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Addictive Behaviors Result Of Cymbalta?


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#1 Jentri

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Posted 19 April 2017 - 03:33 PM

I've been on Cymbalta for about 2 months, also on welbutrin which has been fine but since adding the C, I'm feeling very impulsive and all my addictive behaviors are coming out. I have lost 20 lbs (I'm 5'7 and 125lbs) I don't eat and exercise daily, I'm abusing alcohol, and I'm feeling like I have sexual addiction as well. Risky behaviors like phone sex with strangers and stuff like that. I'm married. I know I should probably get off the Cymbalta but honestly, I kind of like these side effects although I know it's bad. Anybody feel anything similar to this or am I an alcoholic, anorexic slut on my own, lol but not really funny.

#2 fishinghat

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Posted 19 April 2017 - 05:33 PM

Hi Jentri

 

There is a fair amount of research that documents this type of high risk behavior with Cymbalta. Although very rare it does happen (especially the alcohol). I assume you didn't have these issues before the Cymbalta. You want me do dig out some research articles on this subject for you or your dr to look at let me know. As far as I know the only solution is to come off the Cymbalta.


#3 Jentri

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Posted 19 April 2017 - 05:41 PM

Thanks for your reply. I did some googling but didn't really find anything describing these side effects. If you have any handy, I'd love if you could share.

#4 fishinghat

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Posted 19 April 2017 - 05:52 PM

I do medical journal research for anyone on this site that wishes it so I will be glad to do some digging. I should be able to post some info tomorrow.


#5 Jentri

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Posted 19 April 2017 - 06:21 PM

Thank you

#6 fishinghat

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Posted 20 April 2017 - 08:24 AM

Working on it now and should finish around noon.


#7 fishinghat

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Posted 20 April 2017 - 10:31 AM

  • First post on info. More to follow. It looks like Lady Nancy's comment was right on about the mania.

Sexual effects while taking Cymbalta.

Please note that many of these articles relate the high risk mania as being related to Bipolar Disorder rather than Major Depression or Anxiety.

https://www.ncbi.nlm...pubmed/22024021

Persistent genital arousal disorder: successful treatment with duloxetine and pregabalin in two cases.
In both women, the treatment proved to be very successful over a long period of time. One of them experienced full remission (duloxetine) and the other one experienced substantial improvement (pregabalin), over a period now lasting for more than a year.

https://www.ncbi.nlm...pubmed/21091877

Sexual function during long-term duloxetine treatment in patients with recurrent major depressive disorder.
Cymbalta can cause sexual dysfunction (decreased sexual labido and performance).

https://www.ncbi.nlm...pubmed/17627739

Changes in sexual functioning associated with duloxetine, escitalopram, and placebo in the treatment of patients with major depressive disorder.
Same as above.

https://www.ncbi.nlm...pubmed/26003261

Psychiatric disorders and sexual dysfunction.
Same as above

https://dailymed.nlm...f2-c185fbad64ba

The following is from the drug insert information that come with Cymbalta.

5.8 Activation of Mania/Hypomania
In adult placebo-controlled trials in patients with major depressive disorder, activation of mania or hypomania was reported in 0.1% (4/3779) of CYMBALTA-treated patients and 0.04% (1/2536) of placebo-treated patients. No activation of mania or hypomania was reported in DPNP, GAD, fibromyalgia, or chronic musculoskeletal pain placebo-controlled trials. Activation of mania or hypomania has been reported in a small proportion of patients with mood disorders who were treated with other marketed drugs effective in the treatment of major depressive disorder. As with these other agents, CYMBALTA should be used cautiously in patients with a history of mania.

Note - Mania is a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." Symptoms include ...

 

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep (e.g., feels rested after 3 hours of sleep.)
  3. More talkative than usual or pressure to keep talking.
  4. Flights of ideas or subjective experience that thoughts are racing. Increase in goal directed activity, or psychomotor acceleration.
  5. Distractibility (too easily drawn to unimportant or irrelevant external stimuli).
  6. Excessive involvement in activities with a high likelihood of painful consequences.(e.g., extravagant shopping, sexual adventures or improbable commercial schemes). Wiki

6.6 Effects on Male and Female Sexual Function in Adults

Changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of psychiatric disorders or diabetes, but they may also be a consequence of pharmacologic treatment. Because adverse sexual reactions are presumed to be voluntarily underreported, the Arizona Sexual Experience Scale (ASEX), a validated measure designed to identify sexual side effects, was used prospectively in 4 MDD placebo-controlled trials. In these trials patients treated with CYMBALTA experienced significantly more sexual dysfunction, as measured by the total score on the ASEX, than did patients treated with placebo. Gender analysis showed that this difference occurred only in males. Males treated with CYMBALTA experienced more difficulty with ability to reach orgasm (ASEX Item 4) than males treated with placebo. Females did not experience more sexual dysfunction on CYMBALTA than on placebo as measured by ASEX total score. Negative numbers signify an improvement from a baseline level of dysfunction, which is commonly seen in depressed patients. Physicians should routinely inquire about possible sexual side effects.

http://www.gjpsy.uni...cle-mustafa.pdf

A Case of Possible Duloxetine-Induced Mania

"Her mood initially improved but two weeks into treatment she developed insomnia, hyperactivity and sexual arousal."

"Around the time of admission her symptoms constituted irritability, psychomotor agitation, pressure of speech, flight of ideas, insomnia, auditory and visual hallucinations, grandiose and persecutory delusions, aggressive and reckless behaviour, sexual disinhibition and lack of insight."


https://www.nami.org...tine-(Cymbalta)

The following is from the Nami data sheet on Cymbalta.

"Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees)."

http://www.mayoclini...ns/DRG-20067247

Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away.


#8 fishinghat

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Posted 20 April 2017 - 10:42 AM

Second Post on this issue
 
This information is about PSSD which is a condition that develops in some patients after quitting Cymbalta or many of the ssri/snri. It is the total shutdown of all sexual feeling, desire and ability after discontinuing use of the medication. This shows the strong effect that Cymbalta has on the HPT axis (see below). One key symptom of this condition is extreme high risk sexual behavior for 3 to 5 days prior to shutdown of the sexual function. I know you are not going through withdrawal so little to worry about the shutdown but it just shows the type of mania effect Cymbalta can have.
 
 
(The hypothalamic–pituitary–thyroid axis (HPT axis for short, a.k.a. thyroid homeostasis or thyrotropic feedback control) is part of the neuroendocrine system responsible for the regulation of metabolism.As its name suggests, it depends upon the hypothalamus, the pituitary gland, and the thyroid gland.The hypothalamus senses low circulating levels of thyroid hormone (Triiodothyronine (T3) and Thyroxine (T4)) and responds by releasing thyrotropin-releasing hormone (TRH). The TRH stimulates the pituitary to produce thyroid-stimulating hormone (TSH). The TSH, in turn, stimulates the thyroid to produce thyroid hormone until levels in the blood return to normal. Thyroid hormone exerts negative feedback control over the hypothalamus as well as anterior pituitary, thus controlling the release of both TRH from hypothalamus and TSH from anterior pituitary gland.[2]
The HPA, HPG, and HPT axes are three pathways in which the hypothalamus and pituitary direct neuroendocrine function.)

J Clin Psychopharmacol. 2015 Jun;35(3):273-8. doi: 10.1097/JCP.0000000000000300.

Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship.

Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.
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Eur J Pharmacol. 2015 Apr 15;753:263-8. doi: 10.1016/j.ejphar.2014.11.031. Epub 2014 Dec 4.

Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) ion channels.

⦁ Treatment of paroxetine-induced penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) by Low-power Laser Irradiation (LPLI) is unknown in medical literature. The aim of the current article is to report partial efficacy of LPLI for paroxetine-induced persistent penile anesthesia. We report on a male patient who presented with a history of reversible loss of smell, taste and skin sensitivity occurring within a week after start of 20mg/day paroxetine-hemihydrate for a depressive period. Concurrently, patient suffered from penile anesthesia, scrotum hypesthesia, anejaculation and erectile difficulties with normal sexual desire. During 2.5 years of paroxetine treatment and throughout 2 years after paroxetine discontinuation, genital and sexual complaints persisted. Penile anesthesia was treated by LPLI with single and multi diode pulsed laser probes. After 20 LPLI-treatment sessions of 15min each, patient reported partial return of penile touch and temperature sensation. Clinical improvement of glans penis sensitivity was reported to 20% and 40%, compared to pre-paroxetine treatment penile sensitivity during erect and flaccid states, respectively. However, anejaculation and erectile difficulties remained unchanged. Briefly, in the current patient with early onset of PSSD, LPLI treatment reduced paroxetine-induced penile anesthesia. It is hypothesized that SSRI treatment induces disturbances of transient receptor potential (TRP) ion channels of mechano-, thermo- and chemosensitive nerve endings and receptors resulting in the penile anesthesia in PSSD. It is further hypothesized that there are two types of PSSD, one of which occurs soon after the start of SSRI treatment.
---------------------------------------------------------------------------------------------------------------------------

The Open Women' Health Journal, 2007, 1, 1-3

Prolonged Post-Treatment Genital Anesthesia and Sexual Dysfunction Following Discontinuation of Citalopram and the Atypical Antidepressant Nefazodone

------------------------------------------------------------------------------------------------------------------------

The Open Psychology Journal, 2008, 1, 42-50
1874-3501/08 2008 Bentham Open

Persistence of Sexual Dysfunction Side Effects after Discontinuation of
Antidepressant Medications: Emerging Evidence


http://pssd.nl/Persi... medication.pdf
---------------------------------------------------------------------------------------------------------------------------
Persistent Sexual Dysfunction after Discontinuation of Selective
Serotonin Reuptake Inhibitors

A B S T R A C T
Introduction. Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are
very common in patients taking selective serotonin reuptake inhibitors (SSRIs). It has been assumed that these side
effects always resolve after discontinuing treatment, but recently, four cases were presented in which sexual function
did not return to baseline. Here, we describe three more cases.
Case #1: A 29-year-old with apparently permanent erectile dysfunction after taking fluoxetine 20 mg once daily for
a 4-month period in 1996.
Case #2: A 44-year-old male with persistent loss of libido, genital anesthesia, ejaculatory anhedonia, and erectile
dysfunction after taking 20-mg once daily citalopram for 18 months.
Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since
taking several different SSRIs over a 2-year period from 2003–2005.
Results. No psychological issues related to sexuality were found in any of the three cases, and all common causes of
sexual dysfunction such as decreased testosterone, increased prolactin or diabetes were ruled out. Erectile capacity
is temporarily restored for Case #1 with injectable alprostadil, and for Case #2 with oral sildenafil, but their other
symptoms remain. Case #3 has had some reversal of symptoms with extended-release methylphenidate, although it
is not yet known if these prosexual effects will persist when the drug is discontinued.
Conclusion. SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they
are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations
were briefly discussed. Csoka A, Bahrick A, and Mehtonen O-P. Persistent sexual dysfunction after discontinuation
of selective serotonin reuptake inhibitors. J Sex Med 2008;5:227–233.

http://psychrights.o...aetal(2007).pdf
OR
http://onlinelibrary...07.00630.x/full
---------------------------------------------------------------------------------------------------------------------------------------------
International Journal of Risk & Safety in Medicine 26 (2014) 109–116
DOI 10.3233/JRS-140617

One hundred and twenty cases of enduring
sexual dysfunction following treatment

Abstract.
BACKGROUND: There have been reports for over a decade linking serotonin reuptake inhibitors, finasteride and isotretinoin
with enduring sexual dysfunction after treatment stops.
OBJECTIVE: To explore the clinical pictures linked to all 3 drugs.
METHODS: We have selected 120 reports to RxISK.org reporting the problem and mined these for data on age, gender, drug
of use, and impact of the problem.
RESULTS: The data make it clear that the three drugs show extensive overlap in symptom profile, regardless of sex or country
of origin.
CONCLUSIONS: The availability of 120 reports from over 20 countries add to the case for the validity of the syndrome. This is
severe and enduring condition can result in death. An understanding of its physiology and an approach to treatment are needed.

http://wp.rxisk.org/...Is-and-PSSD.pdf
------------------------------------------------------------------------------------------------------------------------------------------------
The prescriber information for Prozac from Eli Lilly's website. Halfway through the 15th page is a clause which reads, “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.
------------------------------------------------------------------------------------------------------------
Journal of Contemporary Psychotherapy June 2009, Volume 39, Issue 2, pp 135-143

Sexual Side Effects of Antidepressant Medications: An Informed Consent Accountability Gap

Sexual side effects of antidepressant medications are far more common than initially reported, and their scope, quality, and duration remain poorly captured in the literature. Antidepressant treatment emergent sexual dysfunctions may decrease clients’ quality of life, complicate psychotherapy, and damage the treatment alliance. Potential damage to the treatment alliance is greatest when clients have not been adequately informed of risks related to sexual side effects. It had previously been assumed that sexual side effects always resolve shortly after medications are discontinued. Emerging evidence, however, suggests that in some individuals, sexual dysfunction side effects may persist indefinitely. The authors argue that all psychologists should be well-informed about sexual side effects risks of antidepressant medications, should routinely conduct a pre-medication baseline assessment of sexual functioning, and take an active role in the informed consent process.
--------------------------------------------------------------------------------------------------------------------------
Wikipedia article
http://www.thefullwi...ual_dysfunction
---------------------------------------------------------------------------------------------------------------------------
https://www.ncbi.nlm...pubmed/25483212

Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) ion channels.

⦁ Treatment of paroxetine-induced penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) by Low-power Laser Irradiation (LPLI) is unknown in medical literature. The aim of the current article is to report partial efficacy of LPLI for paroxetine-induced persistent penile anesthesia. We report on a male patient who presented with a history of reversible loss of smell, taste and skin sensitivity occurring within a week after start of 20mg/day paroxetine-hemihydrate for a depressive period. Concurrently, patient suffered from penile anesthesia, scrotum hypesthesia, anejaculation and erectile difficulties with normal sexual desire. During 2.5 years of paroxetine treatment and throughout 2 years after paroxetine discontinuation, genital and sexual complaints persisted. Penile anesthesia was treated by LPLI with single and multi diode pulsed laser probes. After 20 LPLI-treatment sessions of 15min each, patient reported partial return of penile touch and temperature sensation. Clinical improvement of glans penis sensitivity was reported to 20% and 40%, compared to pre-paroxetine treatment penile sensitivity during erect and flaccid states, respectively. However, anejaculation and erectile difficulties remained unchanged. Briefly, in the current patient with early onset of PSSD, LPLI treatment reduced paroxetine-induced penile anesthesia. It is hypothesized that SSRI treatment induces disturbances of transient receptor potential (TRP) ion channels of mechano-, thermo- and chemosensitive nerve endings and receptors resulting in the penile anesthesia in PSSD. It is further hypothesized that there are two types of PSSD, one of which occurs soon after the start of SSRI treatment.

https://www.ncbi.nlm...pubmed/25815755

Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship.

Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.


 


#9 fishinghat

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Posted 20 April 2017 - 11:00 AM

Last posting
 
Alcohol consumption

http://www.fda.gov/d...y/ucm088579.pdf

Page 5 of 6 from FDA
⦁ Use of Cymbalta concomitantly with heavy alcohol intake may be associated with severe liver injury. Avoid heavy alcohol use while taking Cymbalta.

The FDA site says that 0.46% of Cymbalta users reported increased alcohol consumption.

https://www.ncbi.nlm...pubmed/25161814

Chronic treatment with prazosin or duloxetine lessens concurrent anxiety-like behavior and alcohol intake: evidence of disrupted noradrenergic signaling in anxiety-related alcohol use.
Cymbalta lowers alcohol consumption.

https://www.ncbi.nlm...pubmed/18195589

Effects of naltrexone, duloxetine, and a corticotropin-releasing factor type 1 receptor antagonist on binge-like alcohol drinking in rats.
Decreased binge drinking in rats.

Note. The decrease in alcohol consumption would most likely not pertain to those suffering with mania and that is supported by looking at the alcohol related postings on this site where many report excessive consumption while being on Cymbalta.


#10 Jentri

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Posted 20 April 2017 - 01:11 PM

Wow. Thank you so much for all of that useful information! It definitely sounds like I'm experiencing some mania. Mania feels kind of good though. Definitely better than the depression I felt before. I guess I'll speak with my Dr.

#11 fishinghat

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Posted 20 April 2017 - 01:54 PM

Yes you should as mania can become obsessive and overwhelming, almost addictive.  I think you really need to come off it. I will be interested in what your dr says. Be sure and let me know what he says and if there is anything else you need let me know.


#12 TryinginFL

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Posted 22 April 2017 - 03:02 PM

Welcome Jentri!

 

Your first post sounded exactly like me when on this poison - I hate to admit it but I was right there too (only difference is that I am divorced)  Wow, did I consume the Scotch...

 

Our Dr. fishinghat has given you so much valuable information - he is our pillar of strength!

 

I have been off of this crap for 3 1/2 yrs now, but the cold turkey approach was really too much (for anyone)  I was in hell for a year getting off - some of us have stuck around to help you Newbies and hope you will post often and ask as many questions as you need - we are always here for you and don't be embarrassed cuz we do not judge here.

 

Liz


#13 brzghoff

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Posted 22 April 2017 - 05:46 PM

Hi Jentri,

 

I had to speak up as I started to drink heavily when i went first onto Effexor and then migrated over to Cymbalta a few years later. Both are SSNRIs. while your situation could be mania, i was on a mood stabilizer at the time as well. first depakote and then lamictal. others on this forum had the same experience wth drinking as i had. when i quit cymbalta i stopped drinking immediately. didn't miss it in the least. these days i have an occasional beer or glass of wine. currently i am weaning off lamictal. at my worst on the C i was drinking 2-3 beers and 1/2-1 bottle of wine a day. 

 

definitely not a good thing to drink even moderately along with psychoactive drugs due to the impact it can have on the liver. in my case i have a full blood work up every year and have always gotten high marks - so i guess i dodged a bullet, but still not recommended. 


#14 GettingGimpy

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Posted 23 April 2017 - 06:21 PM

After one month of taking Cymbalta, I relapsed with my MJ addiction after 3 years of sobriety. Alcohol and drug use is extremely common with people taking it. 





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