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What's Causing This? The Withdrawal? Benzos?

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#1 Petaa



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Posted 29 December 2018 - 08:50 AM

Hi, just looking for some advice/thoughts on distinguishing between withdrawal side effects and symptoms of anything else?

Background info: I have an amazing psychiatrist who's been responsive, monitoring the withdrawal, and who I am very grateful for. Thus, I feel like coming off Cymbalta hasn't been nearly as bad for me as I hear from others.

Over the course of the past few years I've tried a number of antidepressants without much success. About 5 months ago my psychiatrist recommended Cymbalta and over that time my dose was increased up to 90mg.

Over the past month I've spiralled downhill. Following strong suicidal ideation and an attempt, we decided that Cymbalta wasn't working for me, and to admit me to hospital for a bit of respite and to begin the process of changing medications.

Over the course of 5 days I was tapered down to 60mg, 30mg, and then ceased Cymbalta altogether. At the same time I was in hospital (new environment, different eating and sleeping patterns etc,) I was taking benzos for the first time as PRN to help calm me, I was at the bottom of a depressive spiral, I took my yearly "medication holiday" from Ritalin, and I was started on a new medication (lamotrigine).

1 week into no-Cymbalta and I'm currently on 25mg lamotrigine, 25mg seroquel, 40??mg proranolol, and diazapam as PRN when needed.

All this is to say, it's difficult to work out which factor is causing each of the symptoms I'm experiencing.

So here's the symptoms and my thoughts:
- Increased suicidal ideation (I ended up having another attempt while in hospital. These thoughts had been there before ceasing Cymbalta and do tend to get worse when I'm in hospital, so I don't think it's overly attributed to the withdrawal. However my periods of uncontrollable urges to harm myself have moved from once every few nights to multiple times per day. They're causing much more distress and periods of thoughts so intense I feel like my brain might explode.)
- Ringing in my ears (low volume and not overly bothersome. Sort of just sounds like cicadas.)
- Almost having an appetite again? (I haven't felt hunger in a long time, sometimes unknowingly going up to 24 hours without eating and not realising until passing out. Over the past few days if I've accidentally missed a meal my body let's me know much earlier which has been fantastic. I've also started craving particular foods again. My current theory is that this is due to the Ritalin stopping.)
- Dizziness and passing out (I've always been a dizzy person, particularly with the eating issues above, but this has been moreso than normal)
- Occasional nausea
- Hot and cold flushes (switching from sweating to shivering and back within 5 minutes)
- Sleep paralysis. (NUMBER ONE MOST BOTHERSOME! Every night and sometimes for hours in the morning I can't move. I dream that I've called out and someone comes in to help, but find that I haven't moved at all and still can't. Originally I thought this was the effect of sleeping on benzos, so I took a few days of not allowing myself to use them as PRN, but it still occurred. Now I'm not sure.)

Notably, I wasn't on Cymbalta for a long time and I have not experienced any skin prickling or electric zaps. I guess my biggest question is about the sleep paralysis. It's not listed as a common symptom on most websites, so I'm curious as to whether this might be cymbalta related? Additionally, are any of the others commonly heard of? Or probably from other causes?

And I suppose maybe on top of that I'm just looking for a bit of support/community right now.

#2 fishinghat


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Posted 29 December 2018 - 09:32 AM

" All this is to say, it's difficult to work out which factor is causing each of the symptoms I'm experiencing."

In general I agree with your drs approach. While it is recommended to very slowly wean off the Cymbalta if you are feeling suicidal then one must react more quickly. Putting you in the hospital was the right move as coming off the Cymbalta may increase the suicidal thoughts and actions at first. I don't even have a problem with the meds that the dr put you on but I do have a problem with the speed at which he/she did it. There are so many side effects and interactions with these meds that starting that many in such a short time can cause more problems than they fix. Having said that I would say that your symptoms are classic for Cymbalta withdrawal. I have read all the posts on this site and it seems like I recall several people who had sleep paralysis. I will double check and come back and let you know.

The benzo will help and is the standard approach but there are a couple other meds that may do as well that aren't addictive or have a withdrawal. Unluckily drs are in love with benzos.

#3 fishinghat


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Posted 29 December 2018 - 10:04 AM

As you can see below that is fairly common. If we can help in any way we are always around. Hang in there and keep us posted.

Rigidneophyte on 06 December 2018 - 12:36 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
Everything was pretty ok for a week, some trouble sleeping. Now I cannot sleep through the night. The skin pricking feeling is rough, but the biggest problem is the dreams. I seem to be in some sort of sleep paralysis or something. In my dreams I'm in my bed trying to sleep, then try to wake myself up. Whenever I try to sit up in my dream I'll get an intense dull pain in my head, like when you stand up to fast but slightly more painful. Like suddenly all the fluid in your body is in your head and it's hard to move and the pressure has increased.

Posted by Bearfan on 02 July 2018 - 05:38 PM in What are you feeling?
I was on cymbalta 30 mg, and trazodone 50 mg for sleep, for about 30 months from 2012-2015. I actually felt great during this time. Never had anxiety or depression or OCD during this period. Only thing was sleep paralysis which I later learned was probably from the trazodone.

Posted by fishinghat on 12 July 2017 - 09:17 AM in Medical Support
On September 6, 2016, the FDA wrote a letter to Forest Labs about Viibryd. New warnings will be added to the Viibryd label related to a link between the drug and acute pancreatitis. Acute pancreatitis can lead to serious injury and even death. Pancreatitis, especially if it reoccurs, can lead to pancreatic cancer, which is almost always fatal.
Additionally, it is expected that new warnings related to sleep paralysis will also added to the Viibryd label and prescribing information. Sleep paralysis is a condition in which a person is awake but cannot move or speak. Generally, sleep paralysis occurs upon waking and lasts less than one minute. Although sleep paralysis is a serious condition, and can cause psychological harm in the most severe cases, the condition is generally not life threatening.
After a one-year, open-label study assessing the safety and tolerability of vilazodone in people with major depressive disorder, the most common adverse effects were diarrhea (35.7%), nausea (31.6%), and headache (20.0%); greater than 90% of these adverse effects were mild or moderate.[8] Whereas in randomized controlled trials these rates were 28%, 23.4% and 13.3%, respectively.[8] In contrast to other SSRIs currently on the market, initial clinical trials showed that vilazodone did not cause significant decreased sexual desire/function as with many other antidepressants, which often cause people to abandon their use.[4]

Posted by fishinghat on 12 July 2017 - 08:14 AM in Medical Support
Reports of adverse reactions temporally associated with VIIBRYD that have been received since market introduction and that are not listed above include the following:
General Disorders and Administration Site Conditions: irritability
Nervous System Disorders: sleep paralysis
Psychiatric Disorders: hallucinations, suicide attempt, suicidal ideation
Skin and subcutaneous tissue disorders: rash, generalized rash, urticaria, drug eruption
Gastrointestinal System: acute pancreatitis

Posted by Raven72 on 02 March 2017 - 10:57 AM in Nutritional Support
received symptom
So, sleep paralysis stinks. I have had the worst week.

Posted by Berry on 06 February 2017 - 08:18 AM in How to Find Support
I was having crazy nightmares and very scary episodes of sleep paralysis accompanied by visual hallucinations

Posted by startled on 18 July 2016 - 10:55 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
I still seem to have a bit of "sleep paralysis,as just as I am waking up I will think I am listening to family conversations,and I Am sure I hear it,and I step out and look,nobody! I even hear arguing that is not happening,and sometimes it's people across the street or in the yard,and nothing! So, I can honestly say you are not alone.

Posted by FiveNotions on 22 January 2015 - 11:06 AM in What are you feeling?
Sleep paralysis is totally freaky/scary, isn't it? I had it, often, while on crapalta ... now that I'm off, not once in a bit over a year ...

Posted by Besst on 22 January 2015 - 04:16 AM in What are you feeling?
It's called Sleep Paralysis, and I am now having this too while withdrawaling, very disturbing.

Posted by Besst on 14 January 2015 - 02:01 AM in Weaning Off Cymbalta
Day 14 sixth day at 10mg - originally planned to be down at 5mg but devloped these side effects so I am holding steady for awhile. Today was pretty shitty day. I was experiencing mild brain zaps all day. It feels like its in the frontal lobe of my brain. It feels like somebody stuck in a hand blender in my prefrontal cortex and is making it buzz and whirl around. I feel dizzy, lightheaded and feel the consant buzzing/zapping/shivering sensation as if I am going to quickly pass out or have a seizure. I fell asleep, and had an episode of sleep paralysis. I've had a few of these in life. Its horrible, you're awake but body is paralyzed and still asleep, I sat there while still asleep, shaking my head trying to bust out of the sleep. Finally I was able to explode awake and break through the sleep barrier. I was having continuous brain and body zaps while in the dream, I was even having a weird dream that I had a TENS device (an electrostimulator device) attached to my body in the dream and it was shocking me.

Posted by ShadyLady on 02 October 2014 - 04:53 PM in What are you feeling?
Seroquel, OMG, gave me some sort of sleep paralysis

Posted by FiveNotions on 02 July 2014 - 10:36 AM in What are you feeling?
Oh yes, I know exactly what you're experiencing, describing! The sleep paralysis is something I've always had, even before crapalta....I had it more while in hard withdrawal...during the first two to three months...it's awful, isn't it? Aaaargh.....
Also, while on the poison my dreams were always extremely vivd, often lucid, with me knowing full well that I was asleep and dreaming, and being able to determine my actions in the dream....I loved those, and actually miss them now that I'm off....
As to the sleep paralysis....a trick I used during withdrawal was to sleep with a light on....it kept the boogeyman away, I kid you not....and, to make it even weirder, because the light was on and I can't sleep if there's any light in the room at all, I wore a blindfold....but, I knew that the light was on....so, that kept the sleep paralysis from happening.....not saying that's rational or logical, just that it worked for me.....
Another thing that might help is to sleep with a sound machine...water sounds, rainfall sounds, etc.....I used this also, actually, still do, as I love the sound of rainfall and it helps me drift off to sleep.....
Also, read up on sleep paralysis on the internet....I believe that there's a serotonin connection...and crapalta acts to increase the serotonin level in the brain...so, if you miss a dose, or are reducing your doses, there's a reduction of brain serotonin levels....and boom...sleep problems of various sorts....
I'm going to check the forum archives to see if there's anything else on sleep paralysis...if I find something, I'll post the links here....

Posted by Jandzio on 02 July 2014 - 10:24 AM in What are you feeling?
I was dreaming, but had some form of sleep paralysis in my dream. I wasn't able to do anything or control anything, and there would be 'voices' saying that I'm not capable of dealing with my depression/anxiety and then I'd try to scream, but I couldn't and I'd have everlasting panic attacks.
I was just wondering if anyone has experienced anything like this before and has lived to tell the tale... I'm too scared to go to sleep now :/

Posted by adri on 30 April 2014 - 07:02 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
Thanks for the quick reply! I'm working with my DO as they are also doing blood work to see if I have lupus or hypothyroidism. The reason they said to go CT is because of the drastic switch in it going from helping me to being a zombie and having the horrible nightmares, sleep paralysis, and panic attacks.

Posted by Kfire91 on 13 June 2013 - 12:48 AM in What are you feeling?
Before beginning the weaning process, both my brother and I did a little research (thank God, or else we would've tried quitting cold turkey) and found that the best way was to wean very slowly down. So I started at going down 10 mg....big mistake. Even that slight jump from 40 to 30 was too much to handle. I had symptoms I had never had in my life, even before being on Cymbalta! I had cold sweats, headaches, rage, irritability, suicidal thoughts, thoughts of hurting others, sleep paralysis, night terrors, confusion, weird visions, sore joints, impulsivity, vision impairment, brain zaps, severe fatigue.. you name it, I had it. I

Posted by chimera on 18 May 2013 - 11:56 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
it's ok, I am 5 odd weeks off, and the dreams are still going, but come in batches rather than every night now. I know they'll slow down as time goes on, though highly unpleasant due to sleep paralysis with them.

Posted by chimera on 28 April 2013 - 01:54 PM in What are you feeling?
hallo:) thanks, this is another thing that I now know will pass! I am doing ok, the nightmares are still cropping
up (along with some rather Exorcist like levitation hallucinations when they happen, but a bit of research
showed this to be a phenomenon of sleep paralysis luckily.

Posted by chimera on 24 April 2013 - 08:19 AM in ARE YOU NEW HERE? Words from the wise about Cymbalta
I had to do a faster withdrawal than I wanted due to allergy, so I did 30mg for a week, broke capsule and did 15 for a few days, then off completely. now on day 13 off.
have used the supplements mentioned above. same withdrawal effects as mentioned above too. sharp dizziness on moving eyes to the right (this seems a classic one from what I've seen) and horrific nightmares/sleep paralysis. that has probably been the most distressing part of it.

'Tim', on 15 Jan 2011 - 6:41 PM, said:
I have been taking Cymbalta for a while and when I had missed a dose I felt these symptoms. This weekend, I ran out of Cymbalta (I take 90mgs per day) and the withdrawl symptoms are unsettling. I have been having the electrical sensations throughout my body, felt faint, had trouble sleeping, and like I was having a seizure or stroke last night in bed. I had a feeling of sleep paralysis where I could not move in bed, heard a gurgling or boiling sound in my ears

Posted by Feelin_Crazy on 09 June 2010 - 08:19 PM in ARE YOU NEW HERE? Words from the wise about Cymbalta
My symptoms are:
Sleep Paralysis (self diagnosed on www.webmd.com
Hallucinations (which are apart of the sleep paralysis)
Insomnia when I can't sleep (because of anxiety due to sleep paralysis)...

Posted by anaemic on 22 August 2009 - 04:04 PM in What are you feeling?
Here are the feelings I usually go through in a normal day. Some good, mostly crap...
24.) not being able to distinguish some dreams from reality--sleep paralysis

Posted by schmb01 on 10 July 2008 - 03:51 PM in Weaning Off Cymbalta
Oh, the sleeping and waking with panic attacks was horrid! Even using the Sleepytime, I still had it, but it was much less extreme. Some have described it as sleep paralysis, and I felt that too.

Posted by blueskye on 21 June 2008 - 12:12 AM in Cymbalta in the News
now blake if the paralysis last for more than a few minutes after you wake up dude, i don't know what to tell you (except I think a trip to the doc...).... but maybe (and this is me just speculating) your brain is still "zapping" while you are asleep and then when you wake up it takes longer for your brain to tell the rest of you that you are awake because it's so side tracked... that would explain the vibrations (the zapps) and a temporary paralysis... which isn't uncommon to wake up with anyway... especially if you are having stressful and strange dreams (its much more common to wake up with temporary paralysis after those kinds of dreams) i seem to remember a couple of classes on the subject of sleep paralysis (which i know is scary as anything when it happens!) I will try to find some notes from class and see if anything jumps out for ya!

Posted by schmb01 on 29 March 2008 - 01:01 PM in What are you feeling?
Yes, I have had those times where I am asleep, yet trying to wake myself up, and feel paralyzed, if that is what you are describing as paralysis. It makes me nervous to try to go to sleep sometimes too.

Posted by schmb01 on 09 March 2008 - 08:39 AM in What are you feeling?
*************HELP*************** I have not been to sleep. As soon as I start to doze off, the noises in my head become unbearably loud; the electric noises, the slamming, and now it is like someone has turned up the volume on my tinnitus. Yet, I get in that sleep paralysis state, and can't really go on to sleep, but can't quite wake myself up! For me, this is far worse than the emotional swings. At one point I managed to pull my right eye open, and I was panicked. Then it was so horrible that I thought I had gotten up, only to find I was still in bed with these horrible noises. I am so tired, and I just don't know what to do until tomorrow when I can call my doctor. I really don't want him to give me another med for sleep, but I am at my wits end. I'm hoping I can put in a movie and maybe just fall asleep on the couch.

Posted by speedracer on 03 March 2008 - 08:28 AM in What are you feeling?
Well, last night was really bad in terms of the nightmares. I got some sleep paralysis thrown into the mix, which was really nice. I'm going to try an OTC sleep medication tonight to see if I can at least get a good night's rest. I'll post the results tomorrow.


#4 Petaa



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Posted 29 December 2018 - 10:29 AM

Thank you so much for the info and validation regarding the sleep paralysis being not completely unheard of.

I'm not too worried about the benzos being addictive for me. My body has a very black and white reaction with medication where I'm either extremely extremely sensitive to it (eg, 12.5mg of seroquel is generally enough to completely knock me out for the entire night) or I feel no effects at all (eg most antidepressants and almost every benzo so far including Valium/diazepam). Since benzos have always fallen in the later of those two categories and don't provide me with much relief, I almost always refuse them and only take them to appease nurses mostly.

A follow up question: other than the intense and overwhelming sleep paralysis - my symptoms haven't been too bad. If after a week I've experienced very few side effects, am I likely to have a bad experience later on? Most posts I've read show people noticing withdrawal symptoms within a day or two, so am I likely to just be one of the very lucky ones and this is one of those situations where my body has next to no reaction with cymbalta at all?

(Since it's 2:30am where I am and I've been trying to sleep for 4 and a half hours now, I might have to add insomnia to that list.)

#5 fishinghat


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Posted 29 December 2018 - 11:23 AM

I am really glad your symptoms are so tolerable. I would recommend some melatonin but if the nurses found it they would want to up your benzo instead.  lol


I too get little benefit from benzos. Drs here typically start with hydroxyzine or clonidine which are non-addictive with no withdrawal. Hydroxyzine works well for sleep as well.

#6 invalidusername


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Posted 29 December 2018 - 02:05 PM

Hi Petaa - and welcome to the forum.


I see you have already met 'Hat, and you couldn't have got better advice that side of the Atlantic, so not much for me to add as that which I understand, I would certainly agree with.


Regarding you expecting returning experiences, Cymbalta is a tricky little number, and it can sneak back up on you, but again I side with Hat and your doctors in removing you from the meds asap. The withdrawal can be treated by itself as and when it occurs, but the important thing was to remove the culprit of your reactions. Sometimes the way forward is not an SSRI or SNRI and symptoms can be treated with a number of other approaches. In the UK it always comes down to a cost per head, so we get what we are given - regardless of whether it will help or not.


I would say that you are in safer hands with what you are on and that you need to give a little time to stabalise. 


Like yourself, I am extremely sensitive to medication and yet, reactions still seem to surprise me. However, the process through which our neurons and so forth need to go through to right themselves is very much a subjective matter. No one person will be the same. For frame of reference, I had about 3-4 days of peace before all hell broke loose when I stopped Cymbalta, so whilst I would like you to take comfort from this, I cannot be sure.


For now try to take comfort in knowing the poison to your apple has been removed and whilst things may still seem worrysome, you are affording yourself the opportunity to get better. You have also found a good community in us to offer support. Stay connected and keep us updated. 


All the best and God Bless.

#7 KathyInFL


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Posted 29 December 2018 - 10:46 PM

I am really glad your symptoms are so tolerable. I would recommend some melatonin but if the nurses found it they would want to up your benzo instead.  lol


I too get little benefit from benzos. Drs here typically start with hydroxyzine or clonidine which are non-addictive with no withdrawal. Hydroxyzine works well for sleep as well.


Hat, I can't find your post asking why doctors are so quick to put us on benzos since they are so addictive. My doctor did about 20 years ago for "fear of flying", that's the only time I used to take them, twice a week. Right now if I get overly anxious, I will take one. Since I've had a supply available to me for so long, and even though I do have addictive traits, I am happy to report that I'm not addicted to them! Now if they were alcohol or opiods, that would be a different story with me!  :blink:

#8 fishinghat


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Posted 30 December 2018 - 08:39 AM

It is just their training KFL. They are taught that it is the 'standard' treatment. Get the patient feeling better and we will worry about the rest later. Same way with ssri and snri. Shame to put so many people through all this suffering.

#9 Petaa



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Posted 30 December 2018 - 09:12 AM

Hi and thanks to everyone who's responded. Time for an update on my situation, brought to you in 2 parts.

Firstly, the actual question. Although only a day has passed I'm starting to be able to pick up a pattern in terms of symptoms. A year or so ago when coming off Olanzapine I experienced some horrible withdrawal side effects, but they were much worse in the morning. (As to be expected. It was sort of a morning sickness experience.) I know it can be common in terms of withdrawal side effects from a number of medications to experience bouts of naesea/vertigo/dizziness in the morning. What I was wondering if anyone has experienced it the other way round? I'm finding that this time around with cymbalta I'm having dizzy spells, passing out, naesea, vertigo etc. but concentrated only from about 7pm-10pm. Also I'm noticing that the dizziness doesn't occur as usually when standing up quickly after sitting or lying down, but the other way around. If I'm walking around and then I stop and sit, it appears to get worse. It all feels so backwards! Dubious advice would be greatly appreciated.

Part 2 - not overly cymbalta related but just related to my whole experience lately in general and without any question in particular, but more just seeking validation.

I was recently (3 days ago) once again subject to the extreme abuse and incompetence of the staff at my local public hospital. Following my attempt the other day after worsening suicidal ideation, the private hospital I am at wanted me to get assessed, and with short staffing over the holiday period and no doctor able to assess me, the best way to keep me safe was to head to the public hospital with the plan of being there 1 night to be assessed and looked after before returning the following morning. After speaking with the mental health staff in the public hospital, all were in agreeance that I was stable enough to be a voluntary patient overnight. About half an hour later after signing the voluntary admission form I was told that it had been overturned by a doctor who was called over the phone, had never met me, seen my face or spoken to me before. When asking why, nobody had a reason for me. I was told I wasn't allowed to have any of my belongings (including my phone to contact family or my doctor and ask for help with the situation) and was sat in a plastic chair not able to move for 25 hours while being watched by a security guard.

Once again I'm extremely grateful to my psychiatrist, who managed to call upper management of the hospital and sort things out, getting me out of there as soon as possible.

This isn't my first negative experience with the incompetence of the public health system in Australia, but I certainly didn't expected it to be this bad this time, considering the circumstances and having multiple doctors on board with the plan.

Right now I'm quite angry thinking back on it all. It was a horribly negative experience which made things much worse. It's starting to hit me that it's impacting my ability to reach out for help in situations where my suicidal ideation or thoughts of self harm are getting worse. There's the constant fear in the back of my mind that "you can't ask for help. You can't tell the nurses. They'll send you back". I'm having to consciously fight against this just to keep myself safe. Since building up on lamotrigine takes a long time, this unsafe period of strong and uncontrollable thoughts is likely to be here for a while, so I'm going to have to get over that fear and build up my comfort in reaching out for support.

#10 Petaa



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Posted 30 December 2018 - 09:21 AM

I would recommend some melatonin but if the nurses found it they would want to up your benzo instead. lol

Actually, surprisingly my psychiatrist is very pro-melatonin and actually recommended I use it quite a while ago. I didn't notice a huge effect, but haven't tried it in a while so might ask him about it as a possible option again. Thanks for the suggestion!

#11 fishinghat


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Posted 30 December 2018 - 09:57 AM

Part 1

Actually this is to be expected. The digestive tract is the number one area in the body to use serotonin. Light in the morning and during the day brings on increased serotonin production and symptoms decrease. As evening comes on the serotonin is converted to melatonin to get the body rest to rest. Unluckily, with the reduction in the serotonin the GI system gets upset.

Part 2

You can thank the hospital lawyers for the plastic chair and the 25 hours spent in it. Any hint of suicidal thoughts and they take this kind of action to reduce their liability.

Melatonin. On the melatonin I would recommend a liquid sublingual version. Regular melatonin goes into the system slowly and lasts a while. It often leaves people slow and groggy in the morning. Sublingual (under the tongue) goes into the blood stream rapidly, gets you to sleep quicker and does not last as long. Several of our members use it when they wake during the night so they can go right back to sleep and also to avoid that hangover feeling in the morning.

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