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#121 fishinghat



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Posted 19 July 2018 - 09:29 AM

Zoloft and Hypothyroidism and Leucopenia

Zoloft effect on TSH, T3 and T4

Radiation Exposure - Dec 2014 - March 2015
Start Zoloft - Oct 16, 2013
Notified of overexposure - May 15, 2015
First low WBC May 15, 2015

sertraline - TSH increased and T4 reduced.
Effects of various antidepressants on serum thyroid hormone levels in patients with major depressive disorder.

sertraline and fluoxetine showed reductions in TSH,T3 and T4 levels.
Peripheral thyroid hormones and response to selective serotonin reuptake inhibitors.

No changes in Thyroid TSH, T3 or T4.
Effects of selective serotonin reuptake inhibitors on thyroid function in depressed patients with primary hypothyroidism or normal thyroid function.

T3 increased and T4 and TSH not effected.
Effects of sertraline treatment on plasma cortisol, prolactin and thyroid hormones in female depressed patients.

Effects of long term treatment with sertraline (Zoloft) simulating hypothyroidism in an adolescent.
A 16-year-old depressed adolescent, who had received sertraline treatment for the previous 18 months, developed insomnia, daytime somnolence and lack of energy. His thyroid function tests revealed low levels of total T4 with normal levels of free T4 and TSH, and a normal thyrotropin-releasing hormone (TRH) stimulation test. Discontinuing sertraline resulted in improved sleep and disappearance of daytime somnolence. Although daytime somnolence and low levels of total T4 can mimic hypothyroidism, in this case sertraline only displaced the bound-fraction of total T4 and was not associated with true hypothyroidism

reboxetine - TSH reduced and T4 increased.
sertraline - TSH increased and T4 reduced.

sertraline and fluoxetine showed reductions in TSH,T3 and T4 levels.

Effects of long term treatment with sertraline (Zoloft) simulating hypothyroidism in an adolescent.

Treatment with sertraline for 4 weeks increased plasma cortisol levels, while 24 weeks of sertraline treatment increased plasma T(3) levels in depressed patients.

Peripheral thyroid hormones and response to selective serotonin reuptake inhibitors.

Patients on a stable dose of levothyroxine who are then started on a selective serotonin reuptake inhibitor, in particular sertraline (Zoloft), may show a rise in their TSH level and require an increase in their thyroid hormone dose

95,764 people reported to have side effects when taking Zoloft.
Among them, 618 people (0.65%) have Hypothyroidism

#122 fishinghat



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Posted 19 July 2018 - 09:37 AM

Zoloft and Hypothyroidism and Leucopenia (Cont.)

Other Adverse Reactions Observed During the Premarketing Evaluation of ZOLOFT
Other infrequent adverse reactions, not described elsewhere in the prescribing information, occurring at an incidence of < 2% in patients treated with ZOLOFT were:
Endocrine disorders - hypothyroidism
There was an increase in follicular adenomas of the thyroid in female rats receiving sertraline at 40 mg/kg (2 times the MRHD on a mg/m2 basis); this was not accompanied by thyroid hyperplasia.

Zoloft and Leukopenia
My WBC 3.8 Thous/mm3 (Low) and AbsNeut 1.6 Thous/mm3 (Low)
Continues to be low but at this time I do not see much hope of it rising, continue to monitor.
Sertraline-induced agranulocytosis. Agranulocytosis is a condition where the absolute neutrophil count is less than 100 per microliter of blood.

Sertraline- and mirtazapine-induced severe neutropenia.
Neutropenia associated with quetiapine and sertraline: A case report and review of literature.
Drug insert
6.2 Postmarketing Experience
The following adverse reactions have been identified during postapproval use of ZOLOFT. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Hemic and Lymphatic – agranulocytosis, aplastic anemia and pancytopenia, leukopenia, thrombocytopenia, lupus-like syndrome, serum sickness
51,803 people reported to have side effects when taking Sertraline.
Among them, 213 people (0.41%) have Leukopenia
95,764 people reported to have side effects when taking Zoloft.
Among them, 571 people (0.6%) have Agranulocytosis
Sertraline-induced agranulocytosis.

Neutropenia Associated With Sertraline Use: A Case Report

Leukopenia and neutropenia caused by sertraline
Zoloft Withdrawal

Am J Psychiatry. 1994 Mar;151(3):450-1.
Withdrawal reaction after sertraline discontinuation.
Louie AK, Lannon RA, Ajari LJ.
No abstract

Sertraline withdrawal in two brothers: a case report.
Rosenstock HA.
withdrawal symptoms of (1) dysequilibrium (2) dysesthesias (3) dizziness and (4) a flushing sensation.

Irritability Agitation Dizziness Burning or tingling sensation anxiety Confusion headache insomnia Tiredness.

I get dizzy a lot, my vision seems blurry, I have these tingly feelings in my fingers and toes, and the worse part is the "electric shocks" that seem to run through my body all day. I feel sick to my stomach a lot and it's hard to eat. (3 days later) I'm getting a bit better. I'm sleeping better but I still have the dizziness and the "electric shocks". I used to wake up all sweaty but that doesn't happen anymore either.

I took Zoloft for 5 years in the past and over a week stopped taking them with NO withdrawal symptoms but not this time I guess I foolishly thought it would be the same this time.

#123 fishinghat



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Posted 19 July 2018 - 09:39 AM

Zoloft Withdrawal (Cont)

last time i tappered off the drug i was ok for about 2 months but then i was hit with a big bang of anxiety and dispair- i was forced to go back. currently im at 25 mg down from 50mg-- i'm hoping that in time i can just continue to tapper down until i'm totally off of it.

I have spent the last 6 months, slowly withdrawing from the medication, which I can no longer afford. For the past month, I have been without zoloft, but I am now having periodic anxiety attacks, and perseveration about random things, some paranoia, and now sucidial thoughts
past year I have been taking 25mg every other day, or even every third day, in preparation for stopping altogether.This past Friday, I took my last dose.
It is now Thursday. Since yesterday I have been suffering from brain zaps, disorientation, spatial/depth perception problems, inability to focus, nausea, dizziness, vertigo, and, beginning today, a feeling of deep sadness.

Week One: Alternate one day taking 50mg, the next 25 mg (half a pill)
Week Two: Take 25 mg daily
Week Three: Take 25 mg every other day
I completely quit after week three, and I haven't felt normal since.

I had been on zoloft for 2 years. As much as 150 mg , but in the last year it was only 50 mg. I thought I had done a good job of ramping down, over a few weeks. to 25 mg then 12.5 , and then 12.5 every other day. But now I've been withdrawing for a week and a half. It's good to know that this all fits in with what others have experienced though, and to know that it might be up to a month of this. Now I guess I just need to decide if I hang in or go back to a low dosage to maybe alleviate some of this.. But then exend the process.
when i first tried getting off of my 200 mg/day dose of zoloft (after being on it for three years), i'd never felt so AWFUL in my life. i followed internet instructions of dropping my dose by 25 mg every two weeks. obviously, this didn't work. i thought trying to wean myself off was futile, and that i would have to take it for the rest of my life. WRONG! it takes almost TWO YEARS to ween yourself off of a 200 mg/day dose
I am just starting tapering off of 100mg zoloft to 75mg two weeks ago. I was doing fine and everything until a couple days ago.
....i went 50 to 37mg to 30mg to 25mg to 18mg to 12mg then six every other day for two weeks it was fine except for the first two weeks i felt some nausea but no brain zaps and i totally know what you mean by feeling like you were in the clouds i finally feel back to myself and its great!!!!!!!!!!!!!
he increased it each time I went in until I was on 150 mg. Now I was sick, depressed, and going through menopause. But by far the worst part was being numb. I could care less about anything. When my friends and loved ones went through grief or sadness I could not cry with them. So they all probably think I am heartless.
Anyway I have began tapering and started in April by chipping away a little of my pills a little at a time because I've tried and failed so many times. I got down to 50mg and stayed 0n that for 1 month. Now I am shaving a little off that for a week until I'm down to 25mg, and I'll stay on that until I can cut that in half.

It took me two and a half years to taper off Zoloft from 300mg

my advise to those quitting.
from dosage 200, drop to 150mg for 1 whole week.
from dosage 150, drop to 100mg for 10 days.
from dosage 100, drop to 50/75mg for 2 weeks.
from dosage 50/75. drop to 25mg for 3 weeks.
from dosage 25, completely stop medication.
doing it this way if you have been on the medication for 1 year or more is advisable.

I was on 150mg for one year minimum. I dropped zoloft by 25mg each 3 weeks and I'm at 0 since a month. In fact, it's my 5th week right now. No problem for the first 2 weeks, then I got anxiety, insomnia, well almost everything in the side-effect list. But it was nothing compared to the 4th week and right now.

I've been tapering since the spring, from 200mg and am currently at 112.5mg. I've been on it for about 15 years, between 200 and 250mg. I've gained probably 25lbs, gradually, but have lost about ten, since reducing to my current dosage of 112.5mg hs. My first two reductions of 25mg were smooth, the third reduction was rough, the fourth smooth, but this current reduction of only 12.5mg has been hard, again. Most recently I reduced by 12.5mg a couple of days ago from 100mg, so am happy to be in the double digits now more or less. I plan to reduce again by 12.5mg in a couple of months or more. I stayed at 100mg for about 4 months, making sure I felt well and stable. Within about a week, with each reduction I feel ill, as I do now - with nausea, weakness, occasional crying spells, a bit down, slow, gastrointestinal issues, hard to focus... I made the mistake I think of initially starting this recent reduction by alternating doses of 75mg one day and 100mg the next ( for about two weeks), so I had a day where I felt fine and a day where I felt horrible. I started with the 87.5mg today, so will take awhile I suppose to stabilize. I also switched to taking it in the morning today. I started at 250-300mg a year ago and am now at 75mg for about a month and a half and still having withdrawal effects from that last taper (from 87.5mg down to 75mg). I felt fine for about 10 days and then massive NAUSEA, insomnia, sweating, aching joints and muscles, gastrointestinal pains and problems..Though even at 5% tapers now, I still seem to be hit with the w/d. I'm now at 70mg, from an original dose that wavered between 250 and 300mg (for 17 years). I have read that the length of time to get off an antidepressant should be at least one month for every year you have been on it. I was last at 50mg August 15 and have tapered by 6.2 since then, every 9 days or as soon as I felt stable and I felt very well those two weeks, but now it's hit me, again- all the flu-like withdrawal symptoms. Just wanted to leave an update of where I'm at in my tapering off Zoloft. About a year and a half ago I was at 250-300mg Zoloft, and am now at 37.mg!! I'm now at 31.2mg Zoloft. Only five more tapers of 6.2mg to go until I'm done. I've been nauseous for the past ten days with a new withdrawal symptom (for me) of left-sided headache nearly twenty-four hours a day, but seems to be easing since yesterday. Often I feel on the verge of vomiting, and am achy but that is easing up again for this 6.2mg taper. Taking a lot of ibuprofen and Gravol. I taper by 6.2mg. From an original dose of 300mg max, I'm now down to 25mg. Still get very sick -achy, nauseaus, headache, irritable, diarrhea/gastroparesis, vomiting (occasional) with each taper. Unbelievable. It will be two years in February since I began tapering off. I'm just looking at my journal and I see I went from 50 to 43.6mg (by tipping out 1/4 of the powder in a 25mg capsule + taking with another 25mg). I stayed at 43.6mg from August 16/10 to August 22/10 (not that long relative to my more recent reductions). On August 22 I went down by another 6.2mg to 37.5mg (roughly) and stayed there until Sept 14. Sept 14 I went down by another 6.2mg to 31.2mg and stayed there until November 22ish. You see I haven't been tapering too fast, because each time I suffer the same symptoms- nausea, headache, achy muscles, joints etc., upset digestive system, eventual insomnia...These all do eventually pass, but I am surprised each time I am hit with the same symptoms, same intensity.

I just ordered a scale which measures down to .001 grams....got it on ebay for around $25.
I understand that these scales are great for accurately measuring meds.I'm about 5 weeks into 25mg and still don't feel stable, mostly physically- achy, digestive slowing, nausea, hard to focus...but manageable. My next four reductions will be by roughly 6mg, by dividing the 25mgs of powder into 4.I've been at 25mg for 7 weeks and finally feel stable for a few days in a row- no nausea, much less achy, no stomachache. Finally! I won't do another taper though for awhile, just so sick of feeling sick.Was finally feeling better after 7 weeks at 25mg, from 31mg (original dose of 300mg two years ago). Now I feel sick again with same digestive system problems, nausea, aches, headache for the last 8+ days. I was last at 25mg for over four months, waiting for terrible withdrawal of mainly nausea, stomachaches and body pain, to subside. I became very frustrated two weeks ago with the constant nausea so thought I would try taking pill in pm rather than am. Well, the day I missed the dose I began to feel better and better as the day went on- the nausea, pain and stomachache subsided. I still cannot believe it and am angry, but I haven't taken any since and have felt much better, fine in fact. I quit the Zoloft altogether about 3 weeks ago. It was going well until I started crying a lot, maybe a week ago. I could deal with that, but then the rest of the symptoms crept up one or two at a time in the last three days and feel nearly unmanageable. Nearly all my usual withdrawal symptoms have returned full force- pain (upper, then lower back that migrates back and forth), in muscles, achy, as well as clicking joints and bones everywhere, which maybe are displaced by tight muscles, nausea, insomnia to 2:00 to 4:00am, sweating, chills, then massive shaking most nights, out of proportion anger and tears interfering with work... Stomach hurts too, bowels still working this time, no sinus headache this time, so far. Hopefully tomorrow will be better. I hoped this wouldn't happen. I was feeling so well. No intention of taking Zoloft to ease this hell, not yet.

Go down so slowly you are shaving off tiny parts of pills or just a granule or two of capsules.
Wait 3 days to a week before each new lowering so you have a chance to get back some emotional strength to face the next round.

A patient receiving sertraline for depression developed dizziness and orthostatic hypotension on repeated attempts to discontinue the drug. All other organic factors were ruled out. The hypotension was proved to be secondary to sertraline by repeated rechallenges. After a variety of attempted treatments, the agent was discontinued successfully through an extended titration period. This report should guide clinicians in treating patients with a similar problem.

Sertraline discontinuation syndrome presenting with severe depression and compulsions.

#124 fishinghat



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Posted 19 July 2018 - 09:49 AM

Contains - Sodium citrate dihydrate 230 mg
The following information from ...

A pH buffer used to neutralize acids. Also functiuons as an electrolyte providing sodium and Citrate ions to the body.
Industry Uses
Agricultural chemicals (non-pesticidal)

Consumer Uses
Agricultural products (non-pesticidal)
Automotive care products
Building/construction materials
Cleaning and furnishing care products

From Wiki


Sodium citrate is chiefly used as a food additive, usually for flavor or as a preservative. Its E number is E331. Sodium citrate is employed as a flavoring agent in certain varieties of club soda. Sodium citrate is common as an ingredient in Bratwurst, and is also used in commercial ready to drink beverages and drink mixes, contributing a tart flavor. It is found in gelatin mix, ice-cream, yogurt, jams, sweets, milk powder, processed cheeses, carbonated beverages, and wine, amongst others.

Sodium Citrate can be used as an emulsifier when making cheese. It allows the cheese to melt without becoming greasy.

As a conjugate base of a weak acid, citrate can perform as a buffering agent or acidity regulator, resisting changes in pH. Sodium citrate is used to control acidity in some substances, such as gelatin desserts. It can be found in the mini milk containers used with coffee machines. The compound is the product of antacids, such as Alka-Seltzer, when they are dissolved in water. The pH of a solution of 5 g/100 ml water at 25 °C is 7.5 – 9.0.

Medical uses
In 1914, the Belgian doctor Albert Hustin and the Argentine physician and researcher Luis Agote successfully used sodium citrate as an anticoagulant in blood transfusions, with Richard Lewisohn determining its correct concentration in 1915. It continues to be used today in blood collection tubes and for the preservation of blood in blood banks. The citrate ion chelates calcium ions in the blood by forming calcium citrate complexes, disrupting the blood clotting mechanism. Recently Tri-sodium citrate has also been used as a locking agent in vascath and haemodialysis lines instead of heparin due to its lower risk of systemic anticoagulation.[3]
In 2003, Ööpik et al. showed the use of sodium citrate (0.5 grams per kilogram of body weight) improved running performance over 5 km by 30 seconds.[4]

Sodium citrate is used to relieve discomfort in urinary tract infections, such as cystitis, to reduce the acidosis seen in distal renal tubular acidosis, and can also be used as an osmotic laxative. It is a major component of the WHO Oral Rehydration Solution.

It is used as an antacid, especially prior to anaesthesia, for caesarian section procedures to reduce the risks associated with the aspiration of gastric contents.

Boiler descaling
Sodium citrate is a particularly effective agent for removal of carbonate scale from boilers without removing them from operation[5] and for cleaning automobile radiators.

Do not use with antacids containing aluminum, aspirin, salicylates, lithium or quinidine.

Check https://www.drugs.co...um-citrate.htmlfor further information.

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Posted 06 January 2019 - 05:30 PM

                                                                              2018 Addendum
                                                                                        Page 1

In particular, a number of antidepressant-controlled trials demonstrated that H. perforatum and its active ingredients, hypericin and hyperforin, possess antidepressant properties similar to those of tricyclic antidepressants and selective serotonin reuptake inhibitors but with fewer and milder side effects. St. John's Wort
Thus, the present study confirmed the involvement of GABAergic and NO-sGC-cGMP pathway in the 'anxiolytic-like' effect of pyridoxine (vitamin B6) in mice.
Our results do not provide evidence for a causal effect of circulating folate or vitamin B12 on the risk of depression or anxiety.
We found significantly lower levels of vitamin B12 and vitamin D and higher levels of homocysteine in the patient group (OCD) compared to control group
supplement of vitamin C has a potential preventive and therapeutic effect on mental illness, such as major depressive disorder (MDD), schizophrenia, anxiety and Alzheimer's disease (AD).
We reported rapid-onset hyponatremia and delirium in an older patient after 2 doses of duloxetine, which was used to control his postherpetic neuralgia.
This research provides preliminary support for rTMS as an early intervention for depression and supports the need for sham-controlled trials.

Participants with greater severity of depression and higher anxiety had superior responses to active sTMS, whereas treatment naïve individuals exhibited a greater response to sham.

Similarly, there is some evidence that GAD can be treated with rTMS. The results for treating either phase of bipolar disorder are mixed with most of the current studies showing lack of benefit over sham.

The results suggested that alleviation of GAD by bilateral low-frequency rTMS may be involved in the increase of the level of BDNF and the release of 5-HT in the brain.

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Posted 06 January 2019 - 05:33 PM

                                                                                   2018 Addendum
                                                                                          Page 2

Thus, this pilot study does not only demonstrate that NIRS-based NF (neurofeedback)
is feasible in SAD patients, but also may be a promising method to investigate the causal role of the dlPFC in attention biases in SAD.

Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of Clinical Effectiveness and Guidelines
CADTH Rapid Response Report: Summary With Critical Appraisal
Srabani Banerjee and Charlene Argáez.
Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Nov 13.
This study did not find convincing evidence of a clinically important benefit for mirtazapine in addition to a SSRI or a SNRI antidepressant over placebo in primary care patients with TRD (treatment-resistant depression).

This study suggests that in well-controlled medical settings with adequate monitoring, a single rapid 1-minute injection of ketamine 0.5 mg/kg can be well tolerated and is efficacious in rapidly reducing depression symptoms and suicidal thoughts in outpatients with TRD (treatment-resistant depression). These findings are relevant to the practice of general clinical psychiatry and emergency departments were ketamine can have a place in acute management of TRD.

The odds of responding or remitting during venlafaxine or lithium monotherapy were reduced by 25% and 32%, respectively, with each increase in the number of prior antidepressant treatment trials.

During the treatment of dysthymia (Persistent depressive disorder) with antidepressants in the SSRI group, tachyphylaxis/tolerance might be observed in a relatively in high proportion of cases.
Twin studies as well as more recent genetics-based heritability analyses demonstrate that up to 40 to 50% of the variance in predicting PTSD following trauma is heritable.

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Posted 06 January 2019 - 05:37 PM

                                                                               2018 Addendum
                                                                                         Page 3

Desvenlafaxine (brand name: Pristiq) is a drug closely related to Effexor.
Desvenlafaxine (Pristiq) - is a synthetic form of the major active component of venlafaxine (Effexor). It is approximately 10 times more potent at inhibiting serotonin uptake than norepinephrine.
It has a reputation of as bad or worse withdrawal than Effexor or Cymbalta.


15,653 people reported to have side effects when taking Pristiq.
Among them, 475 people (3.03%) have Nausea and vomiting
15,653 people reported to have side effects when taking Pristiq.
Among them, 731 people (4.67%) have High blood pressure
15,653 people reported to have side effects when taking Pristiq.
Among them, 1,129 people (7.21%) have Exhaustion, fatigue, lethargy, tiredness, weariness

Member Comments
Matt123 - Things were going fine until I began to get a constant dizzy/off balance feeling in February while on Pristiq and it has not gone away, even after swapping tablets to Paxil. In fact now the dizziness becomes intolerable if i try to up any anxiety tablet above a small dose.


albergo11 - To give a brief background, in January of 2013 I was prescribed 50mg of pristiq, had a bad reaction to it,


Mrs301 - My doctor first had me on Pristiq 100mg. Well insurance won't pay for it so it cost me well over $100.00.


Pups4Life - I have a family member who is on Pristiq and happy with it.


vonmarie - (because I had a really bad experience with going off from Pristiq and didn't want to relive that nightmare!)


AaronSD - I eventually started taking Pristiq, which was moderately effective,


sk8mom - By January 2009 I had tried about 7 different antidepressant and had major side effects and bad reaction to them all (I remember trying Paxil, pristiq, celexa,- my psychiatrist tried to combine these with seroquel, risperdal and zyprexa.. zyprexa was the only one I could tolerate..

windupbird - I've been off Cymbalta since Sunday now and have taken Pristiq for 3 days. I'm feeling really sleepy and a lot of dizziness and light headedness. How long will this last? I think its to late to go back to Cymbalta and wean off slowly. I just wanted to be done with it and on Pristiq cause I want to feel better.
My wife was put on Pristiq and weaned off Cymbalta in one week. The results were horrendous. You must wean off Cymbalta very, very slowly. See the post on the official protocol by Professor Healy. The side effects of Pristiq are similar to Cymbalta but it works amazingly well in some patients. See if your doctor could give you a small dose of Prozac whilst you come off Cymbalta and then try the Pristiq. Hope this helps. DonMH.


beachmama - To Kylie, I see that you are going to go to Pristiq. Be advised of the side effects including but not limited to, Increase in BP. I was on it for a short period of time and my normal hypotension (low blood pressure) jumped to stroke status. this is another seratonin drug and you will need to wean off of it.
rigby941 - Easiest.... um - none, really. I've been on so many... Pristiq is pretty bad, I remember - but not as bad as Cymbalta...


Nola - I work nights/weekends at a hospital. I have four consecutive days off. Last Monday, I went to sleep and didn't wake up again till Tuesday night. At that point I decided not to continue taking the Pristiq. I pretty much slept until I had to come to work on Friday night.


Marcia - Feeling like the floor is not solid beneath my feet. (way worse with Pristiq, though)


TinyTimmyTom - I took my Pdocs advice and started taking Pristiq. Apparently I'm sensitive to medications, and I had to get off it ASAP because I was having blurred vision.


rosie - I am a totally different person today. After one day on Pristiq, my mind is clear, my mood is great and the nausea, dizziness and those annoying brain zaps have gone. I will never forget that feeling and the sound when I moved my head too quickly ("ch, ch, ch" sound). I hope this lasts as I have to say, I am excited and optimistic about my future.


sandy63 - My Psychiatrist said it was fine to and do on Pristiq-I have to quit because gave me bad stomach pain which they want my Drs, records from that ordeal of eight months-I have been through hell with this-so sick with vimiting-sweats-chills-severe neck pain--severe depression which Has not ended--after several day my dr. put me on 20mg of Prozac to help-it does but not alot yet been on it for one week- still have alot of sadness,worry and want this to end.


Angela - I was originally on 60 mg but they stopped working for me so a dr prescribed me a new A/I, Pristiq. I took that for a week and a half and was weaning off the Cymbalta too. I started losing weight, no appetite, nauseous and diarrhea. He said to stop taking the Pristiq because that was a side effect, which I never had on the Cymbalta.


Kim - After Pristiq came on the market, he thought it would be a wise decision to switch me from Cymbalta to 50mg of Pristiq right away and should have had "no symptoms at all". WELL I call BS within 2 days I was out of work for a week, vomiting, diahrrea, fever, brain zaps like crazy, every thing I've read about people basically going cold turkey. He upped my Pristiq to 100mg and still it did nothing. Crying all the time, thinking I didn't even want to live like that anymore. I stopped going to him, stopped taking the Pristiq and went back to my 60 of Cymbalta and have been back to that routine for the last year and a half.


really nervous - The Pristiq dosage hasn't been working and I've been anxious and feel like my body is made out of lead! I've also had an upset stomach.


Christy - I am experiencing the same problem. I have been taking Pristiq for 1 yr and half. I recently asked to switch to Welbutrin because I gained 30lbs while taking Pristiq.


saratty45 - I am in Day 5 off Cymbalta. My doctor switched me to Pristiq because I wasn't feeling well and felt the Cymbalta was not working. While I feel relatively mentally clear... able to work productively, etc. physically I feel TERRIBLE. I first experienced nausea, diahrrea, headaches (not extreme) and feelings like mild electric shock going through my body. The intestinal issues are calming down. However, the feelings of electrical shocks seems to be increasing.


wmaraionet - The doctor had put me on Pristiq but my blood pressure is out the roof.


isabell - Now I'm on the new anti-D Pristiq no side effect for me at all and for me it has been like a wonder drug. been on it for 3 1/2 months and I finally feel great, like the old me I haven't been in over 15 years.
I am also keeping a daily journal that keeps track of how I feel and what I have taken. It’s helped me look back and realize how far I’ve come.

#128 fishinghat



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Posted 07 January 2019 - 10:25 AM

                                                                                       2018 Addendum
                                                                                             Page 4

Vyvanse (lisdexamfetamine, a form of amphetamine) is a Schedule II substance in the US, which means that it has a high abuse potential, and its continued use can lead to severe psychological and physical dependence.

In this case, withdrawal symptoms may include:
Hypersomnia (at first)
Lack of motivation.
Dysphoric mood depression.
Increased appetite.
trouble sleeping

Withdrawal symptoms usually appear within the first 24 hours following the last use of Vyvanse and can last several weeks.
The first week is usually characterized as the initial “crash,” during which many people spend quite a bit of time sleeping.
It is also important to note that during the most severe phase of withdrawal, suicidal ideations are possible, and family/friends should be alert to the mental state of the user during this period.


Generally speaking, Vyvanse withdrawal is less severe than other amphetamines, such as Adderall, due to its decreased potency.
Tapering lasts between several weeks and several months, depending upon the individual patient and how large of a dose the patient is taking at the start of tapering.
Staying hydrated is critical during withdrawal.


Reactions reported to FDA when taking Cymbalta and Vyvanse together.

Handling withdrawal.

Avoid other stimulants. Refrain from using other stimulants, such as cigarettes or caffeinated drinks. These can interfere with the quality of sleep, making a person feel even more tired.
Eat well. Staying hydrated and getting a good range of vitamins and nutrients can have a powerful effect on a person's overall mood.
Get a good night's sleep. Make a plan for bedtime and create a good sleeping environment. A person may also wish to place a few drops of aromatherapy oils on their pillow, such as lavender or jasmine.
Schedule some downtime. Avoid planning too many activities or stressful situations when a crash is possible. This can help to reduce anxiety or stress.
Stress relief. Find some effective stress-relieving or sleep-promoting activities. These may include deep breathing, meditation, or listening to soft music.
Avoid depressants. Avoid using drugs that depress the nervous system, such as alcohol. These substances may further disturb a person's sleep and extend the comedown.

At the bottom of this site is a discussion that people had about their experience with this withdrawal.

After reading a lot of stories about peoples experience with Vyvanse withdrawal I would say that the key is to taper over a 2 month period. Those doing that seemed to have less issues with withdrawal symptoms.

Note - The manufacturers of this medication provide no guidance on how to successfully withdraw from their product.

J Clin Psychiatry. 2012 Jul;73(7):977-83. doi: 10.4088/JCP.11m07430. Epub 2012 Jun 12.
Maintenance of efficacy of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder: randomized withdrawal design.
the participants entered a 6-week double-blind randomized withdrawal phase on treatment with lisdexamfetamine dimesylate (same dose) or placebo. During the randomized withdrawal phase, treatment-emergent adverse events were reported in 48.2% and 30.0% of participants in the lisdexamfetamine dimesylate and placebo groups, respectively. Treatment-emergent adverse events with incidence ≥ 5% in the lisdexamfetamine dimesylate and placebo groups were headache (14.3% and 5.0%), insomnia (5.4% and 5.0%), and upper respiratory tract infection (8.9% and 0%).

There were no significant amphetamine withdrawal symptoms noted after LDX discontinuation. Amphetamine withdrawal has not been well studied; however, animal studies suggest behavioral manifestations become prominent within the first 2 days after discontinuation and can persist up to 4 weeks (Paulson et al, 1991). No meaningful differences in response between placebo and LDX were observed on key efficacy measures during the double-blind/randomized-withdrawal phase.


Note - This was all I could find in the medical research relating to Vyvanse withdrawal. Given the results from these studies I would recommend a 3 month tapering period rather than 2 month just to be safe. with this being a powder filled capsule I would suggest the product be weighted out for dose determination. Weight the amount of powder un 3 capsules and then divide by 3 to deter mine the average amount in each capsule. Divide that amount by 100 to determine the amount to decrease the dosage each day. This will undoubtedly require a very sensitive low mass scale.

#129 fishinghat



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Posted 07 January 2019 - 10:27 AM

                                                                           2018 Addendum
                                                                                   Page 5

Posted by brzghoff on 08 April 2018 - 08:38 AM in Weaning Off Cymbalta
Wow. Been a few weeks past a year since i started this taper off lamotrigine/lamictal and i’ve still been holding at 100 mgs since last summer. Its been tough to even consider it. There is almost always a slight edge of anxiety that gives me pause. Overall life is good, but withdrawal, however so slight, is enough to seriously affect my self awareness - where i develop a total lack of it. I over-react, catastrophize and the physical flu like feelings and extreme fatigue are dibilitating whenever i try just a mild drop. I Just cant afford it with my current work situation. Its pretty much just like withdrawing from cymbalta. Totally different drugs, duloxetene and lamotrigine, so i have no idea why withdrawal is virtually the same.
A couple months ago i accidentally forgot to take my daily dose of lamotrigine, didn’t realize it til i got to work and felt sick all day. Took it when i got home, and as per normal therefafter and it took a week to recover. Cymbalta was never that bad. If i forgot a whole dose, when i would take it later that day or next morning i’d feel normal again within hours.
Im totally bewildered.

Posted by OogaBoo on 11 October 2017 - 01:30 AM in How to Find Support
This probably wasn't the best decision, but I quit Abilify, Lamictal, and Cymbalta all at the same time, about a week ago.
I had only been on Cymbalta for a few weeks at 20mg a day.
I've definitely had some withdrawal - mostly lightheadedness as well as nausea (no vomiting thank goodness) and near constant diarrhea.
While this isn't fun, it has been tolerable. Does it make sense to take some Cymbalta in very small doses now that I'm already a week out? I'm concerned that quitting cold turkey will lengthen my withdrawal cycle.

Posted by Muzumi on 24 September 2017 - 07:13 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
Thank you so much for all this information! I have to say I was so focused on Cymbalta that I didn't research Fetzima as much as I should have. You are right that in the case of Effexor XR -> Cymbalta the doses were somewhat equivalent whereas Cymbalta -> Fetzima was quite a drop. My psychiatrist gave me free sample boxes of Fetzima to see how I feel on it and they only come in 40mg. Having me stop the Cymbalta completely was very radical - she is usually good about increasing doses/weaning gradually (esp. with Lamictal which can be lethal if started at too high of a dose) but this time I think she really overlooked the transition.

Posted by gail on 04 April 2017 - 02:43 PM in Weaning Off Cymbalta
I have just withdrawn from Lamictal, it was a three or four weeks that I could barely go out as agoraphobia was through the roof. It's gone now mostly. Hold on, it will get better!

Posted by gail on 24 March 2017 - 06:50 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
I had kind of forgotten how it was in withdrawal, and now I am living through the same nightmare as you all with Lamictal withdrawal. Dear God, how challenging. I never thought that Lamictal would have such a pretty heavy withdrawal. As worst as the C.

Posted by gail on 04 March 2017 - 05:11 PM in Nutritional Support
Withdrawing from Lamictal is worsening the depression and anxiety. Pain where my kidney was removed, makes it hard to work. Both together, makes me wish that I would not be here. I sure did not expect Lamictal withdrawal. It never crossed my f$#@$#mind, I just had enough as it was.

Posted by PtldFrank on 25 January 2016 - 11:59 AM in Weaning Off Cymbalta
I was taking Lamictal for epilepsy, and the big concern for tapering off was triggering a seizure. That being said, the withdrawal process went very smoothly. No trouble.

Posted by PtldFrank on 24 January 2016 - 11:22 PM in Weaning Off Cymbalta
I also took a lot of Lamictal (700 mg/day) until I realized it was giving me pretty bad side effects. I spent 14 weeks going off that (and not driving) in 2014.

Posted by Michgirl on 27 December 2015 - 10:12 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
brz - I had no issues coming off of Lamictal that I know about. I did it slow though. Wish I had done this with Cymbalta. I have similar issues with driving as well.

Posted by brzghoff on 22 December 2015 - 10:33 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
i have heard mixed reports about lamictal withdrawal. the fact that you did it across 18 months sounds like it could be a doozy. was that your choice or did your doc map that out? i know that to avoid the possibility of developing stevens-johnson a taper is required, but i thought for that purpose the taper only needs to be across a month or less. as with most psychoactive drugs, docs seem to think any withdrawal - or discontinuation syndrome - only lasts 2-3 weeks. ha! survivingantidepressants.com recommends a much longer weaning process to minimize what some report as being a terrible withdrawal. i've heard others report it wasn't a big deal. but then for some that's how it is with cymbalta, no big deal. i'd love to get off lamictal, but i am not ready.

Posted by Michgirl on 22 December 2015 - 09:19 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
I was also on Lamictal 150 mg for the past 4 years and I slowly weaned down over the past 18 months to none around the time I went off Cymbalta.

lady2882Nancy, on 17 Apr 2015 - 3:12 PM, said:
I was on a mood stabilizer for a long time and found that it made me very depressed and lonely, and limited my intellectual capacity to solve problems. I was on lamictal from 2008-2012 and when I eventually did taper off over a month or so, I didn't experience any withdrawal effects.

Posted by MichCPA on 11 January 2014 - 01:23 PM in Weaning Off Cymbalta
I am also going off of Lamictal. I had been on 200mg 2x/day for over a year. He told me I could go off that quickly. He said to take 200mg 1x/day for 3 days, then half that for 3 days and then stop completely.

Posted by Gigi on 22 September 2013 - 11:57 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
I was on Lamcital with the Cymbalta. But it makes me spend money and I was getting into trouble. I tried the brain supplements while on the Lamictal and had a terrible reaction. So I started weaning off the Lamicatl at half the dose. 50mg I was able to try the supplements again and I felt really good & no spending money I do not have.
I weaned off Lamicatal totally. The right way. Like I do any medication.

Posted by Imdone on 29 August 2013 - 11:39 PM in Weaning Off Cymbalta
I MADE IT!!! It took me 2 years to get off my original cocktail of Risperdal, Lamictal, Cymbalta, Klonopin & neurontin.

Posted by DonMH on 27 September 2012 - 10:41 PM in Weaning Off Cymbalta

Prozac will work as you come off Cymbalta at the end rather than Effexor.
The bad news is Lamictal is almost as bad to come off. Do not try and come off both at once.

Posted by vsung on 18 June 2012 - 12:09 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
I cannot take off from work because I was just out for 2 months on disability coming off of Abilify and Lamictal. I thought it was horrible weaning myself from that!! Boy I was in for a big surprise since I've came off of Cymbalta.

Posted by Imdone on 24 March 2012 - 01:59 PM in Weaning Off Cymbalta
Often the last psych med you wean off of is the hardest, if you were on multiple, like I was. I got off Risperdal, Neurontin and Lamictal with ease (after being misdiagnosed as Bipolar) but getting off Cymbalta is tough after taking SSRI's and Cymbalta for a long time.

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Posted 07 January 2019 - 10:33 AM

                                                                              2018 Addendum
                                                                                     Page 6

Topamax Withdrawal.

This forum may givwe you some idea on the topamax withdrawal. I could not find any research articles on it.

Good guidance document on topamax withdrawal. Looks accurate.
Fludrocortisone Withdrawal

I suprised me to find out it reduces salt content in the blood and can reduce blood volume. Not good for POTS, I would think.

Notes withdrawal symptoms.

Symptoms of withdrawal include increase in BP.

Adverse reactions to corticosteroids may be produced by too rapid withdrawal or by continued use of large doses.
This same warning exists in manufacturer's literature.
POTS (postural orthostatic tachycardia syndrome)
This is an excellent overview on the current research on the causes of POTS.

A good list of treatment options.
Be aware there are some POTS websites out there that put out some weird stuff.



HRTbroken Posted 12 December 2018 - 11:59 AM
4 months after Cymbalta withdrawal, she is completely confused about her feeling for me. One minute she loves me, the next she does not and my existence is a problem. She developed hyper sexual behaviour wanting to engage in intercourse 10 times a day, not leaving the bed if possible
She first lost her sex drive entirely, didn't want to be touched. Then all of sudden hypersexual,
she did a month long trial of Wellbutrin, which is a dopamine re-uptake inhibitor to see if it would help with the sexual side effects of being on Cymbalta, but she found it made things worse. That was a year ago though. It may have played a role in this,

Lady2882nancy Posted 12 December 2018 - 06:01 PM
From Don't touch me to wanting too much. I was lucky enough to find a Psychiatrist that understood what was happening and put me on a mood stabilizer and got me in with a Psychologist who knew her stuff.

BLB Posted 03 October 2009 - 09:19 PM
Non-stop, uncontrollable, unprovoked orgasms
Because I stepped down from three caps to two then to one and then because of a snafu with ordering a refill went off totally on the Thursday after Labor Day, 2009. I've had lots of withdrawal symptoms and today found this forum while I was looking for help for the most recent problem.

Kelred5 Posted 13 October 2009 - 12:11 AM
I did have something similar to this myself. I was dreaming and waking up while having uncontrollable, unprovoked orgasms. Yes, it's not the most horrible thing but definately strange!!!

kha Posted 25 July 2018 - 10:43 AM
Oh my gosh! Finally someone somewhere who is experiencing what I am. Yes, I'm having the same problem. Unprovoked. Hours on end. Incredibly awkward and life-stopping. And, no, I've not been on any other medication other than cymbalta which I had to quit cold turkey 3 days ago.
"After 8 weeks of antidepressant therapy (for major deprerssive disorder), there were more STPs with vortioxetine than with duloxetine (27.4% vs 22.5%, respectively). "

A success rate in the 20% range. I don't consider that very good. Not exactly encouraging.

#131 fishinghat



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Posted 07 January 2019 - 10:36 AM

                                                                         2018 Addendum
                                                                                Page 7

Cymbalta Withdrawal
Psychother Psychosom. 2018;87(4):195-203. doi: 10.1159/000491524. Epub 2018 Jul 17.

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review.

Fava GA1,2, Benasi G1, Lucente M1, Offidani E3, Cosci F4, Guidi J1.



Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation.


PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: "duloxetine" OR "venlafaxine" OR "desvenlafaxine" OR "milnacipran" OR "levomilnacipran" OR "SNRI" OR "second generation antidepressant" OR "serotonin norepinephrine reuptake inhibitor" AND "discontinuation" OR "withdrawal" OR "rebound." Only published trials in the English language were included.


Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well.


Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.
Scoffy1209 Posted 27 August 2018 - 02:59 PM
I'm also using a CES device which is supposed to help with depression and anxiety -- it emits a low grade current sent through ears. It is very popular in Israel, but drug companies in US have prevented it's proliferation here. Here's a web address for the CES: https://www.alpha-st...ood-conditions/.
Scoffy1209 Posted 27 August 2018 - 02:59 PM
That last one, LDN is a prescription low dose naltrexone which i take at night and it boosts a natural endorphine response overnight and allows me to wake up feeling pretty good and also helps with sleep. Here's a link: https://www.ldnscien...mark-shukhman.
Effects of naltrexone, duloxetine, and a corticotropin-releasing factor type 1 receptor antagonist on binge-like alcohol drinking in rats.
Decreased binge drinking in rats.

Posted by Jennyphresh on 30 September 2016 - 11:24 AM
I am feeling so positive about the low-dose Naltrexone and I feel convinced if I can just rid my system of the evil Cymbalta, I will be a changed person. I think the only reason I haven't lost my sanity is because of the LDN, in fact. I also have .25 mg of Xanax that I can take when the worst hits me, and that helps calm me down, at least.

Several members have taken Bupropion and Naltrexone for weight loss.

Side Effects

In Summary
Commonly reported side effects of naltrexone include: streptococcal pharyngitis, syncope, anxiety, arthralgia, arthritis, dizziness, drowsiness, fatigue, frequent headaches, headache, joint stiffness, nasopharyngitis, nausea, nervousness, obsessive compulsive disorder, panic attack, pharyngitis, posttraumatic stress disorder, sedated state, sinus headache, vomiting, induration at injection site, malaise, pain at injection site, and tenderness at injection site. Other side effects include: muscle cramps, muscle rigidity, muscle spasm, stiffness, depression, and twitching. See below for a comprehensive list of adverse effects.
Inositol is a carbocyclic sugar that is abundant in brain and other mammalian tissues, mediates cell signal transduction in response to a variety of hormones, neurotransmitters and growth factors and participates in osmoregulation. It is a sugar alcohol with half the sweetness of table sugar. It is made naturally in humans from glucose.
Used in the manufacturing of some explosives.

Our results suggest that inositol may be beneficial for depressed patients, especially those with PMDD.

...suggesting an anxiolytic effect of inositol.

inositol had virtually no effect on these responses

Note - Research is very limited with only a slight effect on anxiety noted in most cases.

Posted by Scuffy1209 on 27 August 2018 - 02:59 PM in Weaning Off Cymbalta
In terms of supplements my Dr has me on: inositol, phosphotidyl serene, magnisium, and LDN.

Posted by gail on 12 April 2014 - 01:39 PM in Weaning Off Cymbalta
Funny, saw my witch doctor this week, explained what I was fealing, and gave me capsules with gaba 100mg combined with inositol 500mg and passiflora to calm the brain, she says.
Will start tomorrow, I researched it, and inositol is good for anxiety. Maybe at much larger doses, but, for the moment, that will be enough for me.

Posted by sk8mom on 08 June 2013 - 05:40 PM in Nutritional Support
I live in Canada too, Naturopathic Doctor told me how B complex is important for our nervous system I am taking a multi B (Genestra brands) and most B's in this one go from 50-150mg, there is also Biotin, choline and inositol in it.

Posted by gsmommy on 04 October 2012 - 10:32 PM in Weaning Off Cymbalta
and 1 tablespoon of soy lecithin for the inositol properties that help with anxiety and balancing blood sugar

Posted by Ih8cymbalta on 06 December 2011 - 09:41 PM in Nutritional Support
I've been taking inositol and choline during this process. Doesn't seem to do much of anything.

Posted by alkirk123 on 28 September 2009 - 06:55 PM in How to Find Support
I've been off about 3 weeks now. I'm taking Inositol supplements, Omega 3, a multi vitamin, St. John's Wort, Valerian. I'm really tiring of all the supplements!

#132 fishinghat



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Posted 08 January 2019 - 11:27 AM

                                                                                2018 Addendum

                                                                                      Page 8



Pregabalin is a safe and efficacious compound for GAD treatment. Short half-life (preventing persistence of side effects), absence of active metabolites and no interactions with CYP450 enzymatic system are all favorable pharmacokinetic properties for the treatment of GAD patients, including those with comorbid depressive symptoms or medical conditions. On the other hand, prescription of pregabalin should be handled with caution to minimize the incidence of renal impairment (especially in elderly patients), where a history of substance misuse or concomitant medications (e.g. anti-hypertensives or some antibiotics) are risk factors that can affect renal function.

A categorical analysis of safety, using dropout as the most severe possible outcome, was carried out. No difference between PGB and placebo groups was observed in terms of the dropout rates. PGB was superior to placebo for the amelioration of GAD symptoms. In addition, the dropout rate was not significantly higher than that of the placebo groups. PGB was comparable to benzodiazepines in clinical response, but had lower dropout rates than benzodiazepine.

Pregabalin appears to have a low potential for causing withdrawal symptoms when long-term therapy is discontinued; however, tapering over the course of at least one week is recommended. A review of available evidence indicates that pregabalin is a well-tolerated and consistently effective treatment for GAD, with a unique mechanism of action that makes it a useful addition to the therapeutic armamentarium.

#133 fishinghat



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Posted 11 January 2019 - 03:14 PM

                                                                                 2018 Addendum
                                                                                         Page 9
Pregabalin (Cont.)

And many many more research articles.
Pregabalin side effects - from FDA reports

Posted by vickyp10 on 11 November 2018 - 10:20 AM in Weaning Off Cymbalta
I come off the duloxetine over a few month from 30mg (the pregabaling helped me alot to do this),

Posted by thismoment on 01 February 2015 - 09:34 PM in What are you feeling?
Here is the interactions between Lyrica and Cymbalta. They are sometimes prescribed together, with the pregabalin used as an anti-convulsive.
The interactive warning is MODERATE between these two drugs. See drugs.com
duloxetine ↔ pregabalin
Applies to: duloxetine, Lyrica (pregabalin)
Using DULoxetine together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. 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.

IUN Posted 12/30/18, 02:48 PM
I should also add here the little research that I did on the side effects of the Pregabalin.
The required tests carried out by Pfizer noted that 1 in 480 experienced suicidal action/severe thoughts, so 0.21%. Regardless of the small number, I still think it is quite shocking. However, please read on....
A further study which undertook to establish figures based on the reason for taking the Pregabalin (Epilepsy, Psychiatric and Other) noted the risk of depression to be three times greater for users with existing depression than those with epilepsy alone. A further risk of suicidal thoughts/actions also based on the same measure saw 8.5/1000 reported - so this 0.21% from Pfizer is actually 0.85% if a person prone to depression starts taking Pregabalin.
So lets put this in a simple one-liner context so anyone reading can be suitably warned.
1 in 117 people who take Pregabalin and are prone to anxiety and/or depression will experience suicidal thoughts.
SOURCE: https://www.medsafe..../Lyricacaps.pdf

Pregabalin withdrawal
Pregabalin withdrawal resulted in self-reports of increased spasticity without a concomitant increase in pain, with 91% choosing to continue pregabalin at the conclusion of the evaluation.

Little research is available.

#134 fishinghat



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Posted 11 January 2019 - 03:18 PM

                                                                                  2018 Addendum
                                                                                       Page 10

ssri/snri general

IUN - Posted 05 October 2018 - 02:39 PM
"Over half of UK patients coming off anti-depressants feel suicidal"
"58% become agitated, 58% suffer insomnia... 71% become emotionally numb"
"Over 61% reported more than 10 withdrawal symptoms (of a given 20)"
"Less than 5% of patients were warned about the extreme side effects of withdrawal"
Huge news to hit the tabloids this week... and my thanks to Flower for initially mentioning this in her post.
According to sources, there is to be a complete revisit of how NHS patients are to come off, or switch, anti-depressants. How long this will take for the UK to follow suit, who can know, but it is a big step in the right direction.

The story was given coverage by the BBC, Daily Mail and the Guardian - probably others that I have not seen, but they were all kicked off following the publishing of the below academic paper;

This paper collates a number of other recent studies undertaken by researchers in the last few months and summarises the shocking data. For those that want the link to the one that mentions Duloxetine (aka Cymbalta), you can read the abstract here;

If anyone finds a copy online, please post, but for now it is a purchase-only option, and hope this gives some people a little hope over here on our tiny island.


IUN - Posted 16 October 2018 - 04:12 PM
Noush - here is some homework for you, handpicked from my bookmark library on Escitalopram efficiency, comparisons and remission rates;

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Posted 11 January 2019 - 03:20 PM

                                                                                      2018 Addendum
                                                                                            Page 11

Vinpin Posted 22 June 2018 - 07:50 PM
I dis try the Fierce Green Apple Gatorade and oddly enough, it does seem to help with the nausea (genius?). (Genius!!!! .... again, the forum's worth rings true.....). I may also try some Ginger Ale (Boylan's), which has real ginger in it, along with lemon and lime oil. Just bought it - will report back on how well that works.
Vinpin Posted 27 June 2018 - 08:32 PM
One final note: Before the migraine subsided, I bought Dolovent, which is suppose to reduce both the frequency and severity of the migraines. Dolovent is basically a powerful regimen of Riboflavin (Vitamin B2), Magnesium and Coenzyme Q10. The combination of these three ingredients were found (in a 2015 NIH Study) to show promise in reducing the frequency and severity of the migraines vs. a placebo group. Study summary can be found at:


Fishinghat Posted 28 June 2018 - 07:49 AM

4 Capsules

400 mg riboflavin (vitamin B2),
600 mg magnesium,
150 mg coenzyme Q10
750 μg vitamin A,
200 mg vitamin C,
134 mg vitamin E,
5 mg thiamin,
20 mg niacin,
5 mg vitamin B6,
6 μg vitamin B12,
400 μg folic acid,
5 μg vitamin D,
10 mg pantothenic acid,
165 μg biotin,
0.8 mg iron,
5 mg zinc,
2 mg manganese,
0.5 mg copper,
30 μg chromium,
60 μg molybdenum,
50 μg selenium,
5 mg bioflavonoides.

A typical multivitamin. Items to watch for include that magnesium and Vitamin D both will lower serum calcium.

It contains Selenium which is the most common ingredient in multivitamins that people are allergic to.
I do like the fact that the levels of Vitamin B5 are within safe limits. In recent years there have been a rise in severe side effects to Vitamin B6 as megadosing has become popular.

As with any multivitamin I would recommend starting with a 1/3 tablet a day first and lowly working your way up to the recommended dose. Also have your serum calcium checked every 6 months.
Vinpin Posted 16 July 2018 - 08:27 PM
Took 2 chewable tablets of Nauzene, and that eased the nausea somewhat.

Fishinghat Posted 17 July 2018 - 08:39 AM
A little info on Nauzene. FDA considers it generally safe to consume.

Contains - Sodium citrate dihydrate 230 mg
The following information from ...

A pH buffer used to neutralize acids. Also functions as an electrolyte providing sodium and Citrate ions to the body.
Industry Uses
Agricultural chemicals (non-pesticidal)

Consumer Uses
Agricultural products (non-pesticidal)
Automotive care products
Building/construction materials
Cleaning and furnishing care products

From Wiki
Do not use with antacids containing aluminum, aspirin, salicylates, lithium or quinidine.

Check https://www.drugs.co...um-citrate.htmlforfurther information.

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Posted 11 January 2019 - 03:22 PM

                                                                                    2018 Addendum
                                                                                           Page 12

Tardive Dyskinesia

Tardive dyskinesia (TD) is an involuntary neurological movement disorder caused by the use of dopamine receptor blocking drugs that are prescribed to treat certain psychiatric or gastrointestinal conditions such as;
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Thioridazine (Mellaril)
Trifluoperazine (Stelazine)
As well as;
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
MAOIs: phenelzine
SSRIs: fluoxetine, sertraline
TCAs: amitriptyline, amitriptyline-perphenazine, amoxapine, doxepin, imipramine
Various Antihistamines
Stimulants, have been associated with TD. Stimulants include caffeine, nicotine, guarana, ginseng, legal amphetamines, ephedrine, and illicit amphetamine and methamphetamine.

More likely to get it if you;
Are a woman who has gone through menopause
Are over age 55
Abuse alcohol or drugs
Are African-American or Asian-American

There are two FDA-approved medicines to treat tardive dyskinesia:
⦁ Valbenazine (Ingrezza)
⦁ Deutetrabenazine (Austedo)
Both of these medicines work in similar ways to regulate the amount of dopamine flow in brain areas that control certain kinds of movements. Both of these medicines can sometimes cause drowsiness.
Natural treatments
Ginkgo biloba
Vitamin B6 (Note - Vitamin B5 has a half life of 25 days and is easy to develop Vitamin B6 toxicity with supplements)
Vitamin E

Studies are ongoing to determine possible new drug therapies for the treatment of tardive dyskinesia. Choline, lithium, bromocriptine, baclofen, methyldopa, valproate, clonidine, propranolol, amantadine, clonazepam, and nifedipine have occasionally been helpful but in most cases do not improve dyskinesia. Tetrabenazine is often useful for symptomatic treatment of tardive dyskinesia and is currently available for use in the US. However, it carries the risk of causing or aggravating depression. Other experimental drugs are being tested to reduce or eliminate the symptoms of tardive dyskinesia.
Other therapeutic agents for which there is some anecdotal support include, levodopa (see carbidopa/levodopa), benzodiazepines, botulinum toxin, reserpine, tetrabenazine, and dopamine-depleting agents. Ondansetron, a selective 5-hydroxytryptamine-3 antagonist, has helped some individuals with TD. Discontinuance of anticholinergic therapy may relieve TD. A controversial strategy for treating TD is to continue or increase the dose of the dopamine antagonist.

#137 fishinghat



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Posted 11 January 2019 - 03:25 PM

                                                                           2018 Addendum
                                                                                  Page 13

Tardive Dyskinesia (Cont.)

updated information

Medication-Induced Tardive Dyskinesia: A Review and Update (2017) (excellent document to read)


Medications and Supplements Used to Treat Tardive Dyskinesia
A number of medications and supplements have been identified that ameliorate TD symptoms.



Cholingergic Agents.
Cholinergic agents are used as muscle stimulants to diagnose myasthenia gravis and to treat glaucoma. These agents can also improve the Parkinsonian features of TD. Donepezil, a reversible acetylcholinesterase inhibitor, is currently the only cholinergic medication that has shown benefit against TD.109 Overall, however, cholinergic agents are not a widely accepted treatment for TD as sufficient evidence is lacking to suggest they are more helpful than other treatments.



Clozapine, Quetiapine, Olanzapine, and Apomorphine.
Clozapine, a serotonin and dopamine receptor antagonist, is an atypical APD used to treat schizophrenia. Clozapine is the best current medication recommended for patients who require antipsychotics and simultaneously have TD,111 as clozapine has been reported to reverse TD symptoms.112,113 Clozapine has been linked to TD; however, the incidence is much lower compared to other atypical APDs.114 Drugs with similar mechanisms of action such as quetiapine, a weak striatal dopamine antagonist, and olanzapine, a dopamine and serotonin receptor antagonist, have also been shown to be effective in ameliorating TD symptoms.115 Apomorphine, a dopamine receptor antagonist, can be given in conjunction with L-DOPA to decrease dyskinesias.



Tetrabenazine Analogs.
Tetrabenazine, a vesicular monoamine transporter inhibitor, decreases the severity of TD symptoms.14 However, tetrabenazine is rapidly metabolized and therefore needs to be administered frequently.117 Analogs of tetrabenazine such as valbenazine, a (+)-α-isomer of tetrabenazine, have been approved for clinical trials for the treatment of TD. In a phase IIb randomized, parallel, double-blind, placebo-controlled clinical trial of patients with moderate to severe TD, 67% of patients treated with valbenazine reported a “much improved” or “very much improved” Abnormal Involuntary Movement Scale score compared with 16% of patients taking placebo.



While certain benzodiazepines can cause TD, evidence suggests that some may be beneficial in treating TD.118 Sharma's proposed guidelines for treating TD include clonazepam and were successful in a patient who presented with TD symptoms after long-term treatment with trifluoperazine (a typical APD), citalopram, trihexyphenidyl, and propranolol.119 A case report published in 2001 related that 2 mg/day of clonazepam for 1 year successfully alleviated the TD symptoms of a 66-year-old female, and she did not develop tolerance during the 1-year period.



Propranolol is a beta-adrenergic receptor antagonist used to treat high blood pressure, cardiac arrhythmias, and migraines. A retrospective study of 47 patients with TD that persisted for 17 months after discontinuation of APDs reported that low-dose propranolol appeared to be well tolerated in this patient population, and 64% of the patients saw an improvement in their TD symptoms.



Amantadine is a noncompetitive glutamate receptor antagonist. It is postulated to work by increasing presynaptic release of dopamine and blocking presynaptic dopamine reuptake. Amantadine has been shown to be effective in treating L-DOPA–induced TD in patients with Parkinson disease.



Branched-Chain Amino Acids.
Some evidence suggests that an inability to clear ingested forms of the amino acid phenylalanine is associated with TD. Branched-chain amino acids (BCAAs) are reported to decrease TD symptoms123 because they decrease plasma phenylalanine by stimulating protein synthesis and insulin release.124 BCAAs also decrease the accumulation of tyrosine, another amino acid and an important precursor to dopamine, that reduces overall dopamine synthesis in the nervous system.124 Most important, BCAAs also seem to be effective at decreasing TD symptoms while an APD medication is still on board or the patient has a history of APD exposure.123 BCAAs are available over the counter in a flavored powder preparation to mix with water, so they may be a promising, practical, and inexpensive treatment for TD.



Ginkgo Biloba.
The American Academy of Neurology recommends clonazepam and ginkgo biloba, an extract of the ginkgo biloba tree leaf that is used as a dietary supplement, to enhance cognitive function to treat TD.



Antioxidant Medications and Supplements.
Because evidence suggests that oxidative stress may contribute to TD, several antioxidant medications and supplements are increasingly being used to treat TD: zonisamide, yi gan san (a Chinese herb), levetiracetam, melatonin, omega-3 fatty acids, piracetam, resveratrol, vitamin B6, and vitamin E. A comprehensive update on these medications is available in a 2015 review by Lerner et al.118

#138 fishinghat



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Posted 11 January 2019 - 03:28 PM

                                                                          2018 Addendum
                                                                               Page 14

Tardive Dyskinesia (Cont.)

Specific Medical research on alternate treatments


A randomized, double blind, placebo controlled design was used to determine the effectiveness of MEL (20 mg/day) during 12 weeks in 7 patients with TD. Six patients with TD were treated with placebo. In two patients treated with MEL a significant improvement (more than 60%) of the values of AIMS was detected. In the remainder five, as well as in the patients treated with placebo, no difference was observed during the 12 weeks.

Nineteen patients chronic DSM-IV schizophrenia of 31.3+/-7.0 years' duration, were randomly assigned in a double-blind, placebo-controlled, crossover trial to receive slow-release melatonin, 2 mg/day (low dosage), or placebo for 4 weeks. Supraphysiologic doses of melatonin do not positively affect tardive dyskinesia.

Using a double-blind, placebo-controlled, crossover study, we evaluated the efficacy of 10 mg/d of melatonin for 6 weeks in 22 patients with schizophrenia and TD. The decrease in AIMS score was 2.45 for the melatonin and 0.77 for the placebo treatment groups. This is the first clinical evidence for efficacy of melatonin in the treatment of TD.

Forty-seven patients were analyzed, mean age 63 years. Neuroleptics were discontinued in all patients and duration of TD at the time propranolol was initiated 17 months. Propranolol resulted in improvement in 64% and 77% of those had a moderate to complete or near-complete response. Mean daily dose was 69 mg and duration of therapy 14 months. Three patients stopped the propranolol due to adverse effects: hypotension (2), nightmares (1). Severity of TD and duration of propranolol therapy were associated with response.

A double-blind, intensive case design was used to study the effect of propranolol on tardive dyskinesia. No short-term improvement was observed, but two of the four subjects responded to long-term propranolol use.

In October 1979 I thought itnmmight be worth trying propranolol to modify the annoying mouth movements. Initially, I prescribed 10 mg to be taken four times a day; I soon increased the dose to 40 mg to be taken twice a day. Over approximately 6 weeks the mouth movements decreased; propranolol was continued at 80 mg/d. I last saw the patient 1 week before the time of writing, when she stated that she had run out of the propranolol and had not bothered to renew the prescription. She found that the mouth movements returned quite rapidly; therefore, she immediately began taking propranolol again, 40 mg twice a day.

Branched-Chain Amino Acids
Definition - A branched-chain amino acid (BCAA) is an amino acid having aliphatic side-chains with a branch (a central carbon atom bound to three or more carbon atoms). Among the proteinogenic amino acids, there are three BCAAs: leucine, isoleucine and valine.[1] Non-proteinogenic BCAAs include 2-aminoisobutyric acid.

Long-standing tardive dyskinesia were randomly assigned to receive branched-chain amino acids or placebo. Treatment frequency was three times a day, 7 days a week for 3 weeks. A robust and highly significant difference was observed between patients who received high-dose branched-chain amino acids (222 mg/kg of body weight t.i.d.) (N=18) and those who received placebo (N=18) in the percent change in tardive dyskinesia symptoms from baseline to the end of the 3-week trial. Significant and marked differences were seen between the two groups at the >/=30% and >/=60% levels of decrease in tardive dyskinesia symptoms.

A 2-week trial of a BCAA medical food administered three times a day was conducted in nine men with long neuroleptic treatment histories. Frequency counts of TD movements were collected by videotape throughout the trial and these tapes were analyzed in blind random sequence for both patient and time for TD symptom level changes subsequent to completion of the trial. A statistically significant decrease in the level of TD symptoms was observed for the sample. The symptom changes were also clinically significant in that six of the nine subjects had symptom decreases of at least 58%, with all subjects having a decrease of at least 38%.


TD evaluation at baseline and after 1 and 2 weeks of BCAA treatment given in the form of a drink administered 3 times daily. TD symptom decreases were substantial in 5 of the 6 participants, ranging from 40% to 65%. Two of the subjects received an additional course of treatment, and further reductions in TD symptoms over those seen in the 2-week trial were observed.

Omega-3 Fatty Acids
I found two research articles that both said there was no improvement in TD with the use of Omega 3 fatty acids.


Serum calcium levels were measured in 25 chronically ill psychotic inpatients with involuntary movements, in comparison with 25 otherwise indistinguishable patients without such a syndrome. Those with involuntary movements were significantly more likely to have a serum calcium level below the normal range.

Laboratory studies include....
B. Serum electrolytes- to omit abnormalities of sodium and calcium metabolism that may cause movement disorders.

The blood test showed a light hypermagnesaemia (2.5 mg/dL) not related to a large ingestion of magnesium nor with any symptom of renal failure and levels of calcium of 9.70 mg/dL, which are in the upper levels of normal concentration (normal values: 8.89 - 10.0).

The only treatment was removal of haloperidol treatment.
Forty-eight hours after hospital admission, the patient was discharged. At that time the levels of magnesium in blood were slightly reduced. The blood test was showing an haloperidol concentration of 0.4 μg/L, a maintained leucocytosis and anaemia. Calcium level was of 9 mg/dL, and blood magnesium levels were of 2.1 mg/dL, being both
value considered normal.

Our suggestion is to control the calcium and magnesium levels in
patients receiving a chronic haloperidol treatment to prevent these

There is involvement of calcium in triggering the oxidative damage and excitotoxicity, both of which play central role in haloperidol-induced orofacial dyskinesia and associated alterations.
Results of the present study indicate that haloperidol-induced calcium ion influx is involved in the pathogenesis of tardive dyskinesia

The co-administration of haloperidol and Mg supplementation prevented RS generation in cortex, striatum and SN, and PC levels in the SN.These outcomes indicate that Mg supplementation may be a useful alternative to prevent movement disturbances resulting of classic antipsychotic pharmacotherapy as haloperidol.

Also see above.

#139 fishinghat



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Posted 11 January 2019 - 04:00 PM

                                                                                   2018 Addendum
                                                                                         Page 15

Dystonia - Dystonia is a neurological movement disorder syndrome in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.
The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.

Note - A neurological condition that affects the muscles.

Dyskenisia - Dyskinesia refers to a category of movement disorders that are characterized by involuntary muscle movements, including movements similar to tics or chorea and diminished voluntary movements. Dyskinesia can be anything from a slight tremor of the hands to an uncontrollable movement of the upper body or lower extremities. Acute dyskinesia is a sustained muscle contraction that sometimes appears soon after administration of antipsychotic medications.

Note - An uncontrollable muscular contraction brought on by side effects of certain medications.

Akathisia - Akathisia is a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting. People with akathisia are unable to sit or keep still, are prone to feelings of restlessness, and they may also fidget, rock from foot to foot, and pace.


Antipsychotics (also known as neuroleptics), particularly the first generation antipsychotics, are the leading cause of akathisia. When antipsychotic-induced, akathisia is an extrapyramidal side effect. Akathisia is also a symptom of psychosis, bipolar disorder, and agitated depression. Akathisia is a component of the repetitive movements in some cases of autism and intellectual disability. Other known causes include side effects of other medications, and nearly any physical dependence-inducing drug during drug withdrawal. It is also associated with Parkinson's disease and related syndromes.

Note - This is very similar to dyskenisia but may be caused by a variety of situations not just medication. The movement seen with akathisia is very repetitive and can last long periods of time, even hours. The movements with the other two conditions can be more violent and usually occurs as episodes which usually last less than an hour.
There is still a lot unknown about these 3 conditions. Especially what are the physical differences in the conditions. It is very difficult for the dr to make a specific diagnosis with these conditions because he/she only has the pattern of the movements to go by. Treatments are similar for all three but not exactly the same. All are effected by calcium and magnesium levels (those two elements control muscle contraction) as well as occasionally by potassium and sodium levels.

Valsartan (Diovan )

45 Reports to FDA on withdrawal symptoms. Please note the 6.7% death rate.

20,086 people reported to have side effects when taking Valsartan.
Among them, 36 people (0.18%) have Withdrawal syndrome

Abrupt Diovan Withdrawal

Posted over a year ago
what is your advice for the rate at which i should end my treatment with diovan? is it ok to just abruptly stop? shoud i taper off? im on 160mg once a day. thanks

4 Replies
Dman11111 - what did you end up doing with the diovan \ive been taping off and the feeling is wonderful yes my bp is high again but im going to try alternative nature stuff the side effects were almost killing me now everything is reversing unfornatly the bp is higher again

Posted over a year ago - Reply
Garrettgla - i cannot tell you how dizzy i was on the diovan. i asked the dr. she said taper off over 2 days and immediately go back on the atenolol 25mg. older medication. i did and i gotta tell u i feel so much better. it's cheap too. its keeping my blood pressure low too. so im happy. sorry i waited so long to go off the diovan.

Posted over a year ago - Reply
Debgibsonmt - After a year and ahalf of taking diovan trying to get off is a nightmare. Blood pressure totally erratic even though all blood test show extremely low cholesteral and a CRP of less than 1. So, diovan is extremely addictive and the body seems to loose it's ability to regulate it's own blood pressure. Which, I'm sure, is what the drug company's want.
Posted over a year ago - Reply

Dman11111 - Yes i agree. I am now on the generic of diovan. Because the drug comanies are trying to save money. It is painfully impossible to try and quit diovan. Im sooo glad someone actually agreed with me that it is highly addictive. It would take months for the body to go back to its own regualtion....let me know if you successfully quit ....i found the withdrawl to hard to take. At least right now. Maybee with time i can figure out an alternative. Once again. Highly addictive .......and they will tell you its not! We are living it!!!
Posted over a year ago - Reply

Report on the falsifying of data on Valsartan in order to get FDA approval. Five life threatening side effects were hidden.

Abrupt withdrawal of valsartan has not been associated
with a rapid increase in blood pressure.

Abrupt Withdrawal From Diovan

Posted over a year ago
My Doctor said it was OK to stop taking Diovan which I had been on for nearly two years because I had bad side effects.
I started to get chest pain/angina(?) Should he have told me to taper off the dose?
No answer received.

#140 fishinghat



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Posted 11 January 2019 - 04:03 PM

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F06.4Organic anxiety disorder
A disorder characterized by the essential descriptive features of a generalized anxiety disorder (F41.1), a panic disorder (F41.0), or a combination of both, but arising as a consequence of an organic disorder.
anxiety disorders, nonorganic or unspecified

Organic Disorder
An organic disease is one caused by a physical or physiological change to some tissue or organ of the body. The term sometimes excludes infections. It is commonly used in contrast with mental disorders. It includes emotional and behavioral disorders if they are due to changes to the physical structures or functioning of the body, such as after a stroke or a traumatic brain injury, but not if they are due to psychosocial issues.


Note - To simplify an organic disorder usually refers to a condition caused by damage to the body. Things like head injuries, strokes, gun shots, etc but not usually used to describe damages due to stress, chemical effects, effects of drugs, etc.
Walks in Bright Sunlight - for mood/Serotonin production

Lancet. 2002 Dec 7;360(9348):1840-2.
Effect of sunlight and season on serotonin turnover in the brain.
Alterations in monoaminergic neurotransmission in the brain are thought to underlie seasonal variations in mood, behaviour, and affective disorders. We took blood samples from internal jugular veins in 101 healthy men, to assess the relation between concentration of serotonin metabolite in these samples and weather conditions and season. We showed that turnover of serotonin by the brain was lowest in winter (p=0.013). Moreover, the rate of production of serotonin by the brain was directly related to the prevailing duration of bright sunlight (r=0.294, p=0.010), and rose rapidly with increased luminosity. Our findings are further evidence for the notion that changes in release of serotonin by the brain underlie mood seasonality and seasonal affective disorder.

Med Hypotheses. 2016 Dec;97:34-37. doi: 10.1016/j.mehy.2016.10.011. Epub 2016 Oct 19.
Regular sun exposure benefits health.
Since it was discovered that UV radiation was the main environmental cause of skin cancer, primary prevention programs have been started. These programs advise to avoid exposure to sunlight. However, the question arises whether sun-shunning behaviour might have an effect on general health. During the last decades new favourable associations between sunlight and disease have been discovered. There is growing observational and experimental evidence that regular exposure to sunlight contributes to the prevention of colon-, breast-, prostate cancer, non-Hodgkin lymphoma, multiple sclerosis, hypertension and diabetes. Initially, these beneficial effects were ascribed to vitamin D. Recently it became evident that immunomodulation, the formation of nitric oxide, melatonin, serotonin, and the effect of (sun)light on circadian clocks, are involved as well. In Europe (above 50 degrees north latitude), the risk of skin cancer (particularly melanoma) is mainly caused by an intermittent pattern of exposure, while regular exposure confers a relatively low risk. The available data on the negative and positive effects of sun exposure are discussed. Considering these data we hypothesize that regular sun exposure benefits health.

BMC Dermatol. 2002; 2: 6.
Impact of UVA exposure on psychological parameters and circulating serotonin and melatonin
People tend to feel better after exposure to ultraviolet (UV) radiation. This study was performed to investigate the impact of UVA exposure on psychological and neuroendocrine parameters.
Fifty-three volunteers were separated into 42 individuals who had UVA exposure and 11 individuals who had no UVA exposure. The UVA-exposed volunteers had irradiation sessions six times in a three-week period. All volunteers completed two questionnaires at baseline (T1) and at the end of the study (T3). For the determination of serotonin and melatonin serum levels of all volunteers blood samples were collected at baseline (T1), after the first UVA exposure (T2), and at the end of the study after the sixth exposure (T3).
UVA-exposed volunteers felt significantly more balanced, less nervous, more strengthened, and more satisfied with their appearance at T3. By contrast, the controls did not show significant changes of psychological parameters. In comparison to T1 and T3, serum serotonin was significantly higher and the serum melatonin was significantly lower for the volunteers exposed to UVA at T2. Both, for exposed and non-exposed volunteers serotonin and melatonin levels did not significantly differ at T1 and T3.
It remains obscure, whether the exposure to UVA or other components of the treatment were responsible for the psychological benefits observed. The changes of circulating neuroendocrine mediators found after UVA exposure at T2 may be due to an UVA-induced effect via a cutaneous pathway. Nevertheless, the positive psychological effects observed in our study cannot be attributed to circulating serotonin or melatonin.

#141 fishinghat



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Posted 11 January 2019 - 04:06 PM

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Mania/Sexual Effects while taking/withdrawing Cymbalta.

Please note that many of these articles relate the high risk mania as being related to bipolar disorder rather than Major Depression or Anxiety.

Persistent genital arousal disorder: successful treatment with duloxetine and pregabalin in two cases.
In both women, the treatment proved to be very successful over a long period of time. One of them experienced full remission (duloxetine) and the other one experienced substantial improvement (pregabalin), over a period now lasting for more than a year.

Sexual function during long-term duloxetine treatment in patients with recurrent major depressive disorder.
Cymbalta can cause sexual dysfunction (decreased sexual labido and performance).

Changes in sexual functioning associated with duloxetine, escitalopram, and placebo in the treatment of patients with major depressive disorder.
Same as above.

Psychiatric disorders and sexual dysfunction.
Same as above


The following is from the drug insert information that come with Cymbalta.
5.8 Activation of Mania/Hypomania
In adult placebo-controlled trials in patients with major depressive disorder, activation of mania or hypomania was reported in 0.1% (4/3779) of CYMBALTA-treated patients and 0.04% (1/2536) of placebo-treated patients. No activation of mania or hypomania was reported in DPNP, GAD, fibromyalgia, or chronic musculoskeletal pain placebo-controlled trials. Activation of mania or hypomania has been reported in a small proportion of patients with mood disorders who were treated with other marketed drugs effective in the treatment of major depressive disorder. As with these other agents, CYMBALTA should be used cautiously in patients with a history of mania.

Note - Mania is a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." Symptoms include ...
⦁ Inflated self-esteem or grandiosity
⦁ Decreased need for sleep (e.g., feels rested after 3 hours of sleep.)
⦁ More talkative than usual or pressure to keep talking.
⦁ Flights of ideas or subjective experience that thoughts are racing. Increase in goal directed activity, or psychomotor acceleration.
⦁ Distractibility (too easily drawn to unimportant or irrelevant external stimuli).
⦁ Excessive involvement in activities with a high likelihood of painful consequences.(e.g., extravagant shopping, sexual adventures or improbable commercial schemes). Wiki

6.6 Effects on Male and Female Sexual Function in Adults
Changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of psychiatric disorders or diabetes, but they may also be a consequence of pharmacologic treatment. Because adverse sexual reactions are presumed to be voluntarily underreported, the Arizona Sexual Experience Scale (ASEX), a validated measure designed to identify sexual side effects, was used prospectively in 4 MDD placebo-controlled trials. In these trials patients treated with CYMBALTA experienced significantly more sexual dysfunction, as measured by the total score on the ASEX, than did patients treated with placebo. Gender analysis showed that this difference occurred only in males. Males treated with CYMBALTA experienced more difficulty with ability to reach orgasm (ASEX Item 4) than males treated with placebo. Females did not experience more sexual dysfunction on CYMBALTA than on placebo as measured by ASEX total score. Negative numbers signify an improvement from a baseline level of dysfunction, which is commonly seen in depressed patients. Physicians should routinely inquire about possible sexual side effects.

A Case of Possible Duloxetine-Induced Mania
"Her mood initially improved but two weeks into treatment she developed insomnia, hyperactivity and sexual arousal."

"Around the time of admission her symptoms constituted irritability, psychomotor agitation, pressure of speech, flight of ideas, insomnia, auditory and visual hallucinations, grandiose and persecutory delusions, aggressive and reckless behaviour, sexual disinhibition and lack of insight."


The following is from the Nami data sheet on Cymbalta.
"Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees)."


Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away.

#142 fishinghat



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Posted 11 January 2019 - 04:09 PM

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About 25 members mentioned swelling/edema in legs and feet. Many were put on Lasix (a diuretic) for the swelling and most reported little improvement. Two did mention that it helped. Cymbalta is famous for causing sodium and potassium levels to be out of spec and this has been suggested as the cause of some of the swelling so you might want to check that out. Several members have had it determined they had low sodium and/or potassium during withdrawal and two of those with edema had that diagnosis. One thought it was from melatonin and when she stopped taking it the edema subsided. Probably a dozen members have had low sodium levels that contributed to miniseizures.


Posted by piceas on 28 April 2017 - 07:02 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
First time I've ever posted on a forum. I just had to after googling 'edema and cymbalta withdrawal' and finding this site. I've been researching since I began having issues and this is the first time this site came up. I can't believe how uninformed my doctors are about this. Primary care physician and psychiatrist were clueless. The only advice my psychiatrist has is to take a different antidepressant,
But then on March 27 my arms and legs began to swell. It got to the point that first week I could not fit into any jeans I owned, and could only wear one pair of very adjustable velcro shoes. I thought maybe it was from work, as I stand and walk all day and use my arms and hands extensively. I made an appointment with my PCP.
10th day of a 30mg dose, I still have severe edema. Wearing compression hose 24/7.
My psych tells me I can stop taking the Cymbalta, as it should be "out of my system" at this point. Her only reaction to the swelling is that I should see my PCP about it. I decided to stop the 5mg of Lexapro too. I had my suspicions about the edema being withdrawal related at this point.
Now ending week 5 and still swollen. Been on Lasix (diuretic) for 2 weeks, which has helped slightly.

Posted by Xiaojie on 01 April 2014 - 12:29 AM in What are you feeling?
So what I'd really like to know is: Does the fluid retention ever disappear or am I stuck with it forever, and I just need to get used to it? As I've said before in other posts, my fluid retention isn't merely having swollen feet, hands, and ankles - it's edema of my entire body that began since quitting Cymbalta almost 6 weeks ago. I didn't have the edema to any degree when I was taking Cymbalta, and I have no history of heart/blood pressure issues. So I just. Don't. Get it...
The two stubborn ones I'm still contending with are the fluid retention and weight gain, both of which cause my bones and joints to ache constantly. The fluid retention isn't simply swollen hands and feet. It's edema of my entire body, the likes of which I have never experienced before. My legs feel so heavy when walking and standing, my lower back pain is so intense when standing that I cannot do it for more than 5 minutes at a time. Transition from sitting to standing position and visa versa is excruciating, too.

Posted by lady2882Nancy on 21 July 2013 - 06:02 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
The edema can be quite extreme for some. I couldn't even wear my normal shoes for a week or so. Then I found some fennel seed tea and that did the trick. One nice cup in the morning for a few days and that was the end of that.
I am going to buy some more next time I get to the health food store and try it for some of the other things that seem to cause edema for me to see if it helps.
Fluid retention seems to be the bane for women with all kinds of things.

Posted by lady2882Nancy on 14 July 2013 - 01:24 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
Yes I had the edema very badly. I used fennel seed tea to get rid of it and then a small daily dose of dandilion root tea each morning kept it from coming back

Posted by lady2882Nancy on 23 March 2013 - 11:21 AM in How to Find Support
Good news people. I found an easy way to get rid of that bloat and edema.
Better yet it is in most people's spice rack or the spice rack at a grocery store as seeds or ground.
Fennel seeds, they are most effective if they are ground but even a tea made with the whole seeds and allowed to steep for 15 minutes or so will bring relief. A cheap $10 coffee grinder will grind all kinds of seeds quickly and easily, just remember to keep ground products refrigerated as they quickly lose strength once ground.

The brain zaps, the muscle twitching, the edema (I lost 50 pounds in one weekend on Lasix), the potassium deficiencies, the neuropathy. The brain fog, the muscle jerks, the vertigo and dizziness, the relentless pain and the real show stopper, the inability to walk! I feel like I just crawled out of a 90 year old woman suit.

'cowboymom', on 12 Mar 2010 - 3:20 PM,
The brain zaps, the muscle twitching, the edema (I lost 50 pounds in one weekend on Lasix), the potassium deficiencies, the neuropathy.

Posted by needoffthisdrug0326 on 13 September 2018 - 06:39 PM
It's been about four and a half weeks now and I thought I'd give an update:
Swelling ankles and feet. ​This is slightly better. Still swelling some, but I actually have legit ankles most days, so yay.

Posted by sk8rmama24 on 19 April 2018 - 09:03 PM
My blood pressure, which was usually normal to the high side of normal basically jumped to stage 2 hypertension (I am getting readings near 144/95 often through-out the day) without passing go or collecting $200. Not a slow creep, but a rapid jump. Apparently there IS a reason I started having nosebleeds in the shower recently and I am pretty sure it has nothing to do with me being overweight. Not really sure if the swelling is causing the hypertension, or the hypertension causing the swelling, seems to be like a chicken or egg situation from what I have read so far. They are interrelated, but not always present together.

Posted by trish49682 on 05 September 2016 - 09:53 PM
I am having many symptoms spoke about on here anxiety, swelling bad in legs and feet, joints hurt. I have a strong water pill I can take it isn't phasing it much.

Posted by mrs301 on 25 May 2016 - 08:14 PM
And, my allergist put me on Lasix, which does absolutely nothing for the swelling.

Posted by ThisBetterPass on 13 September 2014 - 11:56 PM
I'd say the swelling is about 2/3 of what it was like last night. Yesterday was rough but today was better.

Posted by ThisBetterPass on 13 September 2014 - 02:52 PM
One rare one for me that popped up is ankle swelling.

Posted by K8EQ on 31 March 2014 - 01:54 PM
I'm thinking of just foregoing the 15mgs and cold turkey the rest of the way. For those of you out there..........there IS light at the end of the tunnel isn't there??!!! Will the swelling in my knees EVENTUALLY go away???

Posted by DinCA on 01 August 2013 - 05:10 PM
She kept pushing me on losing the weight but nothing was happening. and she didnt believe me that I was trying. then I was also having problems with some swelling. Now after about a month of being off it...the swelling is AWEFUL. I thought I was gaining weight really fast too but when I took something for water retention...I actually fit comfortably into a pair of pants that I thought I had not only out grown but totally OVER grown so far this time, at least, was from the water retention.

Posted by tazzie on 21 July 2013 - 04:48 PM
I also have swelling but am hoping it will remedy itself. I was only taking 30 mg a day. I am on my 10th day without the Cymbalta

Posted by buzzbuzz on 21 July 2013 - 08:32 AM
I had swelling in my extremities when in the throes of withdrawal. I couldn't get my wedding rings off. I was 2 to 3 pounds heavier for almost 3 months. I took my last few little cymbalta mini-pills (bought empty gelatin pill capsules at the health food store) this past March and I had horrible w/d symptoms for three months!

Posted by truckprincess on 02 January 2013
Think the sinuses are still a bit off but does seem as though the swelling is getting better.

Posted by Kattin on 10 November 2010 - 05:46 PM
Also was having swelling in legs, ankles & feet. Not sure if that was from Cymbalta, but put on lasix and pottasium, so will see what happens.

Posted by mysticcherokee on 17 October 2009
Sleep probs worse and swelling in feet. Increased the melatonin to 6 mg, after stopping the elavil. swelling wouldnt go down. Little balloons left and right of ankles.Feet hurt, and sides started swelling. Ceased all supps. Sleeeeeep bad. Swelling going down. Reintroduced one days melatonin, swelling up.

Posted by Houdi on 11 August 2009
I had pain and swelling in my feet and hands during withdrawal. These were one of the last symptoms to leave my body. Took lots longer than 4 weeks for me to shake.

Posted by nossri4me on 16 October 2008
I also had a recent weight gain (after recently losing 12 pounds) and had the weirdest fatigue, backache and hand and foot swelling for a four day stretch last week.

#143 fishinghat



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Posted 11 January 2019 - 04:25 PM

                                                                                      2018 Addendum
                                                                                             Page 19

Blood Tests

Conditions which Members have found that caused their mental health issues or made their withdrawal worse.

I felt like my body couldn’t take them any more, my testosterone had dropped and I wasn’t really feeling things.

"I was given Cymbalta for anxiety/depression way back then, which now it turns out I never actually had--I have a thyroid condition which went undiagnosed (until late last year) and that is what was causing my symptoms of anxiety and depression."

It has been a battle, and I have had multiple healthcare providers tell me I am just having anxiety, or stressed, and one even wrote " ? hypochondria" in my medical record. I persisted though, and ironically, the doctor that referred me to a psychologist for hypochondria (on my first visit no less, with no exam or complete health history) also ordered some bloodwork and a nerve conduction test. My initial bloodwork came back with abnormal results and I wish I could have seen the look on his face when he reviewed the labs.
Long-story short, I have the antibodies and markers for an autoimmune disease, plus an acute Epstein Barr viral infection, which I never had before because I have no antibodies to it, just the early antigen testing and presence of the virus came back positive.

My specialist discovered the underlying diseases causing my POTS, which are Ehlers-Danlos Syndrome and mitochondrial disorder.

sk8rmama24 Posted 16 September 2018 - 12:36 PM
As of September 7, 2018 I have been diagnosed with celiac disease; an autoimmune condition where ingestion of gluten, a protein, causes an immune response that leads to intestinal damage that results in digestive malabsorption and nutrient deficiency and malnutrition.

Posted by Vinpin on 10 December 2018 - 04:44 PM
Got preliminary blood test results back from the doctor - not the best. My main concern is my low white blood cell count, but I also have high cholesterol, low Vitamin D & B12 levels and a high potassium level.

needoffthisdrug0326 on 30 September 2018
I had some lab work last week and everything was normal except my iron was slightly low and my vitamin D was also low

Posted by Cjmansf on 24 April 2018 - 02:06 PM
Low vitamin D which I am addressing.

Posted by brzghoff on 14 April 2018 - 01:16 PM
i just started seeing it in my labs. thats how we found out I was vitamin D deficient

Posted by notsobad on 10 October 2017 - 11:55 AM in Nutritional Support
My vitamin D levels were extremely low...they've improved but are still low, so the doctor put me on a super dose for couple months. The day after taking 50000 IU of vitamin D3 I suddenly feel like a normal person, like I'm able to rationally think about my day and do activities without getting mentally and physically fatigued. Life just feels normal and not difficult.

Posted by MrsGriffin on 17 August 2017 - 07:43 PM
In addition to my serotonin being low, lab work revealed that my Vitamin D levels were low so I have been taking a Vit D3 supplement

Posted by fishinghat on 15 August 2016
If you read some of my previous posts you will note that I have dropped taking my magnesium lately. It got too high and my calcium too low.

Posted by okcarmen on 23 February 2013 - 05:02 AM
and I also have an incredibly low iron level. My iron level is 12 when a normal one is at least 128.

Posted by CatLover on 03 July 2016
It came back with a B12 level that was extremely low and I had Iron deficiency anemia so bad she almost sent me to the hospital to get the iron.

Posted by houseofmiro on 26 September 2014 - 06:58 AM
I now have to go and get B12 shots for the next month or so as my B12 and Iron levels have tanked.

Posted by Sufferinsilence on 01 February 2014 - 08:37 PM
not only is my iron count on a mere 8 when it's meant to be a low of 15 and hight of 150 making me achy dizzy and extremely tired and emotional I am feeling mostly all withdrawals from lack of cymbalta but my blood tests also reveal I have a virus of some sort,

Posted by melly on 20 April 2012 - 02:04 PM
I also forgot to mention that my blood pressure is up and my iron count is low.

Posted by Sam I am on 19 January 2011
Personally, I was told I was low on iron, so a natural source iron supplement worked for me there

Posted by Debbie M. on 20 July 2010
I got severely anemic and had to go on iron supplements. My reading was 9.

Posted by Junior on 08 June 2010
yesterday I was getting a blood test done because my iron count is a little low

Posted by Lindarrr on 01 May 2010
My doctor had me do some blood tests and found that I was iron deficient and had amaemia, which was probably why I was so sleepy and exhausted all the time. I ended up having an iron infusion

Posted by scarydays on 12 May 2013 - 04:14 AM
The test showed low potassium and they had give me lots of fluid,

Posted by Uriel on 06 November 2012 - 08:24 PM
There were other things like my minerals were all messed up so i was on potassium and magnesium . Its amazing what that drug screws around with

Posted by eearley on 11 July 2011 - 11:14 AM
He's had patients end up in ICU from withdrawing cold turkey. My potassium level was dangerously low and they gave me a mega dose to help bring it up, along with 2 bags of IV fluid to help with the dedydration.

Posted by tired08 on 15 April 2008 - 10:35 AM
However this particular doctor didn't deny that this could be caused from the cymbalta withdrawl. bad enouh that something could be wrond but not bad enough to keep me. I waa dehydrated and low potassium they gave me something for that and sent me home to see the cardiologist which is what I was trying to do before going to the ER.

Posted by Alicemarie on 26 April 2013 - 05:27 PM
By the 5th day I was in the emergency room. I seriously thought my body was shutting down. What they found at the emergency room was low sodium, chloride and calcium and a high lactic acid level (lactic acidosis indicates that your body is not getting enough oxygen.

Posted by Uriel on 21 October 2012 - 04:02 PM
The main thing my tests showed was I had no selenium this is what helps you sleep and no Lyzime which is natural lithium ,

Posted by Hel on 10 December 2018 - 06:49 PM
blood test showed abnormal thyroid, anemia

Posted by Bkc26 on 16 July 2018
Withdrawal Symptoms:
Thyroid tests erratic

Posted by CatLover on 09 February 2017 - 02:32 PM
My thyroid levels are now perfect but my liver enzymes are continuing to rise. I now have to go get an ultrasound of my liver. Could the fatty liver be a result of the Cymbalta? I am sure the hypoT is, as I didn't have it at all until I weaned off Cymbalta.

Posted by jealbrecht on 27 September 2014 - 03:10 PM
I also started to take synthroid again (in the last week) since my thyroid hormone tests showed I was low T4 and my hair has started to really thin out (or is that another Cymbalta withdrawal symptom?).
I had labs done at the end of May, and last week - so 4 months apart. Over all cholesterol # is fine, but the LDL-P and small LDL-P have risen, along with glucose, but not bad on that. It was 90, now is 95. The Hemoglobin A1c is .1 above normal (that measure the body's ability to process sugar over the past 3 months.)
My thyroid is a little off, but we've been working on that with bio-identical meds for a while.

Posted by Amybc7 on 24 July 2014 - 05:18 PM in What are you feeling?
I'm taking a chance and reaching out there - does anyone else have issues with their Thyroid? This is a new deal for me - and sadly the challenge of regulating my thyroid coincides with my withdrawal.

Posted by ofarrells7 on 27 March 2017
but everything has come back normal except for a slightly elevated liver enzyme.

Posted by Justoffcymbandwellb on 15 March 2016
my Prolactin levels are about 20% high on all the labs I've done recently

Posted by fishinghat on 23 June 2014
High estrogen and prolactin.

Posted by TWhil195 on 10 September 2014
My cortisol levels this time around were sky high

Posted by Goldie on 19 October 2008 - 10:43 PM
Any ideas or suggestions would be greatly appreaciated. My cortisol levels are high, but the doctors tell me everything else is normal

Posted by EBB on 21 August 2018 - 12:18 AM
We got the results and her estrogen is high and progesterone and testosterone are low.

Posted by pelycosaurus on 24 September 2011
I got my labs done and i have really high testosterone and low vitamin D.

Posted by Bulldog on 04 August 2009 - 02:11 PM
He ordered a testosterone test and found out it was very low. It was the answer to a lot of the issues I was having. Had a ton of blood work done and found out my testosterone is still low and that I am Vit"D" deficient and that my liver is reading high levels.

Posted by ratdog on 31 March 2008
I have found my thyroid is hypo, my testosterone is low, and have NO energy.


#144 fishinghat



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Posted 11 January 2019 - 04:27 PM

                                                                                2018 Addendum
                                                                                       Page 20

Bead Count

Scuffy1209 Posted 16 August 2018 - 02:21 PM
Just wanted to reiterate really helpful info i found on a forum here -- I discovered that Lupin brand generic cymbalta is actually filled wtih tiny 5mg minipills instead of hundreds of little grains of "cymablta sand"

Maybeceejay Posted 11 July 2018 - 07:34 PM
My 30mg capsule had 56 beads, and my 60mg capsule had roughly 88 beads (some flew away and I think I lost count once).
my box of 60mgs are Tixol and my box of 30mgs are Cymbalta
For those that don't know Andepra AN is the name for Cymbalta in Australia.

mamma1st Posted 23 October 2018 - 06:17 PM
The manufacturer of her current bottle is Ajanta Pharma. I opened up one of the capsules earlier and there were 70 beads inside.

Ayla65 - Posted 04 November 2018 - 08:29 AM
Mum's Cymgen here in South Africa come in capsules (blue and green) and have 569 tiny white balls (of poison) in each capsule.

Gardenlady Posted 04 December 2017 - 08:31 PM
I counted beads in my Teva brand 60 mg capsules and they all had varying numbers. The average was 315 beads.

Reading Material

Scoffy1209 Posted 16 August 2018 - 02:15 PM
For those who are interested, here are some resources on Functional Medicine and specifically Dr. Kelly Brogan who is a holistic psychiatrist out of NYC.

Dr. Kelly Brogan:

Books i read that have changed my life:
Digestive Wellness by Elizabeth Lipski
A mind of your Own by Kelly Brogan.

IUN - Posted 17 October 2018 - 01:09 PM
Have you read any of Claire Weekes' books? I cannot recommend them highly enough. There has been a number of successful books written about anxiety, and they have all re-written (or stolen) her methods.
The Chimp Paradox is another good book for theory and practise. Even though it is aimed at getting your mindset right, be confident, successful etc, I was shocked at how much could be put to good use for anxiety sufferers.

#145 fishinghat



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Posted 11 January 2019 - 04:29 PM

                                                                                  2018 Addendum
                                                                                          Page 21


Lowered TSH, and rasied t3 and t4

administered daily for 20 days by gastric intubation increased serum 3,3',5-triiodothyronine (T3) and tetraiodothyronine (T4) concentrations

Thyrotoxicosis following the use of ashwagandha


Piperine (Black Pepper extract)
This compound is typically found in conjunction with Ashwagandha.
Piperine lowers the serum concentrations of thyroid hormones, glucose and hepatic 5'D activity in adult male mice.

Same finding

...enhancement of the absorption and bioavailability of herbal and conventional drugs.

The study shows that in the dosages used, piperine enhances the serum concentration, extent of absorption and bioavailability of curcumin in both rats and humans with no adverse effects.

Piperine's bioavailability enhancing property is also partly attributed to increased absorption as a result of its effect on the ultrastructure of intestinal brush border.

The results showed that piperine increased the plasma exposure (AUC) of linarin by 381% along with an increase in the Cmax by 346% and the Tmax from 0.05 h to 0.2 h. The present study revealed that piperine significantly enhanced the oral absorption of linarin in rats by inhibiting P-glycoprotein mediated cellular efflux during the intestinal absorption and likely simultaneously by inhibiting the metabolism of linarin.

Piperine (a main active component in both black pepper (Piper nigrum Linn.) and long pepper (Piper longum Linn.), was validated as the world’s first bioenhancer in 1979. The possible mechanisms of bioavailability enhancement action of piperine include increasing blood supply to the gastrointestinal tract, decreasing gastrointestinal emptying, and inhibiting drug metabolizing enzymes and P-glycoprotein (P-gp). It has been demonstrated to be effective in enhancing the bioavailability of rifampicin, phenytoin, sulfadiazine, resveratrol, fexofenadine, tetracycline, propranolol and theophylline, etc.. In particular, a dual drug-loaded nanoformulation containing curcumin [which has demonstrated efficacy as an anticancer agent but has a very low bioavailability (about 1%)] and piperine for the treatment of multidrug-resistant cancers has been recently proposed and prepared to enhance the bioavailability of curcumin.

#146 invalidusername



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Posted 12 January 2019 - 11:00 AM

Noticed that you have appended Pregabalin to the list here - a good move for future sufferers. 


Very useful library this.

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