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Weight Loss And Increase In Symptoms


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#1 blanam

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Posted 11 December 2017 - 04:36 PM

I never realized that my inability to lose weight while on Cymbalta was actually a side effect of the Cymbalta. Somehow I thought it was due to menopause, which part of it probably is/was.

 

But I started to lose weight without even trying when I was almost off the stuff, and I have lost a total of 18 lbs in the last 3 months, the bulk of it being in the last two months.  What I"ve noticed lately is an increase in several depression and uncontrollable crying spells.  I seem to remember reading something on this forum about Cymbalta being stored in fat cells.

 

Is it possible that as I lose fat, the drug is being released in my body and causing more severe symptoms?  Does anyone have any research literature on this topic?

 

Thanks.

 

 


#2 fishinghat

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Posted 11 December 2017 - 05:15 PM

Hi blanam

 

You are exactly right. Cymbalta is fat soluble and stored in fat tissue (adipose tissue). We have had members before comment on this

situation. Many had flair ups in symptoms when they were losing weights and I always suspected it was from the release of Cymbalta from the fat tissue. I remember I read an article once about a lady who still had Cymbalta in her system after 1 year. She was obese and after coming of the Cymbalta and stabilizing he lost a bunch of weight. I have tried to go back and find that article a couple times but as things go I could never locate it again. I will see what I can find in my library and post. 


#3 fishinghat

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Posted 11 December 2017 - 05:26 PM

Sorry, for some reason it did not copy and paste well. I hope you can understand it. I am going to look for more info.

 

 

From:
http://www.drugs.com/pro/cymbalta.html
Duloxetine hydrochloride is a white to slightly brownish white solid, which is slightly soluble in water."
Note - From the structure we can see that the compound is primarily non-polar and therefore should be fat soluble.

From:
http://www.drugbank.ca/drugs/DB00476
Water Solubility = 0.00296 mg/mL (Vertually insoluble)
Note - If it is not water suluble (polar (has a negative or positive charge)) then it is non-polar (not charged) and would be lipid soluble.

From:
http://www.selleckch...l-cymbalta.html
Chemical Information

Solubility (25°C) * In vitro DMSO 67 mg/mL (200.67 mM)
Water <1 mg/mL (<1 mM)
Ethanol <1 mg/mL (<1 mM)

Note - Dissolves well in DMSO a relatively nonpolar solvent.

From:
http://toxwiki.wikis....com/Duloxetine
Soluble in dimethylformamide (nonpolar) and water.

From:
https://www.ncbi.nlm...les/PMC3299448/
Table I
Amount of Solid Lipid (fat) Required to Solubilize 20 mg of DLX and Percent Partitioning of DLX in Lipid vs Water
Solid lipid Amount (mg) % Partitioning
Glyceryl monostearates 400 92
Glyceryl behenate 700 33
Glyceryl palmitostearate 650 60
Geleol 450 60
Gelucire 44/14 800 –

From 33% to 92% lipid (fat) soluble.
Ta

https://oup.silverch...BIA4LVPAVW3QbleII. Postmortem Tissue

 

Distribution of Duloxetine


Table http://www.ema.europ...776.pdfstmortemTissue

Duloxetine was
highly bound to proteins in plasma, the mean percent bound to human plasma proteins at a duloxetine
concentration of 150.2 ng/mL being 95.9%

Duloxetine was present in high concentrations in the stomach and intestinal contents at 3 to 12 hours
postdose. Kidney, liver, and lung contained the highest tissue concentrations. Overall, the liver was determined to be the primary organ responsible for the metabolism of duloxetine

 

Distribution of Duloxetine
Table II. Postmortem Tissue Distribution of Duloxetine
Duloxetine Concentration
Central Femoral
Case Blood Blood Vitreous Liver Gastric Bile Urine
No. (mg/L) (mg/L) (mg/L) (mg/kg) (rag Total) (mg/L) (mg/L)
1 ND* ND . . . . 0.42
2 +< 0.05 ND ND - - -
3 0.28 - - 5.7 86 1.3
4 0.30 0.19 0.11 2.2 0.67 0.47
5 0.46 - - 22 0.09
6 0.25 0.08 . . . .
7 0.22 - 0.06 1.3 0.08 1.3 0.17
8 0.59 0.26 0.23 - - 3.1 -
9 0.17 0.10 - 1.2 0.39 1.1 0.07
10 0.08 0.05 - 0.28 - 0.57
11 0.22 0.09 - 3.3 0.20 2.0 0.11
12 0.23 0.20 0.09 4.4 - 0.69 0.08
In the elimination specimens, bile was the main excretion
product and averaged 1.4 mg/L (0.57-3.1 mglL, n = 7), whereas
the urine averaged 0.22 mg/L (0.07-0.47 rag/L, n = 6). These
relative levels were expected as duloxetine is extensively metabolized,
and only a trace amount of unchanged drug is excreted
in the urine (4,5).

An evaluation of the dosing records along with the remaining
duloxetine capsules that were collected as medical evidence in
6 of the 12 cases (1-4, 7, and 11) indicate that these individuals
were in compliance with their duloxetine prescriptions. This
suggests to the authors that the measured blood levels appear
to represent postmortem therapeutic values.

Conclusions
Duloxetine is a relatively new drug prescribed for pain management
and depression that has recently been encountered
in our casework. With duloxetine's poor response on the
GC-NPD, detection of the drug must be performed by alternate
means. In a period of a year and a half, duloxetine was detected
in 12 cases by GC-MS. Based on the toxicology and autopsy
findings in these postmortem cases, duloxetine was not implicated
as the sole cause of death. Duloxefine has a high volume of
distribution and, as expected, exhibits postmortem redistribution.
The tissue distribution of duloxetine in postmortem samples
has been provided to aid the forensic toxicologist in the interpretation
of their casework. These are the first postmortem duloxetine
cases to be reported in the literature, and it is the
authors' belief that more data need to be evaluated in order to
establish clear postmortem therapeutic levels

 

Duloxetine Concentration
Central Femoral
Case Blood Blood Vitreous Liver Gastric Bile Urine
No. (mg/L) (mg/L) (mg/L) (mg/kg) (rag Total) (mg/L) (mg/L)
1 ND* ND . . . . 0.42
2 +< 0.05 ND ND - - -
3 0.28 - - 5.7 86 1.3
4 0.30 0.19 0.11 2.2 0.67 0.47
5 0.46 - - 22 0.09
6 0.25 0.08 . . . .
7 0.22 - 0.06 1.3 0.08 1.3 0.17
8 0.59 0.26 0.23 - - 3.1 -
9 0.17 0.10 - 1.2 0.39 1.1 0.07
10 0.08 0.05 - 0.28 - 0.57
11 0.22 0.09 - 3.3 0.20 2.0 0.11
12 0.23 0.20 0.09 4.4 - 0.69 0.08

 

In the elimination specimens, bile was the main excretion
product and averaged 1.4 mg/L (0.57-3.1 mglL, n = 7), whereas
the urine averaged 0.22 mg/L (0.07-0.47 rag/L, n = 6). These
relative levels were expected as duloxetine is extensively metabolized,
and only a trace amount of unchanged drug is excreted
in the urine (4,5).

An evaluation of the dosing records along with the remaining
duloxetine capsules that were collected as medical evidence in
6 of the 12 cases (1-4, 7, and 11) indicate that these individuals
were in compliance with their duloxetine prescriptions. This
suggests to the authors that the measured blood levels appear
to represent postmortem therapeutic values.

Conclusions
Duloxetine is a relatively new drug prescribed for pain management
and depression that has recently been encountered
in our casework. With duloxetine's poor response on the
GC-NPD, detection of the drug must be performed by alternate
means. In a period of a year and a half, duloxetine was detected
in 12 cases by GC-MS. Based on the toxicology and autopsy
findings in these postmortem cases, duloxetine was not implicated
as the sole cause of death. Duloxefine has a high volume of
distribution and, as expected, exhibits postmortem redistribution.
The tissue distribution of duloxetine in postmortem samples
has been provided to aid the forensic toxicologist in the interpretation
of their casework. These are the first postmortem duloxetine
cases to be reported in the literature, and it is the
authors' belief that more data need to be evaluated in order to
establish clear postmortem therapeutic levels

 

Duloxetine Concentration
Central Femoral
Case Blood Blood Vitreous Liver Gastric Bile Urine
No. (mg/L) (mg/L) (mg/L) (mg/kg) (rag Total) (mg/L) (mg/L)
1 ND* ND . . . . 0.42
2 +< 0.05 ND ND - - -
3 0.28 - - 5.7 86 1.3
4 0.30 0.19 0.11 2.2 0.67 0.47
5 0.46 - - 22 0.09
6 0.25 0.08 . . . .
7 0.22 - 0.06 1.3 0.08 1.3 0.17
8 0.59 0.26 0.23 - - 3.1 -
9 0.17 0.10 - 1.2 0.39 1.1 0.07
10 0.08 0.05 - 0.28 - 0.57
11 0.22 0.09 - 3.3 0.20 2.0 0.11
12 0.23 0.20 0.09 4.4 - 0.69 0.08
In the elimination specimens, bile was the main excretion
product and averaged 1.4 mg/L (0.57-3.1 mglL, n = 7), whereas
the urine averaged 0.22 mg/L (0.07-0.47 rag/L, n = 6). These
relative levels were expected as duloxetine is extensively metabolized,
and only a trace amount of unchanged drug is excreted
in the urine (4,5).

An evaluation of the dosing records along with the remaining
duloxetine capsules that were collected as medical evidence in
6 of the 12 cases (1-4, 7, and 11) indicate that these individuals
were in compliance with their duloxetine prescriptions. This
suggests to the authors that the measured blood levels appear
to represent postmortem therapeutic values.

Conclusions
Duloxetine is a relatively new drug prescribed for pain management
and depression that has recently been encountered
in our casework. With duloxetine's poor response on the
GC-NPD, detection of the drug must be performed by alternate
means. In a period of a year and a half, duloxetine was detected
in 12 cases by GC-MS. Based on the toxicology and autopsy
findings in these postmortem cases, duloxetine was not implicated
as the sole cause of death. Duloxefine has a high volume of
distribution and, as expected, exhibits postmortem redistribution.
The tissue distribution of duloxetine in postmortem samples
has been provided to aid the forensic toxicologist in the interpretation
of their casework. These are the first postmortem duloxetine
cases to be reported in the literature, and it is the
authors' belief that more data need to be evaluated in order to
establish clear postmortem therapeutic levels.

http://www.ema.europ...776.pdfstmortemTissue

Duloxetine was
highly bound to proteins in plasma, the mean percent bound to human plasma proteins at a duloxetine
concentration of 150.2 ng/mL being 95.9%
Duloxetine was present in high concentrations in the stomach and intestinal contents at 3 to 12 hours
postdose. Kidney, liver, and lung contained the highest tissue concentrations. Overall, the liver was determined to be the primary organ
responsible for the metabolism of duloxetine.


#4 fishinghat

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Posted 11 December 2017 - 06:00 PM

I really can't find where anyone has studied antidepressant accumulation in fat tissue. Sorry


#5 blanam

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Posted 11 December 2017 - 10:28 PM

Thank you for your feedback and thanks for trying.  At least there's an explanation for the increase in symptoms.


#6 blanam

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Posted 17 December 2017 - 03:23 PM

I wanted to provide an update.  The exacerbation of discontinuation symptoms has been intolerable.  I keep losing weight, and have now lost 20 lbs in the past 7-8 weeks.  I'm happy for the weight loss, but the crying and feeling of dread & doom have been overwhelming!

 

I finally met with a new psychiatrist last week and he said he thought the only thing that could help would be low dose Prozac.  I didn't want to go on another antidepressant, but I couldn't continue the way I was.  I haven't had a life in 7 months!

 

So I started on Prozac last Thursday at 2.5mg (40mg is therapeutic dose).  After 2 days, I awoke yesterday and I felt myself for the first time in about 9 months!  It was night and day.  And today I still feel good.  No depression, no anxiety.  I'm able to function effectively in my life, I feel lighter, I feel positive, I can daydream about possibilities, etc...It really feels like I've crawled out of the black hole and into the sunshine.  I hope it lasts.

 

The plan is to go up to 5mg and stay there for 6 months, then wean off and see how I feel.  I've accepted that if I still feel horrible, that I'll just stay on a low dose of Prozac if it means being able to live life.

 

I really feel that I've been harmed by this medication, as have so many others, and I'm going to look into seeing whether or not I have a case for a lawsuit.  If anyone has had advice, please feel free.


#7 fishinghat

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Posted 17 December 2017 - 04:38 PM

That is great that it only took 2.5 mg. If I was you I would only take the 2.5 mg whenever withdrawal symptoms appear. This will minimize your usage.

 

As far as Cymbalta lawsuits, well just google that and many lawyers will pop up. I don't blame you.

 

Keep us posted blanam.

 

By the way I tried Prozac up to 50 mg for 6 months and it had absolutely no effect on my withdrawal. You are lucky.


#8 blanam

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Posted 18 December 2017 - 11:11 AM

Thanks FH.  I have googled Cymbalta lawsuits and a lot of the firms that come up say they aren't accepting lawsuits for Cymbalta.  But I'll call some of them.

 

So sorry to hear that Prozac didn't help you.  I remember taking Prozac in the 90s, starting at 20mg.  It was awful!  Felt like electricity running through my veins.  But it sounds like the Zoloft has been helpful to you.  Everybody's brain is different.  That's why it's so important to find a good psychiatrist who can work with your individual brain.  I can't believe that 2.5mg of Prozac has turned my life around, and only after 2 days of taking it.

 

Happy Holidays!


#9 fishinghat

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Posted 18 December 2017 - 02:03 PM

Happy Holidays blanam and to everyone of our members out there, past and present.

 

God Bless


#10 gail

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Posted 19 December 2017 - 01:26 PM

Hello Blanam,

So so happy for your feeling better. Let's cross our toes and hope that it continues. Prozac is a real good choice for its long half life which makes it easier to get off.

2.5 mg, wow, and if things go rough, don't feel shy to upper it. Enjoy your time!

#11 blanam

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Posted 29 December 2017 - 01:09 PM

So another update....

 

The "high" I had on my 3rd day of 2.5mg Prozac didn't last.  So I went up to 5mg about a week ago.  The only way I can describe the effect is that the Prozac provides a veil between myself and "The Depression".  I know I'm still anxious and depressed, but it's just not in my face like it was before the Prozac.  I can get through the day, I'm not crying non-stop, I can even laugh and have fun.  But I'm still not myself, still don't feel the way I want to, and I'm very much aware that the withdrawal symptoms are still there.  

 

I'm going to see where I'm at after 4-6 weeks on 5mg.  I really don't want to go up as the whole point is to get off medication.  If I can get by on 5mg, I'll stay there for about 6 months and see.  

 

I'm just very worried that I've done permanent damage to my brain being on duloxetine for 15 years!  

 

If anyone has any feedback, feel free to provide it.

 

Let's hope the New Year brings relief to all of us!


#12 fishinghat

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Posted 29 December 2017 - 05:10 PM

Sounds like a good plan blanam. You will be OK. Patience to you my friend.


#13 gail

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Posted 29 December 2017 - 07:19 PM

Hello Blanam,

Just a thought here, as all my problems started at menopause. At first, bio hormones helped a lot. The estrogen patch which finally stopped my hot flashes, plus the progesterone.

Just wondering if you have thought about that.

My belief is that whatever works to have a quality of life, go for it! I tried everything under the sun, lots of money spent in natural products. Zero relief.

Trials and errors. The point is not to be med free, it's to have a certain quality of life!

I wish you guidance and patience for the year to come, Gail

#14 blanam

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Posted 29 December 2017 - 11:45 PM

Thank you Gail and FH.  Patience is not my virtue, haha.

 

Thanks for your thoughts Gail.  I've been in menopause for 14 years now.  I thought all the weight gain was menopause.  I think part of it was, but now that I'm off Cymbalta, it's obvious the weight gain was primarily Cymbalta.  

 

And I'm with you about quality of life.  I'm coming to terms with the fact that I may just need meds for a while, maybe even the rest of my life if the Cymbalta withdrawal doesn't abate.  

 

I'll work on the patience....





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