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Started Cymbalta For Pain 2 Months Ago. Worried About Withdrawal When I Quit. What To Do?


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#1 AuroraB

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Posted 13 June 2018 - 10:20 AM

Hello everyone,

 

So here goes... starting in Fall 2017 I began having issues with pain (vulvodynia). My Dr. diagnosed me with nerve pain and in April I started taking Cymbalta 30mg. Prior to that, the pain was really difficult for me to deal with and created a great deal of anxiety. I could hardly think about anything else. I took 30mg for about 6 weeks. It really seemed to help with the pain, reducing it by more than 50%.

 

Recently, I bumped to 60mg because the pain wasn't completely gone and because I thought it might help alleviate my depression (I have been depressed for 10+ years, but always refused to take medication for it).

 

I don't have too many side effects. I'd say the worst ones are constipation and water retention. 

 

However, I don't want to take an antidepressant for the rest of my life, and reading all these stories about how difficult it is to go off of Cymbalta, I'm wondering what I should do. Should I go back to 30mg now? Should I try quitting in the coming months, because the longer you wait the tougher it is? I'm worried the pain will come back. 

 

Any insight would be greatly appreciated!


#2 fishinghat

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Posted 13 June 2018 - 10:38 AM

Welcome AB

Two main choices for coming off. Wean down slowly using the bead counting method or cross taper to Zoloft, Lexapro or Prozac and wean off that real slowly. I can tell you we have had many many members who took it for pain and almost everyone that tried to come off of it had what is called rebound pain. This is where the original pain comes back but worse. This usually persists for several weeks before subsiding to the original pain levels.

By the way many, but not all, can easily drop to 30 mg with little to no difficulty. I have not noticed that time on the drug relates to a more difficult withdrawal. I remember one lady who was on Cymbalta 3 weeks and had a terrible withdrawal but to be fair my sister-in-law has come off of Cymbalta twice cold turkey (which is not recommended) and never had a symptom.

Let us know if there is anyway we can help.

#3 gail

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Posted 14 June 2018 - 05:49 AM

Hello Aurora,

Welcome to the forum, such a beautiful name by the way.

With Fishinghat on this. Going back on 30, Cross taper with the three choices given to you, while you are on 30 mg. Bead counting the 30 mg and ramping up on one of them.

Of course, you can try other methods, we are so unique, you could be one that can stop just like that, can't know till you try it, should you do so and feel worse, just reinstate at the previous dosage.

Since you have a story with depression, you might want to stay on one of those.

Fishinghat, what are the options for pain? We rarely talk about this,Aurora needs something to ease that pain. Thank you Sir!

#4 fishinghat

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Posted 14 June 2018 - 10:10 AM

Options for pain are so limited. Opioid or opioid derivatives make up the majority of the hard core pain killers but are very very addictive and have become an epidemic in the USA. Of course there is ibuprofen, acetaminophen, aspirin and other OTC pain killers but they just don't pack the same punch. Some of the other options are lyrica, topical pain killers (like lidocaine) and some antidepressants. Not a big choice. Than of course there is acupuncture which can be very effective depending on what type and location of the pain.

#5 gail

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Posted 14 June 2018 - 01:56 PM

Thanks Fishinghat, limited.
Gabapentin for neuropathic pain, what I have plus opioids.
Gotta do what you gotta do.

Note: I did taper the hydromorphone, I found it easy to get off, not sure if I went the whole way. But had to come back on it for pain. Last June before surgery, I went as high as 133mg. Sure, I can't remember much of this time nor can read my notes(lol)

#6 AuroraB

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Posted 14 June 2018 - 06:52 PM

Thank you for your answers. I will go back on 30 for the time being and discuss tapering with another antidepressant next time I see my doc. Do SSRIs like Zoloft do anything for pain ?

 

Gail, I see you're from Sherbrooke. I am from Montreal so we're practically neighbours, right ? I read a little about Gabapentin. Did you have any issues with weight gain because of it?


#7 gail

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Posted 15 June 2018 - 05:08 AM

Hello Neighbor,

So nice to see that we're real near, about 1 hour and 45 minutes away.

Fishinghat will tell at what point Zoloft works for pain.

So back on 30mg, see how goes. Zoloft is a good one, besides diarrhea in the last times that I took it, I had no side effects. But it didn't work for me.

As for Gabapentin, almost one year into it for neuropathic pain, I'm back to the weight I was months before surgery. But, I barely eat. That may be why the weight is stable. I'm also on Paxil. Two meds that are known for weight gain. I find myself with a belly,which I never had, because of the 2 inches lost with the spinal fusion.

Aurora, is your pain constant?

Sure a good thing you live in Montreal, should anxiety rise with the lowering of Cymbalta, we have here an over the counter med that takes care of it. In the US,they don't have it.

Let me know Aurora, we'll be following you!

#8 fishinghat

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Posted 15 June 2018 - 09:15 AM

Cymbalta is the only antidepressant that works for pain as far as I know but I will check. Be back.

#9 fishinghat

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Posted 15 June 2018 - 09:18 AM

Here is an excellent article on ADs for pain from the Mayo clinic. SSRIs least effective, SNRIs most effective and TCAs OK but most side effects.

https://www.mayoclin...ns/art-20045647

#10 AuroraB

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Posted 16 June 2018 - 04:34 PM

Thanks again to both of you for the information.

 

Gail, my pain wasn't constant before I started taking Cymbalta, and still isn't. Which makes it difficult to even tell how exactly the medication is working. The pain level varies throughout my hormonal cycle, and sometimes within the day. These past few days it's been higher, but I don't know whether that's hormonal or because I lowered my dose... In any case it's disheartening, and accompanied by an increase in my anxiety levels. And again, perhaps more anxiety causes more pain ? As I said my initial post, I went through a period where my pain was the only thing I could think about and I had to stop doing a lot of things as I wasn't functional anymore. I can't imagine going back to that.


#11 gail

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Posted 17 June 2018 - 04:16 AM

Hi Aurora,

Not constant, varies with your hormonal cycle. So, up and down, here and there.

I would say that pain brings anxiety, brings back the fear of before Cymbalta.

I'll be back later, need to check something out.

#12 gail

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Posted 17 June 2018 - 05:45 AM

I'm back as I didn't know what vulvodynia was.

The Mayo clinic explained real good. You must have read it. Aurora, back to your question, I have no answer. As stupid as that(lol)

I have read that depression can go with this condition. Sure doesn't help.
Does Cymbalta help with the depression?

I'm so sorry that I can't help you, it's up to you to decide Aurora. I do hope to see you posting again. If you haven't read what the Mayo clinic says, you might have a few suggestions on their site. Au plaisir de te revoir mon amie! Xxxx

#13 fishinghat

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Posted 17 June 2018 - 08:12 AM

AB
 
Cymbalta and many other ADs cause a condition called Post ssri Sexual Dysfunction (PSSD). Cymbalta heavily effects the HPA axis (hypothalamic–pituitary–adrenal axis). This axis is the chemical relationship between the hypothalamic, pituitary and adrenal gland. This disrupts the ability of these organs to control each other.

PSSD usually hits right after the final dose of Cymbalta is taken and lasts around 1 to 2 months. Many never notice the signs and symptoms because they are too busy fighting the withdrawal symptoms. If symptoms last over a 2 month period then they are considered permanent. These symptoms include vulvodynia, loss of hormone production (both testosterone and estrogen),loss of the ability to ejaculate or reach orgasm, loss of vaginal fluid production, loss of libido, penal anesthesia (loss of all feeling in the penis), erectile dysfunction, sexual mania and much more sexual related issues. I have considerable medical research on the issue and would be glad to share it with you if you are interested.

I have this condition and in my case it is permanent (5 years now). I have seen several specialists which say it is not treatable. But the good news is that for most it only last 2 to 3 months and then returns to normal.

#14 AuroraB

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Posted 20 June 2018 - 04:32 PM

Gail - Unfortunately the Cymbalta makes no difference whatsoever with the depression. I am back to taking 30mg and I'm thinking that such a "low" dose cannot help with that in my case. For the short while that I took 60mg, it only seemed to make me drowsy, but that could have been caused by something else. Down the line, perhaps a SSRI will prove more effective.

 

I have seen that article from the Mayo Clinic. It is a good article; indeed most people haven't heard of vulvodynia. Because it is a diagnosis of exclusion, I don't know for sure what caused the pain in the first place. Many women with vulvodynia have an injured pudendal nerve. I don't know whether or not that's my case. Cymbalta is actually the first and only treatment I've tried at this point. I know there are other options (nerve blocks, gabapentin, lyrica, lidocaine..), but I suppose my doctor has seen good results in other patients with duloxetine. There's also physiotherapy (I have issues with my lower back that might be related).

 

Merci et porte-toi bien :)

 

Fishing hat - I'm sorry you're dealing with this condition. I understand how much it affects day to day life. Hopefully when I do stop taking Cymbalta, more long term issues won't come up. I didn't know Cymbalta was associated with PSSD. Wow... as if withdrawal wasn't bad enough.

 

I will keep reading this forum throughout this whole ordeal...


Edited by AuroraB, 20 June 2018 - 05:20 PM.

#15 gail

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Posted 20 June 2018 - 06:29 PM

Thank you Aurora for posting.

We will be looking forward for an update. A la prochaine!

#16 AuroraB

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Posted 12 July 2018 - 08:34 PM

July 12 Update

 

So I've been bead counting and gradually reducing my dose since my last post. I figured I would try to do it at a "moderate" pace I guess I'd call it, and switch to a slower pace if that didn't work for me. So far I'm doing good. I haven't experienced effects that I can attribute to withdrawal. 

 

There's about 150 beads in my 30 mg capsules and I've been removing 5 beads per day (with a few instances where I made a larger drop). As of today, I'm down to only 20 beads. I'm thinking that now I should probably slow down and remove 2 beads per day. 

 

Lowering my dose doesn't seem to have an impact on my pain level to be honest. I've been closely monitoring my pain level in relation to my hormonal cycle and at this point I'm left wondering if Cymbalta ever even helped. I'm expecting a surge in my pain in the coming days; I'll see whether it's any worse than in the past few months.

 

I really hope that I'll be okay with the last few beads.


#17 gail

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Posted 13 July 2018 - 05:36 AM

Hello Aurora,

Wow, 5 beads a day, and no withdrawal symptoms. You are blessed Aurora!

Oh yes, do slow down. 20 beads to go, you know the drill, should it go bad, back up to where you were stable. Thank you for updating, it's the rarest update. I've read. Meaning, going at a fast pace with no withdrawal symptoms. Just Wow!

I would suggest one bead a day, the last ones are the toughest, I would hate for you to have to go too high to stabalize.

Many thanks for updating, it's really appreciated.

#18 fishinghat

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Posted 13 July 2018 - 08:49 AM

Doing great Aurora. Keep up the good work.

#19 AuroraB

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Posted 14 August 2018 - 09:03 PM

Hello again. I've been thinking about posting an update for a while but didn't get around to it. But I think it's good that I provide the full story to people here. So... following my last post, I continued to decrease my dose (by two beads a day, then by one) and now it's been a few weeks that I'm completely off Cymbalta.

 

As for withdrawal symptoms well... that's where it gets somewhat confusing to me. I never experienced brain zaps, dizziness, headaches... things of that nature. However, recently my depression symptoms have considerably worsened. I'm not sure if it's a symptom of withdrawal though. I've lived with depression for many years, and I've always had better months, then not so good (or just plain horrible) months, even before Cymbalta. These days it's really really bad though. Along with the depression, I've had serious issues with food for more than a decade, but these past few years for the most part I had a handle on it, and maintained a relatively stable weight. Now I have a gained *a lot* of weight since quitting Cymbalta, as I binge eat and can't find the will to stop. I hardly manage to get out my apartment. I'm thinking that maybe the drug messed up my already problematic serotonin levels or something like that and that food is a substitute drug ? I don't know.... 


#20 gail

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Posted 15 August 2018 - 07:04 AM

Bonjour Aurora,

So good to see you again. Since you've been living with depression on and off, the withdrawal makes this worse for a while. The old condition is still in the background. Your route looks very much like mine, plus anxiety through the roof, this why I was put on Cymbalta. It made it so much worse.

So, I cold turkeyed at 15mg, I was already going crazy on it. The first months were terrible, so were the others. I started the merry go round of antidepressants. Sadly, nothing worked for me.

I suggest to take something else to help with your condition. What do you think? Terrible months, good month and vice versa. I can guarantee that it doesn't get any better as you age.

I don't know what to say about the binging, sorry. Are you agoraphobic? Any anxiety? I see that your pain has subsided, right?

So glad you stopped by Aurora, au plaisir!

#21 fishinghat

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Posted 15 August 2018 - 08:47 AM

Hi AuroraB

 

It is so hard to get a handle on what is causing what isn't it?  Gail was right, usually the depression gets worse right after coming off before settling down some. How much it will settle down you won't know for a couple months.

 

Is it just withdrawal or return of symptoms? Hard to tell but one thing you can do (it is up to you though) is to take about 10 or so beads and see if the symptoms get better. That would be enough to help your withdrawal but not enough to significantly effect your baseline depression. I hate to see you take any more Cymbalta though. Up to you.





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