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2 Failed Tapers. Very Sensitive To Drops. Advice Please.


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#1 Noush

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Posted 14 October 2018 - 04:41 AM

Hi. I have been on 40mg Duloxetine for 5 years. I was put on it for Postnatal Depression/Anxiety. I returned to feeling well after several months, although was left suffering from bad PMS each month. So it was decided by Dr & Gyno that I should stay on it. I decided last year that it was time to taper off & did so by dropping 2.5% every 2i days. I only got to my second drop & all hell broke loose. Heart racing, dizzy, extreme anxiety, nausea, insomnia. So I reinstated. After 4 months, I didn't to try again at only 1.5% drops. Again, when I reached roughly the 5% dose reduction point, all hell broke loose & I ended up having to take a week off work & reinstate to 40mg. In July, a friend I met through a Cymbalta Facebook group, recommended this site & so I decided to try tapering at 1 bead per week. Again, two weeks ago I got down to a 18 bead reduction, which would be approx 4.5/5% and I started with insomnia (literally no sleep all night), nausea, anxiety, dry mouth, loose bowels, racing heart when resting & ended up having 1 day off work. So after 3 days, I increased my dose by 6no beads & am feeling pretty much back to normal again.

So my question is, has anyone's ever been this sensitive to drops? If I slow the taper to a bead every 2 weeks it will take me over 14 years yo get off this stuff. The thought of bead counting every day for 14 years is soul destroying.

Any advice would be very much appreciated.

#2 fishinghat

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Posted 14 October 2018 - 06:46 AM

Welcome Noosh

I must admit that you are as sensitive as I have ever seen. I would suggest changing over to Zoloft, Lexapro or Prozac, stabilize and then wean off that AD. They are usually easier to handle. I am really sorry you are having these issues. Tough medicine to handle for sure.

#3 Noush

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Posted 14 October 2018 - 07:28 AM

Thank you Fishinghat. I can't take Prozac, as I had a bad skin allergy to it before trying Duloxetine.

How would you recommend bridging over to Zoloft or Lexapro? I am happy for it to take a year or two.....but not 14 😂

#4 invalidusername

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Posted 14 October 2018 - 08:20 AM

Noosh - a warm welcome from me also.

 

My goodness - I thought I was sensitive, and I am allergic to a whole list of medication. I was only on a full dose (of 60mg) for 6 weeks before coming off (due to adverse reactions), and there have been times when my depression got so bad that I would be on these little sods for good. The difference being that I am using Celexa/Citalopram to cross-taper. I think if I did not have a supporting drug, the present withdrawal would be a lot tougher.

 

Therefore, I would strongly suggest you look into fishinghats advice in looking for a supporting drug.

 

I am only taking Citalopram as it was what I was on before I switched. I wouldn't necessarily suggest it as a supporting drug. I do not know enough about others to suggest an alternative - so again, having far more knowledge of different AD's, I'll leave it to fishinghat.

 

Do you use any other supplements (ginger, omega 3...) to help you through the withdrawal? 


#5 fishinghat

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Posted 14 October 2018 - 09:30 AM

Drs normally take 4 to 6 weeks to switch from one AD to another. During that time they slowly reduce the current AD and slowly increase the new AD. It should be mentioned that usually, but not always, the new AD kicks in about the time you are completely off the original AD. That means you will still have a tough time until the new AD fully kicks in.

You might find these interesting.

Cross Tapering

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

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

https://www.ncbi.nlm...pubmed/18494539

http://www.gpnoteboo...m?ID=1637482568
Guidelines from various sources.

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

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

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

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

#6 Noush

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Posted 14 October 2018 - 10:58 AM

Thank you for your comments Invalidusername. Did you have many withdrawal symptoms when you cross tapered? And did you initially try weaning without cross tapering? I have actually been recommended Escitalopram to try.

Thank you Fishinghat, I will have a thorough read of those links.

#7 invalidusername

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Posted 14 October 2018 - 11:37 AM

I am still cross-tapering at the moment. I went 60mg to 30mg (added 10mg Citalopram), then 30 to 20mg (with 20mg Citalopram), and now 10mg (with 30mg Citalopram). Did this last one starting yesterday. The guys here have really helped me thru so far. 

 

I have had head zaps, nausea, seizures, increased anxiety and depression, suicidal ideation, head fog, headaches and the "runs"... Think that covers it....

 

Escitalopram is the purer version of Citalopram. Don't quote me, but I think it is what Citalopram could have been had they approached it a different way, so in my eyes it is an improvement on the molecular formula of Citalopram. If I don't settle as good as I hope on the Citalopram, I will request a change to Escitalopram. 

 

I have read a lot of peer-review journal papers which hold it in high regard compared to other SSRI's - and even some SNRI's. I have links somewhere if you are interested. However, we never quite know how these phara companies work. Call me paranoid, but you just don't know who is paying off whom. A good review of a drug in a peer reviewed journal is worth its weight in gold for the phara company, so a quick back-hander to a research group is an easy win. Of course it shouldn't happen, but what do we truly know.

 

This is why forums like this work. This is good, honest people who have been dealt a bad hand and share experiences to others so that they may benefit. Whilst papers are good, speaking directly to the source - the end users - is the best way.

 

We also have issues in the UK (as do other countries I expect) where the pharma companies offer sugeries and medical centres "special deals" on their drug. That way the doctor suggests those over others as they are saving money. For the NHS here in the UK, each patient has a default amount of money per year, lets say £2000. Each doctors appointment costs £50, a pack of Citalopram costs them £90 and so on. If the doctor goes over this budget, he is in trouble and could face consequences. I have always had this in mind. The NHS is a business, not a charity.

 

BTW - I am an academic researcher myself - you never would have guessed :)


#8 gail

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Posted 14 October 2018 - 11:54 AM

Hello Noush,

Welcome, you were referred by a very respected member, our sweet Juli.

Sensitive? Yes my dear.

Those are certainly not my personal guidelines. My approach would be so different. But then, I'm not a doctor, but I have been to hell. That should count.
Were you to choose Prozac or Lexapro, I would start it right away at a low dose while keeping the Cymbalta at 40. A few weeks in, I would bead count Cymbalta and upper the other antidepressant.

Again Fishinghat, thoughts?

#9 invalidusername

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Posted 14 October 2018 - 12:00 PM

It's a tough call.

 

When cross tapering I have found it is a careful balance between keeping enough Serotonin going round, avoiding too much serotonin, and find the right balance to keep the physical symptoms to a minimum. 

 

Bit of a minefield, but like what you (Gail) and fishinghat said to me when I first joined - your body will tell you. Some very sage advice in just a few words.


#10 fishinghat

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Posted 14 October 2018 - 01:18 PM

"When cross tapering I have found it is a careful balance between keeping enough Serotonin going round, avoiding too much serotonin, and find the right balance to keep the physical symptoms to a minimum.

Bit of a minefield, but like what you (Gail) and fishinghat said to me when I first joined - your body will tell you."

Couldn't have said it any better.

#11 Noush

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Posted 14 October 2018 - 03:17 PM

Hi Gail. Yes, Julie referred me to this group. We met on a Facebook group, who strongly advise against cross tapering & are very anti drugs of any kind.....actually it's quite a negative group. Anyway, I know Juli has had great success cross tapering with Escitalopram (Lexapro) & I think that that may have to be the way forward for me.

Is Serotonin Syndrome less common when on a lower dose of Duloxetine such as 40mg?

#12 fishinghat

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Posted 14 October 2018 - 03:24 PM

Serotonin syndrome is brought on by the total amount of ssri you are taking that is why drs will lower one ssri at about the same rate they raise another one when cross tapering. The lower your dose of Cymbalta the higher the starting dose of Lexapro you can use.

#13 invalidusername

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Posted 14 October 2018 - 03:43 PM

Cross tapering can be used in the context of either coming off - an easing off one drug to another more easily stopped (as fishing hat has recommended), or a switch. I am cross-tapering to switch, not to come off medication altogether. My depression is not yet at a place whereby I would be confident to "go it alone". But believe me, if I could, I would.

 

Just to add to what fishinghat has rightly said about serotonin syndrome, there will not be a "one size fits all" point at which it starts. I was on 60mg Dulox and 10mg Citalopram (equal to 90mg Dulox dose, which of course is fine) yet this made me very irritable and edgy and a bit "hyper". All common attributes of a mild onset of SS. As long as you go careful, I doubt you will be at risk. Most have to take a lot higher doses to constitute a problem. But do bear in mind that some SSRI/SNRI can work together to give a mildly higher dose of serotonin that the combination would suggest.

 

Just keep us all posted here. Gail and fishinghat have far more experience - but I try to bring the knowledge I have gleaned from literative knowledge.


#14 Noush

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Posted 14 October 2018 - 03:55 PM

I will make an appointment with the head pharmacist at my doctors practise in a few weeks, as he said that he would help me as much as he could if I wanted to wean off or cross taper. I had to see him a few months ago, as they were trying to get me to switch to a cheaper generic brand of Duloxetine than the one that I have been on for 5 years. I appealed against the boards decision & had to have an interview with the head pharmacist, who thankfully backed me up & authorised the prescription. Although he tried telling me that he has had many patients who have come straight off Duloxetine without any issues. So he may be as much use as a chocolate lifeguard! 😂

#15 invalidusername

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Posted 14 October 2018 - 04:27 PM

"they were trying to get me to switch to a cheaper generic brand of Duloxetine than the one that I have been on for 5 years"

 

AAARRGRGGGHRHRHHHHHHHHH!!!! You poor sausage.

 

"patients who have come straight off Duloxetine without any issues"

 

These people have a name... lucky b***ards :)


#16 juli

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Posted 14 October 2018 - 10:33 PM

Hey you!  Welcome to the forum :)

I am so happy that you are here because you will get tremendous support and advise.

Love you sweetie.  You can do this!!!

Juli


#17 Noush

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Posted 15 October 2018 - 12:57 AM

Hey Juli

So glad that you recommended this group. You yourself have been such a great support when we both had our previous bad taper experience. So proud of you for getting off this stuff & being brave enough to tackle weaning again after such a bad experience the first time.

I am so determined to get off this stuff and just need to do it with as little withdrawal symptoms as possible. As a department manager, I cannot afford to have anymore time off work due to this rubbish.

I will be on this group daily & once I've seen my GP I will keep you all posted.

#18 fishinghat

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Posted 15 October 2018 - 08:05 AM

Hi Juli

Hope you are doing well. You are a jewel.

#19 juli

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Posted 15 October 2018 - 09:12 AM

Hi there!  I am doing well.  It seems that my body is pretty well back to normal and it is a blessing.


#20 gardenlady

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Posted 15 October 2018 - 09:50 PM

Noush, Welcome to the forum!  I am extremely sensitive to Cymbalta drops, too, and am down from 60 mg to approx 27 or 28 mg (it's hard to know exactly as the capsules vary so widely in bead count).  I am weighing beads as counting is too tedious.  As the capsules vary so much in bead count, it's necessary to count the beads one consumes, not the ones removed, in order to get a consistent dose from day to day.  Because of this, I'm weighing the beads but can't be sure of the mg equivalency. 

 

I, too, was going to cross taper to an SSRI but chickened out as I was terrified of making the large Cymbalta cuts necessary and having a psychotic withdrawal reaction.  I'll be interested to see if you are able to tolerate those cuts when crossing to another drug.  If so, then perhaps it will give me courage to try again.

 

Right now, I'm having severe depression with horrible existential fears.  If it's this bad at 27 mg, I can't imagine what it will be like as I keep going and get lower.  It seems that some of us are held hostage to this poison and find it nearly impossible to get free of it's grasp.  I'm fearful of becoming psychotic and hospitalized where they just pump people full of more psych drugs making the problem even worse.  

 

I'm alone and have no one to help me and am 65 years old, so that's really scary.  I hope that's not the case with you. 


#21 Noush

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Posted 16 October 2018 - 12:33 AM

Hi Garden Lady

Thank you so much for taking the time to comment on my post & share your experience. I'm so sorry that you are having to go through this alone. But can I say, this shows great strength & bravery. Well done for getting down to where you are. That's a huge drop & much lower than I have managed. Have you got anybody close by who you can chat to about the way that you are feeling and just have a good old cry on?

What % drops are you doing & how often? I bead counted 3 capsules to get an average of 370 beads per 40mg capsule. Then bead counted each capsule from then, each week dropping by 1 bead. I did buy some scales & tried weighing last year, but found thst the scales weren't accurate & found that the beads that I weighed out could vary by 6 - 8 beads.

As you are down to such a low dose now, have you considered speaking to your Dr about adding a very very low dose of something else & then cross tapering? You are at a very low dose now.

#22 invalidusername

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Posted 16 October 2018 - 07:34 AM

I never seem to be prepared at just how much the withdrawal can influence a mental state. It reminded me of when I nearly lost it with a doctor I saw who said, related to the depression "just keep telling yourself it is the pills". It doesn't matter what causes it, it doesn't change the fact that it is still there and I have to live with it! So difficult to keep it bottled up sometimes.

 

Garden lady - your words really stuck with me. I sincerely hope things improve. God bless you both.


#23 fishinghat

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Posted 16 October 2018 - 09:01 AM

I can't help but throw in a reminder to everyone that clonidine and hydroxyzine are often successfully used to treat withdrawal including Cymbalta withdrawal. They do not have a withdrawal and are not addictive. Like all medicines they work for some and not others. But they are a safer approach than benzos.

Something to consider.

Hi Garden Lady

My heart goes out to you. I remember how sensitive you are to the drops. Have you considered just staying at your current dosage for a couple weeks and seeing if you could stabilize some before continuing?

If you want to PM me a list of current meds that you are on I will see if I can find anything that may be making matters worse. That's up to you.

#24 Noush

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Posted 16 October 2018 - 02:51 PM

Fishinghat,

I have never heard of Clonidine. Is this classed as a beta blocker? I was prescribed Propanolol when my blood pressure shock up during my last failed taper attempt, but it didn't seem to do anything. Although it was only 10mg & I was told I could take up to 3 tabs 3 times a day. But only took 1 a few times. In your experience, have people who don't tolerate Citalopram very well tolerate Escitalopram Ok? As I believe it is a much cleaner version.

#25 invalidusername

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Posted 16 October 2018 - 03:40 PM

 "have people who don't tolerate Citalopram very well tolerate Escitalopram?"

 

I think you will find that everyone will tolerate differently, thus it would be impossible to tell if someone would have a reaction to Escitalopram or not - regardless of their tolerance of Citalopram. The pharmacokinetics are more-or-less shared between the two however, and Excitalopram is far safer, in so much that it doesn't promote longer QT heart reponse. QT is the electronic part of the heart which operate the responses to and from the chambers and valves. In mild terms, it can give slight delayed heart rhythm which can cause headaches etc, but when worse, it can cause blacking out and even heart attacks. Escitalopram does not do this as it targets a different neurological pathway which bypasses this system.

 

So by "cleaner", this could be one definition, but regardless of any research, I think it would be a case of "suck it and see". In my educated opinion, I would say there would be better tolerance by comparison as there have been more talk of it working better overall compared to a number of other SSRI's and some SNRI's.

 

Hope this helps.

 

What do you reckon fishinghat?


#26 Noush

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Posted 16 October 2018 - 04:19 PM

Invalidusername, thank you for that info. That makes good sense. Citalopram was the first SSRI that I tried 5 years ago before going on Cymbalta. I only took it for a week or so, as it completely stopped me from sleeping. I always assumed that I would have the same reaction to Escitalopram. However, a pharmacist told me that this may not be the case, as Escitalopram is a cleaner version with less side effects.

I am trying to do my research and prepare as much as possible before I 100% decide how to cross taper and what on to, as I have a feeling that my Dr will let me lead the way.

#27 Noush

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Posted 16 October 2018 - 04:22 PM

Invalidusername, thank you for that info. That makes good sense. Citalopram was the first SSRI that I tried 5 years ago before going on Cymbalta. I only took it for a week or so, as it completely stopped me from sleeping. I always assumed that I would have the same reaction to Escitalopram. However, a pharmacist told me that this may not be the case, as Escitalopram is a cleaner version with less side effects.

I am trying to do my research and prepare as much as possible before I 100% decide how to cross taper and what on to, as I have a feeling that my Dr will let me lead the way.

#28 fishinghat

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Posted 16 October 2018 - 05:06 PM

Clonidine is an alpha agonist. While it can be used to control blood pressure it is an excellent treatment for anxiety. Unlike beta-blockers which do not cross the blood brain barrier, clonidine can cross into the brain. It stimulates the pons alpha adrenaline receptors making the brain think there is too much adrenaline in the blood. The brain then reduces the signal to the adrenal gland which reduces adrenaline production.

Beta-blockers like propranolol, atenolol, etc are sometimes used to help control anxiety. Because they do not cross into the brain they are most effective in treating anxiety symptoms in the body (heart pounding, PVCs, tightness in the chest, etc.

IUN description of Lexapro is pretty spot on. Like he said, there is a lower risk of side effects compared to Celexa. Both have an FDA warning against its use in patients over 60 with an irregular heart beat as they can make this arrhythmia much worse.

#29 invalidusername

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Posted 16 October 2018 - 05:12 PM

Noush - here is some homework for you, handpicked from my bookmark library on Escitalopram efficiency, comparisons and remission rates;

 

https://www.ncbi.nlm...pubmed/18922243

 

https://www.ncbi.nlm...pubmed/15107657

 

https://www.ncbi.nlm...pubmed/21206792

 

https://www.ncbi.nlm...pubmed/22786497

 

https://www.ncbi.nlm...pubmed/19393384

 

https://www.ncbi.nlm...pubmed/16259540

 

https://www.ncbi.nlm...pubmed/15274172

 

https://www.ncbi.nlm...pubmed/17848424

 

https://www.ncbi.nlm...pubmed/22381728


#30 fishinghat

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Posted 16 October 2018 - 05:58 PM

IUN - Do you mind if I add that to my library?



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