11 replies to this topic

[Muzumi]

Hi everyone,

I'm new here and I cannot believe the number of articles/reports/testimonies on Cymbalta withdrawal I am finding. If only I had known before I started taking it!

Long story short, I was prescribed Cymbalta for major depression after my Effexor XR pooped out (before it did it was actually the most effective antidepressant I had ever taken - and I've taken many). Anyway, I switched from 150mg Effexor XR to 40mg Cymbalta and unlike many people I didn't experience any withdrawal effects from the Effexor.

I've never been a fan of Cymbalta. I don't feel it's ever done much for my depression and I was constantly tired. My psychiatrist told me to keep trying and upped my dose to 60mg. I felt a bit better but I wasn't sure if it was due to Cymbalta or the many other prescription drugs I was taking. After several months, my psychiatrist finally agreed that Cymbalta just wasn't doing it for me, and agreed to switch me to another antidepressant. She gave me a few names and told me to research my options online. I came across Fetzima, a new SNRI which *according to the label* doesn't seem to have as many side effects as other SNRIs.

My psychiatrist agreed to prescribe me Fetzima 40mg and told me that since I was switching from one SNRI to another SNRI, the transition should be fairly smooth, just like it was with Effexor.

Boy was she wrong! A couple days after my last dose of Cymbalta, I started experiencing withdrawal symptoms. I also had *very* random crying spells (embarrassing when you're on the bus or at work) and there were moments during the day where I suddenly felt intense sadness.

Later that first week, sadness turned to irritability. [Disclaimer: I've been suffering from depression for many years, but I was never suicidal until I started taking antidepressants.] Since last week I've had "breakdowns", for lack of a better word, with strong suicidal impulses and raging self-hatred. My boyfriend took a knife from my hand just in time to prevent me from carving into my arm. I also tried to lock myself in a car hoping I would eventually die from the heat (it's Texas so we still reach nearly triple digits during the day - still it was a very stupid idea that had never even crossed my mind before). My boyfriend once again managed to get me out as I was begging him to let me die. The most disturbing thing about those suicidal impulses is how quickly they appear and disappear. As if I were possessed for a moment.

I managed to convince my boyfriend not to take me to the ER, and I saw my therapist (not my psychiatrist) on Thursday. I'm homebound until Monday and if suicidal thoughts cross my mind again my boyfriend will have me admitted as an inpatient at a psychiatric hospital.

My mood is somewhat back to normal but the physical symptoms have been really awful for the past few days: constant "ice pick" headache, dizziness that sometimes prevents me from standing at all, terrible nausea that makes it hard to eat anything, stomach pain, brain fog, and more.

Looking for some support and some reassurance that these symptoms will disappear soon... When I read that people have been suffering from months it makes me cry; I can't take this much longer! I feel like a crazy person. How come I'm experiencing such severe withdrawal symptoms when I'm switching to a similar drug?
My psychiatrist recommended I take Prozac 20mg to ease the withdrawal symptoms - I thought it helped at first but now I'm really not so sure. And I don't want to get hooked on yet another drug. I feel like a guinea pig and the only silver lining about this nightmarish experience is that a drug capable of causing such terrible side effects shouldn't be in my system. I've been on antidepressants for so long, I'm starting to wonder whether they've been keeping me in a nearly constant depressed state rather than truly helping me.

Currently, I'm taking:
- Fetzima 40mg
- Wellbutrin XL 300mg
- Lamictal 150mg
- Adderall 20mg twice a day
- Klonopin 0.5mg twice a day
- Xanax 0.5mg as needed for anxiety attacks
- Prozac 20mg to ease the withdrawal, but I'm not sure it's helping.

Thank you in advance for the help and support!

[fishinghat]

Welcome Muzumi
Well first of all you are on the minimum dose of Fetzima and I assume that with cross tapering the de will increase that as you come off the Cymbalta.
First of all some info on Fetzima...
From the fda drug insert
https://dailymed.nlm...99-434a1964c3af

Elevated Blood Pressure and Heart Rate: Measure heart rate and blood pressure prior to initiating treatment and periodically throughout treatment.
Abnormal Bleeding: Treatment can increase the risk of bleeding. Caution patients about the risk of bleeding associated with the use of NSAIDs, aspirin, or other drugs that affect coagulation.
Urinary Hesitation or Retention: Can occur. If such symptoms occur, discontinue FETZIMA or consider other appropriate medical intervention.
Seizures: Can occur.
5.10 Discontinuation Syndrome
There have been reports of adverse events occurring upon discontinuation of serotonergic antidepressants, particularly when discontinuation is abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
Monitor patients for these symptoms when discontinuing FETZIMA. Reduce the dose gradually whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, consider resuming the previously prescribed dose. Subsequently, the dose may be decreased, but at a more gradual
discontinuation symptoms: Do not stop FETZIMA without first talking to your healthcare provider. Stopping FETZIMA suddenly may cause serious symptoms. including:
⦁ anxiety
⦁ irritability
⦁ high or low mood
⦁ feeling restless or sleepy
⦁ headache
⦁ sweating
⦁ nausea
⦁ dizziness
⦁ electric shock-like sensations
⦁ tremor
⦁ confusion

5.11 Hyponatremia
Although no adverse events of hyponatremia were reported for FETZIMA-treated patients in the clinical studies, hyponatremia has occurred as a result of treatment with SSRIs and SNRIs. In many cases, hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Cases with serum sodium lower than 110 mmol/L have been reported. Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs. Also, patients taking diuretics or who are otherwise volume depleted can be at greater risk. FETZIMA should be discontinued in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which can lead to falls. Signs and symptoms associated with more severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death.

Medical journal articles...
https://www.ncbi.nlm...les/PMC4825949/
"This agent differs from other available SNRIs in having a greater potency for inhibition of norepinephrine relative to serotonin reuptake."
Note - This means it should be more effective against anxiety than depression compared to most snris.
"These studies documented that levomilnacipran is generally more effective than placebo for the treatment of MDD in the short-term, whereas no firm evidence exists on long-term efficacy for relapse prevention."
"Short-and longer-term studies found that the rate of withdrawal from levomilnacipran therapy due to adverse events was rather low. Moreover the drug appeared to be generally well tolerated. "
"The most frequent adverse events (AEs) under levomilnacipran treatment, with a incidence at least 5% and twice that for placebo were nausea, hyperhidrosis, constipation, heart rate increased, erectile dysfunction and ejaculation disorders in males, urinary hesitation, vomiting, palpitations and tachycardia in females. Most AEs were from mild to moderate in intensity; nausea and headache generally occurred early during treatment and were transient."

More info to follow...

[fishinghat]

Possible Drug interactions

https://www.drugs.co...440-2469,133-54

 

Talk to your doctor before using levomilnacipran together with dextroamphetamine (Adderal). Levomilnacipran may increase the effects of dextroamphetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported.

 

 

BuPROPion (Wellbutrin) may rarely cause seizures, and combining it with other medications that can also cause seizures such as levomilnacipran may increase that risk. You may be more susceptible if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Talk to your doctor if you have any questions or concerns.

 

 

Talk to your doctor before using FLUoxetine (prozac) together with dextroamphetamine (Adderal). FLUoxetine may increase the effects of dextroamphetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported.

 

 

Talk to your doctor before using buPROPion (Wellbutrin) together with dextroamphetamine (Adderal). Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of dextroamphetamine, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma.

 

 

Talk to your doctor before using buPROPion (Wellbutrin) together with FLUoxetine (prozac). Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of FLUoxetine, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma.

 

 

Using ALPRAZolam (Xanax) together with FLUoxetine (Prozac) may increase your blood levels of ALPRAZolam or cause it to stay in your body longer. This can cause symptoms such as excessive drowsiness.

 

 

Excessive use of clonazePAM (Klonopin), or abrupt discontinuation following long-term use, may occasionally trigger seizures in patients taking buPROPion (Wellbutrin).

 

 

Excessive use of ALPRAZolam (Xanax), or abrupt discontinuation following long-term use, may occasionally trigger seizures in patients taking buPROPion (Wellbutrin).

 

 

Grapefruit and grapefruit juice may interact with ALPRAZolam (Xanax) and lead to potentially dangerous side effects.

 

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes eight medicines belonging to the 'Central Nervous System (CNS) Drugs' category:
⦁ amphetamine (active ingredient in Adderall XR (amphetamine/dextroamphetamine))
⦁ dextroamphetamine (active ingredient in Adderall XR (amphetamine/dextroamphetamine))
⦁ levomilnacipran (active ingredient in Fetzima (levomilnacipran))
⦁ clonazepam (active ingredient in Klonopin (clonazepam))
⦁ lamotrigine (active ingredient in Lamictal XR (lamotrigine))
⦁ fluoxetine (active ingredient in Prozac (fluoxetine))
⦁ bupropion (active ingredient in Wellbutrin XL (bupropion))
⦁ alprazolam (active ingredient in Xanax (alprazolam))
Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

[fishinghat]

"My psychiatrist agreed to prescribe me Fetzima 40mg and told me that since I was switching from one SNRI to another SNRI, the transition should be fairly smooth, just like it was with Effexor.

Boy was she wrong! A couple days after my last dose of Cymbalta, I started experiencing withdrawal symptoms. I also had *very* random crying spells (embarrassing when you're on the bus or at work) and there were moments during the day where I suddenly felt intense sadness. "

Not surprising. Effexor and Cymbalta have nearly identical physiological effects while Fetzima controls norepinephrine more and serotonin less. Because of the difference you would expect a more significant set of symptoms while switchin g over to Fetzima.
 
In addition, I must say you are on way too many psych meds but I am sure you already know that. All of these have rather nasty withdrawals as well. 
 
I remember reading a couple articles on Adderal and that it causes the other antidepressants to have more severe withdrawals unless you come off the Adderall first. Don't quote me on that but I will see if I can find that info again.
 
 
 
It takes Fetzima 6 weeks to kick in so you have a ways to go until you see some relief, sorry to say.

"My mood is somewhat back to normal but the physical symptoms have been really awful for the past few days: constant "ice pick" headache, dizziness that sometimes prevents me from standing at all, terrible nausea that makes it hard to eat anything, stomach pain, brain fog, and more. "

That sort of matches the Fetzima start up symptoms in the articles above. If that is the case you should start to see them fading slowly over the next couple weeks. The headaches and nausea were the leading causes of people stopping taking Fetzima in the clinical trial. There is some good info on that drug insert concerning this information. By the way Prozac can cause some nausea on start up as well.

Try to be patient and stick it out. These will take some time to fade but SHOULD go away. Only time will tell.

 

With the long list of psych meds you are on I would be very hesitant to recommend any supplements to you as I would be afraid of making things worse.

[thismoment]

Hi Muzumi

 

fishinghat has identified the Major Interactions between Fetzima (lemomilnacipran) and the other drugs you were prescribed, as well as the sub-interactions between the other meds you are taking.

 

This is quite overwhelming, and with this quantity of disparate medications it will naturally be difficult to identify what's doing what.

 

It certainly would be prudent to ask your medical team about these known major interactions.

 

Take care.

[fishinghat]

You might be interested in checking out this topic on this site. It may give you some ideas on your situation.
 
https://www.cymbalta...ant +depression
 
In addition you might want to consider doing some genetic screening. I have heard that Mayo clinic has a good one. They do a screening for depression/anxiety genes and from what they find they can make recommendations on what medications may work the best.
 
Some info on genetics and depression/anxiety below.

Anxiety and Depression Genes
New!!
https://www.ncbi.nlm...pubmed/25801102
Optimizing treatments for anxiety by age and genetics.
Abstract
This paper highlights recent human neuroimaging and cross-species developmental and genetic studies that examine how fear regulation varies by age and the individual, especially during the period of adolescence, when there is a peak in the prevalence of anxiety disorders. The findings have significant implications for understanding who may be at risk for anxiety disorders and for whom, and when, an exposure-based therapy may be most effective. We provide proof of concept for targeting treatment to the individual as a function of age and genetics, inferred from mouse and human studies, and suggest optimization of treatment for nonresponders.

https://www.ncbi.nlm...pubmed/25106036
Are there depression and anxiety genetic markers and mutations? A systematic review.

https://www.ncbi.nlm...pubmed/24390875
https://www.ncbi.nlm...pubmed/25350786
https://www.ncbi.nlm...pubmed/25262417
https://www.ncbi.nlm...pubmed/25251027
https://www.ncbi.nlm...pubmed/25547397
https://www.ncbi.nlm...pubmed/23986266
https://www.ncbi.nlm...pubmed/25249351


http://www.webmd.com...ponse-to-stress
Summarizes research on a depression gene.

http://www.psycholog...-disorder-fkbp5
Anxiety Gene

http://www.ncbi.nlm....les/PMC3181835/
Research on a anxiety gene.

http://www.livestron...ession-anxiety/
Genes as a factor for anxiety & depression.

http://www.ncbi.nlm....pubmed/23627963
Emotional Gene study on 4 year old children.



http://www.ncbi.nlm....les/PMC3285424/
Genetic Testing in Psychiatry: A Review of Attitudes and Beliefs

https://www.psycholo...ssion-treatment

http://onlinelibrary....20251/abstract
Genetic screening for SSRI drug response among those with major depression: great promise and unseen perils

http://www.psychiatr...iatric-practice
Genetic Testing for Psychiatric Disorders: Its Current Role in Clinical Psychiatric Practice

[Muzumi]

Thank you so much for all this information! I have to say I was so focused on Cymbalta that I didn't research Fetzima as much as I should have. You are right that in the case of Effexor XR -> Cymbalta the doses were somewhat equivalent whereas Cymbalta -> Fetzima was quite a drop. My psychiatrist gave me free sample boxes of Fetzima to see how I feel on it and they only come in 40mg. Having me stop the Cymbalta completely was very radical - she is usually good about increasing doses/weaning gradually (esp. with Lamictal which can be lethal if started at too high of a dose) but this time I think she really overlooked the transition.

I've looked at the interactions between the drugs I'm taking and it does make me feel very uncomfortable. Way back when I started taking meds I started off with Celexa and very low doses of Xanax, and since then it's been an endless cycle of "You're too tired? Let's add some Wellbutrin. Still anxious? Try Klonopin 3 times a day. Can't seem to stay awake? Let's add a bit of Adderall. Mood swings? Lamictal might help with that." Those additions DID help, but I feel more and more uneasy taking so many pills with potentially deadly side effects and interactions. Some days I'm tempted to just stop taking everything - but then I remember my relapses...

"If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, consider resuming the previously prescribed dose."
SNRIs are pretty much the dream for the pharma industry; they make them to difficult to stop that many patients just stay on it indefinitely, and show up at the pharmacy every month like I do.

My depression definitely has a genetic component - it runs on both sides of my family. It also stems from severe PTSD and sadly, I can't expect a med to cure repeated emotional trauma. Working on it with my psychotherapist, though.

I feel a bit better today - it kinda feels like waking up from a nightmare! Thanks again for all your help. My main concern right now is the number of potentially interacting medications I'm taking, but I really don't know how to break the cycle

[fishinghat]

I am glad you have a therapist. They can be so much help. I don't know if you have been with the same  psychiatrist the whole time but if so you might consider a change to one that is not such a pill pusher. just a thought. It can be difficult to find a good one.

 

For right now I would n't consider any changes until you get on the Fatzima, stabilize, and then come off he low dose Prozac. As you well know, don't rush it. Take your time.

[blanam]

Hello Muzumi:

 

I think you're being way overmedicated.  One doesn't take Adderall for being "tired".  Do you have ADHD?  My concern for you is that you have a psychiatrist who is quick to provide a prescription for every symptom you have and who is not looking at the big picture or using an integrative approach.  You are taking 3 addictive substances:  Adderall, Xanax, and Klonopin, 3 antidepressants, and a mood stabilizer.  Nobody needs this amount of medication.  I hope you can find a psychiatrist who is interested in your well-being.

 

I recommend "A Mind Of Your Own" by Kelly Brogan, MD.  This is a must-read.  I'd also recommend EMDR therapy for the trauma, as well as talk therapy.  Exercise, diet, meditation, acupuncture and eventually supplements can all help you to feel better over time.  

 

Good luck on your journey to health!

[thismoment]

When we are wrapped within the struggle, it's difficult to be proactive about being our own medical advocate. But when we are able to, we must.

 

Not everyone is fortunate enough to have a doctor who really cares about our long-term well-being-- many (perhaps most) physicians are overworked humans like the rest of us.

 

It's wonderful to have a loved one or friend that will stand in as our medical advocate while we are struggling-- but not everyone is that fortunate.

 

But at some point, we must do a little research ourselves-- in books, the internet, and the questioning of medical workers.

 

The fact that we are on this forum indicates that we are looking elsewhere-- and that's a great beginning to medical self-advocacy.

[Muzumi]

Hi everyone,

Just wanted to send an update. The suicidal thoughts have mostly receded (fingers crossed) although I definitely cannot say I'm feeling great mentally. Lots of feelings of hopelessness and fear for the future. I am very on edge. My therapist told me she has never seen me so anxious and trust me, that's really saying something. It gets overwhelming. Another symptom that really bothers me is the irritability. Everyone who knows me would tell you that a defining part of my personality is that I am a very patient person who does not lose her temper easily. Well lately I am extremely irritable which causes me to snap at people very easily and to react disproportionately. This leads to a considerable amount of guilt/regret once I've calmed down. This is not me and I don't want it to affect my relationships.
Physically, I still feel sick. I haven't had a proper meal in ages. The nausea and the dizziness (even when I'm sitting/laying down) are the worst. I wasted a day yesterday due to significant stomach pain that just couldn't be relieved.

At this point I don't even know what's Cymbalta and what's Fetzima. A lot of it feels like withdrawal, but I've read that Fetzima can cause rage/anger. I've tried many antidepressants and I usually don't suffer from many side effects at onset but every drug is different...

I'm so sick of all of this. I'm overly medicated, constantly suffering from crippling side effects, some of which have not gone away since I started taking medication years ago. I went through hell stopping Cymbalta and now I'm facing the very likely possibility that Fetzima is driving me insane (I feel like a crazy person dealing with constant anxiety/panic and irritability - Xanax and Klonopin don't seem to help). It makes me want to quit everything, although that would probably kill me.

[fishinghat]

The symptoms really sound like Cymbalta withdrawal but, as you know, with as many meds as you are on it is hard to tell. Hang in there.