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Cymbalta Paws, Protractred Withdrawal Or Relapse?


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#1 Enwa

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Posted 05 June 2018 - 09:26 AM

I'm diagnosed GAD and have been taking antidepressants for the last 10 years. My problem have always been panic about losing control in some way like fainting in social places - I have had 2 rounds with anxiety. CBT 'cured' the first round but second time I needed more help and was put on an antidepressant. I decided to taper my dose from 60 mg Cymbalta to 30 mg and then stopped since I got a new job and didn't have time to go through the hell of a process each taper requires (I get suicidal urges/intrusive thoughts that lead to panic attacks for 1,5 months each dose-change).

Here's the thing: I have been on 30mg Cymbalta since the 18th of January (2018, this year). The initial withdrawal from tapering 60-30 went away after 1,5 months and after that I was fine. Then after about 3,5 months post-tapering (beginning of May) I get hit by a panic attack with suicidal urge/intrusive thought and the process has kind of started again?? I'm now on sickleave and these thoughts/urges have been constant since then. I've only had one day with relief since then (3 days ago). I have also experienced intense tension headache the last 3 days and nightmares each night since the process began and then waking up with panic/anxiety each morning or at night. Also I have lost all sense of hunger which I usually always get when starting or withdrawing from an AD. Today I got another full-blown panic attack worse than before, thought I would lose it and broke down crying after.

Question: Is this a protracted withdrawal or PAWS, second withdrawal phase and the time between have been a window or something? Or is this a relapse?

Please help - I appreciate all information you have!

#2 fishinghat

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Posted 05 June 2018 - 09:38 AM

Welcome Enwa

 

Sorry to hear about your ordeal. It brings back memories.  ALL BAD!!   lol    

 

This does sound like PAWS. Probably not a relapse as it follows a similar trend as to what members here have seen. I will say that usually with a dose change we see a withdrawal effect within 2 or 3 days but that is not always the case.

 

I am curious if you have considered bead counting. Many of our members who have critical jobs do a very slow bead count. It still can have a serious impact but makes it more likely for the person to also handle employment.

 

Also, I assume your dr has put you on hydroxyzine and/or clonidine for the withdrawal as well as panic attacks. Clonidine is extremely effective on panic attacks. More so than most ADs.


#3 Enwa

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Posted 05 June 2018 - 10:05 AM

Thank you so much for the help fishinghat!
Ok, that information calms me as I also feel that this is not a relapse. It feels like I develop Pure O each start or withdrawal from ADs...

I have not tapered using the bead count method unfortunately. My doctor told me to withdraw using the mental hell method lol:

2 weeks 60mg then 30mg every other day
2 weeks 30mg each day
2 weeks 30mg every other day
2 weeks 30 mg every fourth day

I realized when he recommended this that no way I would go that fast so I did 1 month 60-30 which was laying on the bathroom floor almost vomiting/nausea with hot flashes, then 30 each day and then I thought it sounded crazy to stop taking it some days and then reinstating it. I didn't need to shock my body anymore. And then I got the new job so I just stayed thankfully.

I also got no help with meds to take during this process. I was asked if I wanted hydroxyzine but have used that before and it only makes me sleep for 2-3 hours then I'm back at it again so I thought it was unnecessary. I did however ask for Alimemazin which has helped me when it's too much. But this one makes me feel knocked out and I could sleep an entire day and feel out of it and falling asleep anytime the day after.

Could you help me with some questions?
1. Would you recommend me to up the dosage by adding more beads? Wouldn't that make me have more of what I'm going through since it's been 4 months since I took 60mg?

2. Can you recommend any remedies or other non-addictive medicines like Hydroxyzine during this time?

3. How long in general (as I understand we all work different) will it take for the thoughts to pass? I could handle the panic but the thoughts/urges are too much and I'm so tired to having to battle my own mind :(

Thank you so much for your help!
Big hugs

#4 fishinghat

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Posted 05 June 2018 - 11:30 AM

"2 weeks 60mg then 30mg every other day
2 weeks 30mg each day
2 weeks 30mg every other day
2 weeks 30 mg every fourth day"

The FDA recommends against this method as it ramps up your blood levels on the day you take it and by the time for the next on (48 hours later) your blood levels are at 3%. This rollercoaster causes you to repeat this same withdrawal over and over.

When given the hydroxyzine the 25 mg three times a day and 50 mg at bedtime. The dr should have warned you about sleepiness. Usually they start you on 50 mg at bedtime and the sleepiness is not an issue but this gives your body a chance to adjust to the new medicine. They then start you at 25 mg during the day and increase the dose every few days until you reach 25 mg three times a day and 50 mg at night. This phase in period helps eliminate the daytime sleepiness.

Alimemazin is not approved for use in the USA due to its excessive sleepiness. It is an antihistamine as is hydroxyzine.

Have you tried diphenhydramine (common sold as a sleep aide and antiitch medicine. Brand name Benadryl. Many many members have used this to help take the edge off the anxiety. You do build up tolerance to it so most use it for a week or two and then stop for a week. It is in tablet form so you can take a half tablet during the day

"1. Would you recommend me to up the dosage by adding more beads? Wouldn't that make me have more of what I'm going through since it's been 4 months since I took 60mg?"

Many members have success by increasing their dose slightly to take the edge off and stabilize and then return to weaning once stable. May I ask what your current dosage is?

2. I would strongly suggest the use of clonidine. It has no withdrawal, works excellent on panic attacks and is not addictive.

3. It depends but normally 4 months to see any improvement and 6 to 8 months to feel tolerable and one to 2 years to return to normal. But to put it in perspective my Sister-in-law came off Cymbalta cold turkey twice with no withdrawal. Some only have 2 or 3 weeks but theses are not normal. Research says that around 20% have little to no withdrawal, 20% have a year or more and 69% have several months withdrawal.

By the way, thanks for the hug. It was needed. :)

 

 


#5 Enwa

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Posted 05 June 2018 - 12:30 PM

Ah I see - I live in Sweden so probably why the doctor went on a different route :/ Alimemazin is also approved in Sweden but you feel out of it. Maybe I should try hydroxyzine again then. I have not tried diphenhydramine so maybe I should try that too! :)

1. My current dosage is 30mg - I tapered directly from 60 mg to 30 mg (60mg is what I've been on before) - no bead count just switch from one dosage to another

2. I will check out clonidine as well :)

3. Ok but since it's been 4,5 months now with a good window in between maybe I should hope for 6-8 months then meaning july-sep I could feel relief (1-2 years of this and I will probably go crazy lol)

Thank you - you have given me hope in this turmoil, I am forever grateful!

#6 gail

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Posted 05 June 2018 - 12:48 PM

Hello Enwa,

Welcome to the forum. I'm one for details here.

Why and what made you taper the Cymbalta? Weren't you fine on 60?
Had the panic and GAD returned? As I understand, you were put on that for those reasons?

My thinking is different from FH, I would go back to 60 and stabalize. See if you can.
Then bead count slowly down, you can cross taper during the process if too tough.

GAD is a serious illness, and needs to be treated. With All the s#$# that it involves, help is needed. Hydroxyzine and Clonidine works for some but did nothing for me.

I would not continue in this state and if Cymbalta worked for me, I would reinstate at 60mg.

To each his own way of thinking Enwa, either way, it's your decision and we'll respect him.
Do come by anytime you wish!

#7 Enwa

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Posted 05 June 2018 - 01:29 PM

Hi gail, thank you!

I have been taking 60mg of Cymbalta for 5 years - same equivalent dosage in other ADs before - although I started on a low dosage when I first started ADs 10 years ago. I have always said to my doctors throughout the years that I never want to raise the dosage more than half of the full amount since I have such a severe reaction on any adjustment and I felt fine on this dosage. Didn't want to have future problems with having to mix in this mess.

The reason I wanted to taper was that I wanted to see if I could handle it myself and work it out the way I did with CBT the first time. And of the reason that last time I had the second anxiety-based period was 10 years ago. I felt I would feel better without ADs than when having to withdraw and start a new one every so often with the hell that brings :/
During this 10 years I have made adjustments 9 times - 9 times which has marked me and probably given me PTSD from each time having to go through 1,5 months of these urges/thoughts. The reason I have switched is because I felt the ADs often began to stop working after 2 years. The solution to up the dosage each time would give me the same reaction as switching - therefor I wanted to switch as to not end up on high dosages and have an even harder time. Second - the most important reason is not for myself but because I may want to have a child soon with my boyfriend and it's not good to take ADs. I would never let another person suffer from this which is my problem.

I agree with GAD as well :/
Thank you so much for your advice, I really appreciate it!!

Many hugs

#8 Enwa

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Posted 05 June 2018 - 02:33 PM

Also the last 1,5 years I have experienced thoughts coming and going more and more which scared me and made me question if it was Cymbalta since I haven't experienced this on other ADs (only during start or withdrawal phases).

#9 fishinghat

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Posted 05 June 2018 - 04:32 PM

Gail is right in that hydroxyzine/clonidine help some and not others. I am one of those that a benzo does little good for me. One never knows and there are no guarantees. it is, unluckily, trial and error although I would add that clonidine is the number one prescribed drug for panic attacks which are a function of bursts of adrenaline which clonidine controls better than most ADs. ADs work fine for many with GAD but not so much for panic attacks.

Gail is correct, it is your decision and we will certainly help any way we can.

#10 Enwa

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Posted 06 June 2018 - 04:51 PM

Thank you for your thoughts - I have tried benzo and I also felt it didn't do much for me as well.
Hmm I have thought about what you both have said. Today I felt more calm in general and able to cope although I had anxiety but still felt very sad/depressed and felt I don't have the strength to keep this up for long - I need to get some relief/light in this process.

Question: If like you said - I need to reinstate more Cymbalta. How much? I was on 60mg for 5 years. 30mg for the last 4,5 months. Should I up the dosage by bead-counting and adding to the 30mg?

Thank you so much for your help!

#11 Enwa

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Posted 06 June 2018 - 05:01 PM

Gail: I think I'm too far in this process to reinstate to 60mg again, I think that would royally mess me up after this long?
I read somewhere that the brain can handle 10% adjustment per month from ADs. I lowered my dosage by 50% (60-30) which in that case would mean 5 months of adjustment which is now the 18th of June (from 18th of January) :/ Although fishinghat said 6-8 months up to 2 years for the brain to readjust itself which then means July-August this year or June 2020 😢

Could you both give me a recommendation as to best method?

Thank you

#12 fishinghat

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Posted 06 June 2018 - 07:33 PM

Most people drop to 30 with little to any issues. Given that you have been on 30 for a while I wouldn't think it was necessary to go back to 60. If you take the 30 plus 10 mg of beads it may be enough and you don't have as far to wean when you get stable.

 

I noticed that you said you felt more calm today. That is a very good sign that things will get better soon. Once you see that type of improvement it come and goes with the good feeling staying longer each time and the bad feeling being shorter. If you felt even a little better today I would hang on another 4 or 5 days and see if you continue to improve.  


#13 Enwa

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Posted 06 June 2018 - 10:08 PM

Ok, thank you so much! I will try with 4-5 days first :)

#14 fishinghat

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Posted 07 June 2018 - 07:31 AM

I am eager to see how you do.


#15 Enwa

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Posted 09 June 2018 - 06:49 AM

Hi again,

 

Third day now - Yesterday was a good day - I felt empowered and calm but that was probably because of my family and feeling safe.

I have been staying at my parents' house the majority of this time but going home every now and then.

Yesterday I decided it was time to go home again and unfortunately had a really tough time but was able to calm myself down and slept well.

I have been having a hard time this morning aswell. I have thought about it all and come to the conclusion that I have to take an AD my entire life (on a higher dosage - like previously - 60mg instead of 30mg that I am on now) and I'm fine with that. The most important thing for me is to feel good and if it takes ADs to feel good then that is fine with me. I don't think anyone should suffer or feel pain for a long time. Even though it's only been 5 weeks - 5 weeks is a long time when you don't feel good. 

I think I will raise the dosage tomorrow by 10mg - what do you think?

 

Best Regards    


#16 fishinghat

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Posted 09 June 2018 - 07:39 AM

Enwa, it is really up to you. Everyone needs quality of life. You know yourself better than anyone. If you feel that is what you need then so be it. No shame in that. We just want you to be happy. I am glad you are having some periods of light at the end of the tunnel.

God Bless

#17 Enwa

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Posted 09 June 2018 - 08:59 AM

Thank you so much fishinghat for the kind words, means a lot. If I am to increase my dosage by 10mg like you've said earlier, and I have 30mg pills - I am to increase the dosage by 1/3 of a 30mg pill right?

Best Regards

#18 fishinghat

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Posted 09 June 2018 - 10:17 AM

You got it. Good luck. Let us know how it turns out.

#19 gail

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    5 months on cymbalta, scary side effects, never felt good.
    Needed understanding and support, and a place where I was not alone. To read others stories and realizing that I was not the only one going through all that crap.
    In hope that one day, I can return the favors in some kind of way.

Posted 09 June 2018 - 10:40 AM

Hi Enwa,

Don't forget to put your beads in a capsule. Keep us posted!

#20 Enwa

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Posted 12 June 2018 - 06:32 AM

Hi again, I waited with increasing the dosage to talk with my doctor and therapist first but since I talked with my therapist yesterday and haven't been able to get a meeting with my doctor I decided to increase the dosage by 10mg today myself. Yesterday, especially at night, was really bad and I felt I couldn't cope anymore. I'll have to wait and see what this brings.

I just have a question:
- How do you know the increase is fine/not fine? (Will it show from being more calm vs. more anxiety - you'll feel bad or good)
- What increase-program would you recommend? I increased by 10mg today-how long should I keep this up with 10mg until I add 10mg more etc?

Best Regards

#21 gail

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    In hope that one day, I can return the favors in some kind of way.

Posted 12 June 2018 - 08:08 AM

Hello Enwa,

I was away so I missed your posts, just read them. I can't answer your questions.

I don't have an answer for the first one but for the other, our man will be in shortly to answer it. What a process...just hope it goes well after what you've been through.

#22 Enwa

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Posted 12 June 2018 - 09:59 AM

Thank you gail, no problems.
Yes I agree - I'm completely exhausted but feeling pretty OK/calm now - been 3,5 hours since reinstating 10mg extra to the 30mg so first day on 40mg today. I'm praying to god to not have the severe side-effects that I've had until now.

#23 fishinghat

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Posted 12 June 2018 - 05:18 PM

It sounds like the 10 mg increase will do the job. In general you will feel calmer and more "normal". Take a few days to stabilize and get your strength back and then you can consider bead counting if you want to but a lot slower this time.


#24 Enwa

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Posted 13 June 2018 - 03:57 AM

Thank you fishinghat. I feel like I should go up to my original dosage again and stay on it though. This has been such a bad experience that I need to relax and heal for quite some time. What kind of increase program would you recommend?
I have previously taken 60mg and went back to 40mg yesterday.

#25 gail

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    In hope that one day, I can return the favors in some kind of way.

Posted 13 June 2018 - 05:24 AM

Enwa,

I agree with you, but should you feel pretty good on the 40mg, that could be the dose you need to be on.

We need to wait and see. I need to say this, it's a shitty process. That brings hope up and at times brings it down. And one day, the sun will shine for you Enwa.

#26 Enwa

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Posted 13 June 2018 - 08:41 AM

Thank you so much, your words make me smile :) <3

Hugs

#27 fishinghat

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Posted 13 June 2018 - 09:52 AM

I agree with Gail. Give it a few days to see if you can settle in at 40 mg. This is a game of patience.

#28 Enwa

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Posted 13 June 2018 - 10:43 AM

Ok, thank you. Today has been much better aswell. I'm hoping this will continue. Thank you for your thoughts!

Hugs

#29 Enwa

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Posted 19 June 2018 - 10:36 AM

Hi again, it's been a week now since reinstating 10mg. Things have started to get worse again, no panic attacks but constant anxiety/panic. 

I'm thinking of going to the psychiatry ER and staying there for a while. It's been 7 weeks now, soon 2 months and it's just too much.

The specific suicidal thought (which I always get) is constant and I'm scared to be alone which induces a state of constant anxiety/panic. 

There has been so little relief that I feel scared of who I am, what I want and what will become.  

What do you think I should do?

 

Hugs


#30 fishinghat

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Posted 19 June 2018 - 11:32 AM

You have been at 40 mg for a week now. It is time for help Enwa. The suicidal thoughts worry me. A lot of people go on Lexapro, Prozac or Zoloft for the withdrawal. It may not take much of a dose to give you a relief. A hard choice but you have to take care of yourself.





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