17 replies to this topic

[torontoguy]

I am very grateful to have found this site. I am hoping that someone with similar experience can help or suggest something. I started on 60 mg of Cymbalta almost 7 years ago shortly after being diagnosed with MS. Although I have had 2 major depressive episodes 11 and 22 years ago, the last one came on last October and has not subsided. In addition to Cymbalta, I have been taking codeine for the last several years to help alleviate the pain, as well as Xanax and Zopiclone (Imovane/Lunesta) to help me sleep. When the depression took hold, it was clear that the Cymbalta was not working well as an anti-depressant, nor do I think it was really helping my neural pain for which it was originally prescribed.

 

I tried tapering slowly twice earlier this year, but the depression increased and so I returned to 60 mg. I did not experience any significant withdrawal symptoms except for the worsening of the depression. About 5 months ago, I started to taper again very slowly and found a pharmacy that compounded the drug into 10 mg capsules so I could taper more efficiently. I slowly tapered 10 mg at a time and finally came off the drug 12 days ago, with the plan to start 10 mg of Trintillex 5 days after in conjunction with my psychiatrist. After 3 days off Cymblata, I started to get dizziness, a symptom I have never experienced before. I started Trintillex as scheduled and have now been on it for a week. I recognize that Trintillex on its own can cause dizziness, but it started during the transition period and continues to plague me. I have also had significantly increased anxiety and the depression seems to have worsened. I really sympathize and appreciate the hellish experiences that people have described in these forums. This is something that I wish on no one.

 

I am wondering how much, if any, the codeine could be factoring into this whole equation. I am on a high dose of codeine which has allowed me to continue working over the years, but I wonder if it's a contributing factor to the disabling dizziness and worsening depression/anxiety that I've been experiencing. The dizziness seems to get progressively worse over the course of the day and into the evening. I have had to take days off work because of its intensity and because of my low mood and anxiety. I am reluctant to reduce my codeine levels for fear that it will cause a bad situation to get even worse. Has anyone ever went through Cymbalta withdrawal while on codeine or other narcotics? And if so, was there anything that helped or worsened the situation?

 

I would greatly appreciate any feedback or suggestions that anyone has. This is truly a nightmare. Thanks for reading.

[fishinghat]

Welcome Toronto guy

 

I am not aware of anyone who has been on such a combination of meds with the Cymbalta but I can tell you that dizziness, nausea and digestive issues are some of the early symptoms of Cymbalta withdrawal. The decision to go ahead and start the Trintillex was a good one as it can take 4 to 6 weeks to kick in fully. Many of our members, when having to come off Cymbalta, have switched to a antidepressant with a longer half life such as Zoloft or Prozac and then weaned off the new antidepressant. Most suffered withdrawal effects until the new antiD kicked in. I suspect that will be the same with you. I am going to do a little digging and will come back shortly with more info.

[fishinghat]

I found one member that appeared to be on similar medication during their withdrawal so I have copied their post for you to review.

#29608 My Story Of Cymbalta And My Battle To Get Off It
Posted by okcarmen on 23 February 2013 - 05:02 AM in Weaning Off Cymbalta
Okay, so I've been taking 90mgs of Cymbalta everyday for the past 2 years. I was put on it when I was 16 while I was in a psychiactric hospital for depression. I am now 18 years old.
I have been trying to come off it many tries for a while now. Mainly because for the past 2 years it just makes me so tired and drowsy and made me emotionally numb. It even said cymbalata isn't approved for people under 18, and I was 16 when I was put on Cymbalta. I am now 18 years old.
everytime i try to come off cymbalta i experience the notorious withdrawel symptoms which are absolutely unbearable. and I can't go more than a few days without giving up due to the extent of how sick I get.
My current psychiatrist really wants me to start decreasing my cymbalta for good and go through with it. becuase i always stop after day 2 because i get so sick and can't function.
I also take a couple of other medications. Seroquel 100mgs every evening. and I take 40mgs of Ritalin LA every morning. and occasional valium for anxiety. My psychatrist is expecting me to begin decreasing my dose within the next few days. he prescribed me xanax to take 3 times a day for the first 3 days while going from 90 to 60.
But I feel so much pressure to do this, from my family and my doctor. but I am scared of the withdrawel. and how much it will interfere with my life. I won't be able to function, or really do anything. expect lay in bed, medicated on xanax and all my other meds, while experiencing this terrible withdrawel.
I'm also worried that I may end up needing serious medical attention.
I already take 90mgs cymbalta, 100mgs seroquel, and 40mgs ritalin and 5mgs valium
now once i start the decrease from 90 to 60. I will be taking 1mg xanax 3 times a day for 3 days. as well as valium when needed. and also pain killers, anti-nausea medications. I'm concerned that my medications may interact, which a lot of them already do. and the effects of the interactions would be worse due to my body being in a state of severe physichal withdrawel. and i already have a history of health problems. Including heart problems, I was always having palpatations and flutters and irregulaur heart rate and everytime i stand up my heart rate goes really high. I have to get ECG's every month. and I also have an incredibly low iron level. My iron level is 12 when a normal one is at least 128.
Basically I'm just terrified of what's going to happen. I tried getting into hospital to to do this withdrawel because of the severity of it. But no where would accept me because they don't specialise in that. My main fear is the physichal side of things. and i know it's going to be hell.
basically if i don't take my 90mgs in the morning, by 5pm the withdrawel kicks in.
so everytime i have tried just taking 60mgs every morning, towards the evening i start to feel the withdrawel.
I can't sleep, I can't eat, drenched in cold sweat, rapid temperature changes, nausea, muscle aches and pains, headache, my whole head hurts (brain zaps) my eyes hurt, open or closed, my heart beats rapidly, increase blood pressure, dioreaha, vomiting, my whole body from head to toe is in pain. everything, including my eyes. severe shaking. and then mentally i just feel like shit because of the physichal stuff. and i feel unstable and almost manic.
I don't know if I can go through that again.. it seems easier to just stay on 90mgs for the rest of my life. at least then i won't have to go through that. and i would much rather do it in a hospital. because then if something bad happens, considering im going to be taking cymbalta, seroquel, ritalin, valium, xanax, codiene, and maxalon altogether which certainly doesn't seem safe but my doctor doesn't care. clearly based on the amount of medication I'll be taking, along with possible interactions, along with severe DANGEROUS withdrawel, when I already have a history of heart problems. This is just a recipe for disaster. I'm pretty sure I'll end up having a seizure or something becuase that nearly happened last time.
I am so angry at the health system. i can't believe i was put on this medication at such a young age and told nothing of the withdrawel. I can't believe my current psychiatrist is just giving me medication cocktails and telling me to suck it up and do it ALONE in my own house.
sigh. i can't believe hospitals are not equipped to deal with this sort of thing. No drug detox will accept me because anti-depressants is a whole nother league that not many detoxification facilities are familiar with.


Also....
Member Juliei and Propnut reported using low doses of codiene during their withdrawal to help control emotional issues with no mentioned side effect from this use. They did have some dizziness but there again nothing more than other members have reported. I can say that usually the Cymbalta withdrawal dizziness is associated with what we call brain swishing. Focus your eyes straight ahead and then rapidly move your eyes from one side to another without moving your head. You should have a spinning sensation and hear a funny swooshing sound.

[torontoguy]

Thank you so much fishinghat for taking the time to read my post and for your responses. I have searched extensively for comments by people who went off Cymbalta while on codeine/narcotics but there are very few which I find a bit surprising given how many people are place on Cymbalta for pain. I find it odd that while I tapered Cymbalta in 10 mg intervals from 60 to nothing, I never experienced any dizziness or other symptoms with the exception of the worsening of the depression and anxiety which in itself was bad enough. The symptoms started on day 3 following last dose and has continued to persist, now at day 13. I imagine the Trintillex must be a contributing factor as well. It`s difficult to tell if the codeine is also having an impact although I have been on the same high dose along with Cymbalta for several years and never had any significant interactions.

 

I appreciate your comment about switching to a longer life antidepressant although I am now questioning whether this was the right call. I will continue with it and try to speak with my shrink tomorrow if the dizziness and nausea persist. I know that everyone`s experience is unique but is it common for symptoms like dizziness to persist for almost two weeks following cessation of Cymbalta? I knew that the first week would be really rough and planned my work accordingly, but I really thought things would have stabilized by now.

 

Thanks again for taking the time to read and respond and to anyone else who may have any feedback.

[fishinghat]

TG

 

The dizziness usually lasts for 2 to 6 weeks after quitting Cymbalta. The emotional swings, such as anger, depression, crying etc, can last for 6 to 8 months after quitting with the first 2 or 3 months the worse part. Good luck with the dr tomorrow. Let me know what he/she says. I am curious.

[torontoguy]

I spoke with my psychiatrist today and she recommended that I continue with 10 mg Trintillex for now. The plan is to increase it at some point to 20 mg which is the optimal dose, but given how I'm feeling and the dizziness and other symptoms that have persisted, she suggested I wait another week. Sounds reasonable to me. I am the first patient she has on Trintillex which gives me some concern. Understanding how drugs get approved in both Canada and the U.S., I realize that they often don't know all possible interactions until well after something has been approved and in the market. My biggest concern is that I cannot seem to find any literature or experiences that people have had while making the transition while on codeine or other narcotics. If anyone knows of anything, please let me know.

 

Thank you all for your help.

[fishinghat]

"Vortioxetine was approved by the U.S. FDA for the treatment of major depressive disorder (MDD) in adults in September 2013,[13] and it was approved in Europe later that year. Vortioxetine was previously trademarked as Brintellix in the United States, but on May 2, 2016, the US FDA approved a name change to Trintellix in order to avoid confusion with the blood-thinning medication Brilinta (ticagrelor)."             Wiki
 
I agree with you that new drugs that have not been on the market long and that drs have little experience with are a risk. Trintellix has a reputation now as having a bad or perhaps worse withdrawal than any other antidepressant.

I started on Cymbalta right after it came out and the literature from the manufacturer suggested that there was little to no withdrawal or sexual side effects. NOT. I paid the price.
 
For your symptoms you might check out.....
 
https://www.cymbalta...ur-question-is/

It is collection of comments from members on what they have tried and what worked and didn't. I think you will find it helpful in controlling the dizziness.
 
By the way, I concur that your drs suggestion. It is reason able.

[fishinghat]

Just some light reading you might be interested in.  lol

codeine ↔ duloxetine
Applies to: Codeine (codeine) and Cymbalta (duloxetine)
DULoxetine may reduce the effectiveness of codeine. You may need a dose adjustment if you have been taking codeine and are starting treatment with DULoxetine. Let your doctor know if your condition changes or you experience reduced or inadequate relief of your symptoms. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Drugs.com
=============================================================================
https://www.cymbalta...ix-anyone-else/
Post on how members handles the change from Cymbalta to Trintillex (Brintellix)
============================================================
http://www.mdjunctio...a-to-brintellix
=============================================================
Codeine with Cymbalta can contribute to the formation of Serotonin Sybdrome and should be avoided.
https://www.mayoclin...es/syc-20354758
=============================================================
Drug Name: Codeine
Comments
The risk or severity of adverse effects can be increased when Codeine is combined with Vortioxetine. (Trintillex )

Brand Names
Ala-Hist AC, Allfen CD, Allfen CDX, Ambifed CD, Ambifed-G CD, Ascomp, Biotussin, Brontex, BroveX CB, Brovex PBC, Capital and Codeine, Cheracol with Codeine, Cheratussin, Cheratussin DAC, Codar AR, Codar D, Codar GF, Codrix, Colrex, Cotab A, Cotab AX, Duraganidin NR, Fioricet with Codeine, Fiorinal with Codeine, Guiatuss AC, Histex AC, Lortuss EX, Mar-cof BP, Mar-cof CG, Maxifed CD, Maxifed-G CD, Maxiphen CD, Maxiphen CDX, M-Clear WC, M-End Max D, M-End PE, Mytussin AC, Nalex AC, Ninjacof XG, Notuss PE, Notuss-NX, Notuss-NXD, Nucofed, Nucofed Expectorant, Phenylhistine DH, Phenylhistine Expectorant, Poly Hist NC, Pseudodine C, Relcof C, Robafen AC, Soma Compound with Codeine, Statuss Green Reformulated Jan 2012, Triacin C, Tusnel C, Tuzistra, Tylenol with Codeine, Z Tuss AC, Zodryl AC, Zodryl DAC, Zodryl DEC, Zotex C
http://mdg.usgovxml....me=vortioxetine
==============================================================================
Subject Trintillex
Drug interaction
Acetaminophen; Butalbital; Caffeine; Codeine: (Major) Patients should be monitored for a decreased response to vortioxetine when barbiturates are co-administered. Vortioxetine is extensively metabolized by CYP isoenzymes, primarily CYP2D6 and by CYP3A4 and other isoenzymes to a lesser extent. The manufacturer recommends that the practitioner consider an increase in dose of vortioxetine when a strong CYP inducer is co-administered for more than 14 days. In such cases, the maximum recommended dose of vortioxetine should not exceed three times the original dose. When the inducer is discontinued, the dose of vortioxetine should be reduced to the original level within 14 days.
Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Patients should be monitored for a decreased response to vortioxetine when barbiturates are co-administered. Vortioxetine is extensively metabolized by CYP isoenzymes, primarily CYP2D6 and by CYP3A4 and other isoenzymes to a lesser extent. The manufacturer recommends that the practitioner consider an increase in dose of vortioxetine when a strong CYP inducer is co-administered for more than 14 days. In such cases, the maximum recommended dose of vortioxetine should not exceed three times the original dose. When the inducer is discontinued, the dose of vortioxetine should be reduced to the original level within 14 days. (Moderate) Platelet aggregation may be impaired by vortioxetine due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving aspirin, ASA or other salicylates. Bleeding events related to drugs that inhibit serotonin reuptake have ranged from ecchymosis to life-threatening hemorrhages. Patients should be instructed to monitor for signs and symptoms of bleeding while taking vortioxetine concurrently with aspirin products and to promptly report any bleeding events to the practitioner.

Source Physicians Desk referance.
http://www.pdr.net/d...ruglabelid=3348
=============================================================
 

[torontoguy]

Thanks fishingman. I greatly appreciate the time you took to research and respond to my questions. I commend you for the wonderful help you've provided to me and many others as I see.

[torontoguy]

So I'm on day 19 post Cymbalta and the dizziness I have been experiencing is as disabling as it's been. I inadvertently forgot to take my does of Trintillex on Saturday and noticed later in the evening that I was feeling less dizzy and was able to read more clearly. I resumed taking the Trintillex on Sunday but was still feeling somewhat better. By yesterday afternoon, the dizziness was so disabling that I had to leave work early and worked from home today. I am hosting an important work conference on Thursday so my anxiety levels are off the charts. I spoke to my shrink yesterday and told her of my experience. We agreed to discontinue the Trintillex until Thursday and see if there's any improvement. I;m not scheduled to see her again until next Tuesday to so I told her I would email her my update on Thursday.

 

Unfortunately, the dizziness has not relented and I feel like I'm in pharmaceutical hell at the moment. I have only been taking Trintillex for 2 weeks at 10 mg so I don't think tapering would be of any benefit. I'm not sure if the dizziness is being caused by the Cymbalta withdrawal, the Trintillex, the codeine, or some combination thereof. Is it possible that this level of dizziness can be so acute from Cymbalta withdrawal almost 3 weeks out? Does anyone have any suggestions for dealing with the dizziness? This is my third major depressive episode and I must say it's caused some of my darkest days. I've never experienced any significant side effects or withdrawal effects from any medication until now and I have such an appreciation for those who have been going through this for years.

[fishinghat]

Ho TG
 
The dizziness can be very debilitating from Cymbalta withdrawal. Normally by the second to fourth week it is beginning to fade though and given your experience with the miss dose of Trintellix I would agree with your decision to lay off it for a few days and see. what happens. If it is the T things should improve. It is from the Cymbalta things may get worse as you do not have as much aide from the Trintellix in controlling the Cymbalta withdrawal.
 
Others have successfully used Original Dramamine, Meclizine, Rugby Travel med (or any other product like Tylenol cold and flu that contains Phenylalanine). Caution - Phenylalanine makes some people nervous.

[fishinghat]

I think you will find this interesting. Especially that the dizziness from T usually last about a month.


Personalized health information

On eHealthMe you can find out what patients like me (same gender, age) reported their drugs and conditions on FDA since 1977. Our tools are simple to use, anonymous and free. Start now >>>


On Oct, 21, 2017


1,793 people reported to have side effects when taking Trintellix.
Among them, 72 people (4.02%) have Dizziness


Number of reports submitted per year:

Could Trintellix cause Dizziness?

Time on Trintellix when people have Dizziness *:
• < 1 month: 90.91 %
• 1 - 6 months: 9.09 %
• 6 - 12 months: 0.0 %
• 1 - 2 years: 0.0 %
• 2 - 5 years: 0.0 %
• 5 - 10 years: 0.0 %
• 10+ years: 0.0 %

Gender of people who have Dizziness when taking Trintellix *:
• female: 73.91 %
• male: 26.09 %

Age of people who have Dizziness when taking Trintellix *:
• 0-1: 0.0 %
• 2-9: 0.0 %
• 10-19: 2 %
• 20-29: 10 %
• 30-39: 14 %
• 40-49: 8 %
• 50-59: 22 %
• 60+: 44 %

Top conditions involved for these people *:
• Depression (31 people, 43.06%)
• Major Depression (11 people, 15.28%)
• Stress And Anxiety (4 people, 5.56%)
• High Blood Pressure (4 people, 5.56%)
• Bipolar Disorder (4 people, 5.56%)

Top co-used drugs for these people *:
• Wellbutrin (5 people, 6.94%)
• Lamictal (5 people, 6.94%)
• Cymbalta (5 people, 6.94%)
• Abilify (5 people, 6.94%)
• Vitamin D3 (4 people, 5.56%)

Top other side effects for these people *:
• Nausea (36 people, 50.00%)
• Headache (13 people, 18.06%)
• Depression (12 people, 16.67%)
• Nausea And Vomiting (11 people, 15.28%)
• Feeling Abnormal (9 people, 12.50%)


* Approximation only. Some reports may have incomplete information.

[torontoguy]

Thanks very much for this information fishinghat. I have now been off Cymbalta for 24 days and off Trintillex for 7. I was really hoping that the dizziness would have subsided by now, but it continues to persist and is incredibly disabling. My depression and anxiety have also peaked and this is probably the lowest I have felt in many years, if not ever. I've experienced major depressive episodes before but don't think I've ever felt this isolated or alone. I am seeing my psychiatrist tomorrow and I feel like I need to start another medication be it Trintillex or something else. Do you know which anti-depressants are least likely to cause dizziness? Thanks so much for your help.

[fishinghat]

No scientific studies but I did find this article but I can't say I agree with everything in it.

https://www.livestro...-cause-vertigo/

[torontoguy]

Thanks so much for this fishinghat. I'm not sure what I'm experiencing is vertigo but this article is very interesting. I can't thank you enough for your help. I've seen your interest and dedication to so many of us and I think it's remarkable that you are so dedicated to helping people during their time of need. Thank you.

[fishinghat]

Your welcome TG. Many helped me along the way and it is just my way of paying back.

God Bless

[torontoguy]

Just an update. I had a good session with my shrink today (I'm a big believer in talk therapy combined with meds). The dizziness continues this far along and we both think that this is still as a result of the Cymbalta withdrawal. I think my depression/anxiety is too severe not to be taking anything so we agreed to start a course of Cipralex?/Lexapro. I used in about 10 years ago, the last time I experienced a major depressive episode. I can't remember if it was very effective as I was off work for several weeks, but I know that I did not experience many side effects or have any trouble withdrawing so it seemed like a safe choice. We considered re-starting Trintillex but given my previous experience, this seemed like a safer choice. We'll see how it plays out. Hopefully it will bring some much needed relief soon.

[fishinghat]

I have always had good results from Lexapro but know am too old to take it. I am optimistic it will help you.