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Question For A Friend That's On 120 Mgs Of Cymbalta


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#1 Jillybeans

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Posted 10 November 2017 - 09:03 PM

I have a question, a friend I know is on 120 mgs of Cymbalta, he wants to switch to Zoloft or Celexa, as he won't be able to afford Prozac. How does it work to cross taper from Cymbalta with Zoloft? Or Celexa?


#2 fishinghat

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Posted 11 November 2017 - 09:45 AM

Man, I don't understand the problem with Prozac cost. Here it runs, full price, no insurance, $6 to 9 per months (as does Zoloft) and much cheaper than Celexa. Anyway, The switch from 120 mg of Cymbalta to full dose Zoloft (or Celexa) usually takes about 4 or 5 weeks for most drs. They slowly reduce your Cymbalta during this time period and slowly increase the Prozac accordingly.

 

It should be mentioned that there will typically be some Cymbalta withdrawal while the Zoloft or Celexa is kicking in. By the way, if in the future he may want to wean of the antiDs then he might want to lean more towards the Zoloft as the Celexa tends to have a harder withdrawal.

 

Of course everyone is different so this is just generalities of usually, normally, sometimes....If you want I can see if there are any medical research articles on these cross tapers. Just let me know.


#3 gardenlady

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Posted 11 November 2017 - 11:36 AM

Hey FH.  Just read this post and am really interested to know if it's safe to cross over to a SSRI from Cymbalta.  If so, which one is the preferred?  And, yes, I'd like to know of any research you can find on the approach and how to avoid serotonin syndrome in doing so.  

 

There is a Facebook group called Cymbalta Hurts Worse.  Are you familiar with it?  They are adamant against crossing from Cymbalta to any other AD because of Cymbalta withdrawal that they say is inevitable and horrible and because of serotonin syndrome.  The CHW Facebook group is based on Ann Blake Tracy's work which many people think is flawed.  She's not an M.D., but a PhD.   I'd like your opinion.

 

I did read of someone who crossed from a high dose of Cymbalta to Prozac (I think) with no problem and then tapered off the Prozac.  


#4 fishinghat

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Posted 11 November 2017 - 01:06 PM

It is safe if done correctly. The best ones to cross over to are Prozac, Lexapro or Zoloft (they have a longer half-life and are easier to come off of later). We have had dozens of members cross taper with no problems. The key to detecting serotonin syndrome is to watch body temps. A fever of 102F or more can easily happen with serotonin syndrome. If temperature gets to 100F then the drs office should be contacted. At least that is what I have been told during my cross tapers (I have done 5 cross tapers).

"And, yes, I'd like to know of any research you can find on the approach and how to avoid serotonin syndrome in doing so."

No problem I will work on that today and post when I am done.

I have heard of Cymbalta Hurts Worse but do not have a facebook account so have never checked it out. The risk of serotonin syndrome is manageable with little difficulty BUT some people do not like the fact that during the cross taper because you still have to suffer at least some Cymbalta withdrawal until the new SSRI kicks in in a few weeks. Other than that I don't know why they would be against it. Members here have certainly have had success with it.

 

I will get back to you later with that research.


#5 fishinghat

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Posted 11 November 2017 - 02:40 PM

Some light reading. lol

https://www.ncbi.nlm...les/PMC4919171/
Describes how to switch antidepressants.

https://www.ncbi.nlm...cles/PMC181142/
Has section on switching antiDs.

https://www.ncbi.nlm...pubmed/18494539
http://www.gpnoteboo...m?ID=1637482568
Guidelines from various sources.

Haddad, Peter M.; Anderson, Ian M. (October 2007). "Recognising and managing antidepressant discontinuation symptoms". Advances in Psychiatric Treatment. 13 (6): 447–57. doi:10.1192/apt.bp.105.001966  .
Discontinuation syndrome is often prevented by taking medication as directed, and when discontinuing, doing so gradually. When discontinuing an antidepressant with a short half-life, switching to a drug with a longer half-life (e.g. fluoxetine or citalopram) and then discontinuing from that drug can decrease the likelihood and severity of symptoms.[2]

https://www2.gov.bc....epress_appd.pdf
Gov guidelines

https://bpac.org.nz/...pages_34-35.pdf
New Zealand Guidelines

https://www.nps.org....antidepressants
Australian Guidelines
 


#6 Jillybeans

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Posted 11 November 2017 - 04:49 PM

How does the cross tapering works, my friend being on 120 mgs Cymbalta and if he gets Zoloft or Lexapro instead of Prozac? He won't know if he will get the approval for Prozac with his insurance, he has the same insurance I have.


#7 fishinghat

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Posted 11 November 2017 - 05:56 PM

Jellybean, you need to read some of those documents I posted above. Sometimes they just stop the Cymbalta cold turkey and then the next day start you on the new ssri. Usually a low dose at first and then slowly increase dose over the next few weeks. The other method used is called cross taper. For example a dr might drop your 120 mg of Cymbalta by 30 mg a week, So 90 mg for a week and then 60 mg for a week and then 30 mg for a week and then zero. At the SAME time starting you on say 5 mg of Prozac for a week and then 10 mg of Prozac for a week and the 20 mg of Prozac. Now this is just an example. Some drs change over a little faster and some a little slower but this would be ab out average. They do the same thing with Zoloft and Lexapro. Zoloft usually starts off at 50 mg, then 75 and then 100 and then 125mg. Lexapro goes from 5 mg to 10 mg to 20 mg (usually). Like I say each dr has his/her own way of doing it.





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