA and DHA combined. Look for the supplements that are high in EPA (at least 60% of Omega 3 fats in the supplement should be EPA).

1000 - 3000 mg per day of combined EPA and DHA; focus on EPA rich supplements as EPA acts anti-inflammatory


#20 Howtostoppropperly

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Posted 29 August 2016 - 05:11 AM

Do you know when omega 3 should begin to work please? Is a matter of days/weeks/months? 


#21 fishinghat

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Posted 29 August 2016 - 08:24 AM

Usually a few days to a couple weeks. The first thing I noticed was better sleep and a calmer feeling.


#22 Howtostoppropperly

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Posted 02 September 2016 - 05:23 AM

I've been on 50mg coming from 60mg for a week now and so far so good.
Only a few sweats and in the middle of the day, I have 1 or 2 small  anxiety attacks.

 

Next week I will be on 45mg 
The week after I will be on 40mg

The week after I will be on 35mg

The week after I will be on 30mg and will stay on that for 2 or 3 weeks


#23 Howtostoppropperly

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Posted 07 September 2016 - 10:32 AM

I've been on 45mg coming from 50mg for 5 days now and so far so good.
Only my feeling temperature is cold but I did had this already before my weaning.


#24 fishinghat

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Posted 07 September 2016 - 10:39 AM

HTSP, I would give it another 3 or 4 days and if you still feel decent I would drop again.


#25 Howtostoppropperly

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Posted 08 September 2016 - 02:51 AM

I do have some burning skin in lower arms and upper legs a few times a day. (2x 30min a day)
Do you have tips how to for these symptoms?


#26 fishinghat

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Posted 08 September 2016 - 08:30 AM

Sorry HTSP. I don't know how to address this. The skin peripheral nerves are loaded with serotonin so your body is (and will) have to learn to regulate the serotonin without Cymbalta. It should dissipate over the next 2 or 3 weeks.


#27 Howtostoppropperly

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Posted 08 September 2016 - 08:50 AM

Once I'm on the 30 mg (by 26.09) whow should I level down from then?
Still 10% a week or???

30
27
24.30

21.90

19.70

17.70


#28 fishinghat

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Posted 08 September 2016 - 09:01 AM

That is a good beginning. Be prepared to slow down if necessary. Also, a warning, the last 5 to 10% has a very strong bite. Go very slow at the end.


#29 Howtostoppropperly

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Posted 09 September 2016 - 05:11 AM

I think that I'm having severe withdrawal symtomps from stop taking Paxil (+4 months ago) and that the cymbalta isn't fit for me.
Can't that be the case guys? If Cymbalta isn't the right AD for me, what should I take to get better soon. My body is suffering, itchy, tens,...  


#30 fishinghat

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Posted 09 September 2016 - 08:30 AM

It is possible HTSP. Unluckily sometimes it is impossible to tell the difference between Paxil withdrawal, Cymbalta side effects or Cymbalta withdrawal. Have you started your Cymbalta taper yet?





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