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9 Weeks Off. Hoping For Some Input.


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#1 Driven

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Posted 08 September 2019 - 04:24 PM

Hello,

 

I’m new here but have been following for weeks. I found this site as a result from searching about Cymbalta withdrawal since discontinuing just over 9 weeks ago.  I will say, I’ve scoured through MANY posts, etc, trying to identify with whether what I am feeling could be considered normal at part of withdrawal. It feels anything but normal, but it does appear that others have experienced a similar journey! 

 

Here goes…I am a 41 year old male that had a very short stint of anxiety earlier this year based on a life event that I needed help getting through.  Sleep was not happening and it was causing several issues for a few weeks.  I’ve never had anxiety or sleep issues prior to this and took instruction from my PCP to take Cymbalta to help get me through my rough patch and help me sleep.  We both agreed it would be a short stint and that I did not want to be on an antidepressant for any longer than I needed.  I am frustrated with myself for not researching Cymbalta more when I started it but I can’t help that now.

 

My Cymbalta usage:

1 week 30mg (he said this was ½ dose and to move to 60mg after 1 week)

5 weeks 60mg (I had a short bout with anxiety at this mark and my doctor increased me to 90mg)

3 weeks 90mg (I very quickly got past the issues that I was working through and felt great and asked to start a taper plan to get off.  My doctor’s taper plan was to drop to 60mg for 1 month then drop to 30mg for 1 week, then off completely.  I knew this sounded fast and consulted with my functional medicine doctor and she agreed.  She helped me with the 30, 20, 10, etc plan but clearly it was still way too fast).  I was not aware of the very slow bead counting method but I did create my own (which I’m now aware of was still WAY too fast).  I was hoping that being on 9 weeks before tapering would allow an easier withdrawal.

 

Below is basically the journal of my fast taper:

4 weeks 60mg (from 90)…(I had dizziness, vertigo, brain fog for 23 days straight then it just went away…all before I dropped to 30mg.  I felt stabilized and feeling good)

1 week 30mg (feeling good)

1 week 20mg (feeling good.  Some slight vertigo/dizziness)

1 week 10mg (feeling good.  Some slight vertigo/dizziness).

1 week where I dropped from 8mg, 6mg, 4mg, 2mg, 1mg, 15 beads, 5 beads then off (this was all a daily drop all within 1 week).

So, my taper from 90mg to zero took place over 8 weeks. 

*I took my last dose (5 beads) on July 6th.

 

Withdrawal schedule (since coming off July 6th):

Week 1:  Very severe headache, strong dizziness/vertigo 24/7,and brain fog that started about day 2.  Very short episodes of feeling of doom.  Little to no anxiety.

Week 2:  Same with slight improvement early week two for 1-2 days back to same as week 1.  Slightly less headache at end of week two.  Little to no anxiety.

Week 3:  Very similar to week 2.  Still dizziness/vertigo pretty much 24/7.  Little to no anxiety.

Week 4:  Very similar to week 3.  Dizziness/vertigo still persists.  Some bouts with short windows of anxiety.

Week 5:  Very similar to week 4 with exception of increased anxiety.

Week 6:  Very similar to week 5 with small windows of anxiety. Slight windows feeling like the dizziness/vision issues being less severe.

Week 7: Very similar to week 6 with small windows of anxiety. Had a bad panic attack after waking up in bed shortly after falling asleep.  Brain was running 100mph and took about 10-15 mins to slow it down.  It went away within 30 mins.

Week 8: Similar to week 7 with exception of windows of anxiety been more frequent, in some cases, lasting for hours and a few days in a row.  It does go away but it takes work.            

Week 9: I’m just starting week 9 and really struggling with anxiety and bouts of sadness.  They come out of nowhere and are lingering a bit longer than recent weeks.  The headache and dizziness feels like it might be slightly improving.  Maybe?

 

To summarize, I’m currently at 64 days since last dose and my dizziness has seemed to improve a bit.  Brain fog is still persistent, and overall, my brain just feels “off” and not normal.  Head feels heavy and a bit like I’m looking through a tube.  There are very short windows where it feels like most symptoms fade a bit but I’m talking an hour or two (not days).  I believe mental cognition has seemed to improve a bit also.  I’ve only had a few brain zaps through this entire withdrawal (knock on wood).  I’m sorry to everyone that has experienced those in addition to everything else.  I still have the feeling of brain fog, some short term memory loss, vertigo, and overall feeling of my head being detached from my body.  I am VERY CONCERNED at this point with the anxiety and that it feels like it is increasing in frequency.  This anxiety is very new to me and I’m having a difficult time keeping my mind under control on what lies ahead.  Just nervous about how long this will last and if I will ever be better?    

 

All said, I am a very healthy and fit 41 year old that is determined to beat this without any further SSRI/SNRI medication.  I have not missed a day at work and have gotten very good at faking it until I make it!  I  eat clean, hydrate a TON, and have re-introduced light exercise since a couple weeks off.  Light/med exercise seems to help but I’ve overdone it a few times, and it definitely effects my headaches/vertigo feeling.  I have not consulted my psychologist since early in the taper since he acted very naïve about the withdrawal symptoms.  Looking back, he is clueless!  I am working with my functional medicine doctor and she is helping me with the following supplements. 

Daily supplements:

SAM-e (started taking this 4 weeks into my 8 week taper.  400mg am)

5-HTP (started taking this the day after I took my last dose of Cymbalta.  100mg am and pm)

Magnesium

Fish oil (1 serving high EPA/DHA am and pm)

Vitamin C

Vitamin D

Zinc

*I also take testosterone replacement (self-injections weekly) due to testicular cancer 9 years ago.   Been doing this for ~5 years.  Putting this out there as I know testosterone levels can play with anxiety and depression.  I’m very strict to make sure I stay diligent and on schedule as I know low testosterone can be linked to depression/anxiety.

 

I appreciate anyone’s input in advance and hope to get a better understanding of what lies ahead.  I am pretty set on not introducing any new drugs in my system as well as NOT reinstating with a low dose of Cymbalta.  I’m really hoping that my relatively short duration of 17 weeks (including the 8 week taper) may help.  At this point, I have these short feelings where I see light at the end of the tunnel and then hours later it fades away quickly and fear sets in.  I’d be lying if I said I’m not concerned about possible damage to my brain chemistry even being on it a short time.  I’m hopeful that you can tell me this will indeed pass!  Does it sound normal that the headaches, dizziness, etc seem to be slightly improving while the anxiety and excessive worry are getting worse at 9 weeks off?  I’m hoping that maybe it is a sign that healing is happening and the windows of anxiety are part of the healing.  I did make the mistake of visiting the Cymbalta Hurts Worse FB page which will scare the heck out of anyone that PAWS can last for a long time!  I keep reading that improvement should happen between 8-12 week mark but I feel I am still in the trenches!  I am a fighter and staying positive but can use some input!

 

Thank you in advance for anyone that took the time to read through my journey and provide input! 

 


#2 invalidusername

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Posted 08 September 2019 - 04:52 PM

Hi Driven and welcome to the site
 
First up, given your time on the Cymbalta, your taper wasn't THAT fast at all. There have been plenty more which are way faster, and a lot of people would have survived that taper better than yourself, so give yourself a break. You are unfortunately one of the more unlucky ones where this will take time.
 
So if I am hearing you correctly, you are 9 weeks off your last bead. So yes, improvement should be showing at this point, although it is usually 12 weeks that more can be found. I was on Cym for 10 weeks and it took 12 weeks after my final dose to feel anything like normal. 
 
Looking at your supplements, I will ask why you are taking both HTP and SAMe? You need to watch your serontonin uptake here. Magnesium can also bring on symptoms of anxiety - what type are you taking? What is the elemental level and what dose? Fish oil is good - vit C up to 1000mg - and Vit D and Zinc... have you been tested to show low levels of these? If not, we would say to get yourself checked. You would be surprised how many issues supplements can create through interaction and compound dosing. 
 
Fishing Hat is better to speak about the testosterone treatment, and yes, these can affect various levels of the relevant chemicals.
 
All of your symptoms have done the round here. There is nothing there that would worry me. These will pass in good time - but all the supplements concern me a little. 
 
Others will be along to introduce themselves soon, but for now I will wish you well.
 
IUN

#3 fishinghat

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Posted 08 September 2019 - 06:06 PM

Hi Driven

Overall you are not doing too bad. The way your symptoms progressed over time is a common one. The anxiety/depression stage can be the hardest one and last the longest BUT having said that your short time on Cymbalta has obviously helped you. I agree with IUNs questions and comments, especially about the SAM-e and 5HTP which can combine and cause serotonin syndrome. As soon as I get some time tomorrow morning I will look into those dosages and the risk of serotonin syndrome. Both of those probably helped you minimize your anxiety/depression which usually does not develop any windows of relied for 4 months or more. with 5htp and SAM-e there will also be a withdrawal from them as well but we will deal with that at a later time.

In my case Cymbalta caused a total stoppage of testosterone production and after my last dose of Cymbalta I suffered a complete loss of sexual function, feeling, etc. which is a condition called PSSD. Testosterone levels fluctuate considerably during a 24 hour day. As you well may know it causes not only anxiety/depression but extreme fatigue. Cymbalta can have a pronounced effect on testosterone metabolism not only during use but also during withdrawal and should be monitored closely. The depression from low T normally takes the form of great sadness and a feeling that nothing is important in life and just doesn't matter. Much of the depression from Cymbalta is in the form of hopelessness and helplessness and sometimes even borderline suicidal. Of course all of these vary some from person to person.

Now, having said all of this, I can see a steady improvement in your symptoms over the next 3 or 4 months. I know this is miserable but you can deal with it. Please let us know what symptoms are the biggest problem for you and we will approach them one at a time.

#4 Driven

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Posted 09 September 2019 - 12:05 AM

IUN and Fishinghat,

 

Thank you for taking the time to read through my situation and provide feedback.  I’ve read through many of your posts and was hoping you’d answerJ  Finding someone who has been through this is comforting (although I am sorry that you both had to go through it).  I have zero background with any antidepressant medications and this withdrawal process has been a test of character for sure.  Taking one day at a time and staying strong.

 

To answer a few of your questions…

 

  1. In regards to the 5-HTP and SAMe, I started both of these based on recommendation from my functional med doctor as part of my withdrawal strategy.  She has helped others come off SSRI/SNRI medication and recommended this approach.

 

  1. Magnesium I am taking is “Pure Formulas” Magnesium (glycinate).  120mg/capsule (I’m taking 3 capsules in am and 4 in pm).  She is picky about the type of Magnesium and stated this is her top choice.  https://www.pureformulas.com/magnesium-glycinate-180-vegetable-capsules-by-pure-encapsulations.html. I believe I tested low in magnesium in my early bloodwork with her about 3 months back. 

 

  1. Zinc – I was also tested low in this in same blood work. 

 

  1. SAMe- (Fishinghat) I am taking 200mg (1 tablet) in the am.  (not 400mg like I stated above.  I looked closer at my box and realized the mistake). 

 

I did get my bloodwork done about two weeks ago and I have an appointment 1 week from tomorrow to review the results.  It will be good to get another baseline.   I’ll be honest in that I’m second guessing the SAMe and 5-HTP also in that I’m wondering if it is somehow adding to the increased anxiety or making the dizziness and weird vision sensations worse.  I expect she may recommend me to try and remove one of these in my appt next week but I’m a bit nervous about adding another withdrawal on my hands.  I won’t jump to conclusions and talk it over with her for sure.

 

FishingHat,

I am sorry you are dealing with PSSD.  That just isn’t fair on top of all the other side effects Cymbalta causes. So far, I have been able to steer clear of PSSD.  As for the testosterone and Cymbalta withdrawal, I feel like there is a correlation on the day of my “shot” and the next day in terms of increased anxiety.  Almost like it ramps me up.  On the other hand, I’ve tried to stretch the duration between injections and I’ve had some tough bouts with anxiety as well.  I just don’t know if it is just the Cymbalta withdrawal, something with my supplements, or some alignment with testosterone. 

 

Below are my biggest symptoms at this timeframe in order of “concern”:

  1. Anxiety – It has been pretty intense the last 3-4 days in a row and starts right away in am and seems to dissipate during the day.  Some moments of sadness and total frustration.  Evenings seem to be the best with the exception of a few short episodes.  I just can’t tell if it’s this whole process taking a toll on me or something new popping up.  It has been relatively light with a few exceptions until around week 5-6 totally off C.  Do you find it concerning that anxiety has now gotten the highest at 9 weeks off?
  2. Vision disturbances & dizziness – this has been consistent since about 2 days being completely off C.  When I say vertigo I include the vision as part of that.  Slight difficulty on focusing on things in a distance and weird tunnel vision at times.  I do believe I’ve seen small windows of improvement but it has been sparse.  I do think that some of the anxiety is due to being so dang concerned about this and how long it will last. 
  3. Brain fog – it has improved VERY SLIGHTLY but not by much.  I can fake it at my job but it takes a lot of work.  It definitely ebbs and flows with intensity but an overall “light haze” just still persists.  Does this also sound like withdrawal talking?

Thank you again for the input. I really appreciate it.


#5 invalidusername

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Posted 09 September 2019 - 07:26 AM

Hi Driven,

 

Glad you have been monitored for the various inconsistencies with the vitamins and minerals, but you are right that you need to be continually monitored to ensure levels are correct. With regards to the HTP and SAMe, we are dealing with something entirely different as the blood brain barrier needs to be considered and this can be very unpredictable. Where such supplements need to cross the BBB, there is no knowing how much or how little is being absorbed where is should, and therefore what works as one dose for one person, has no bearing on how it will work for another, so very rarely will the first dose be correct as there is simply no knowing. This again, needs to be monitored by someone who really understands the procedures through which these work. There are also a number of studies which refute their ability to aid with withdrawal, which may call for an alternative approach. HTP also has a very short half life and most people find that even taking it 3 times a day that they can feel up and down a lot of the time. 

 

Again, as each case needs to be taken on its own merits, it is very difficult for me to advise, but hoping that your choice of doctor was the right way to go, I hope this will be fruitful for you - but just be aware of the above as you proceed and never be scared about approaching your doctor with these concerns.

 

Hat will be along later to speak more about the other elements of your message... 


#6 fishinghat

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Posted 09 September 2019 - 09:02 AM

Does the anxiety in the morning start up after taking the 5htp and SAM-e or does it start before that? One thing to consider is to separate the 5htp and SAM-e by at least 2 hours to see which, if any, may be causing a spike in anxiety.

"Do you find it concerning that anxiety has now gotten the highest at 9 weeks off?"

Not concerning, some have had this happen before but not many.

Vision disturbances & dizziness may be due to low blood pressure which often occurs during withdrawal. Do you have a bp cuff? Do you sometimes get dizzy when standing? Also, low blood sugar is another effect during withdrawal. Next time it occurs try a little something sweet and see if it gets better. Don't get too carried away though as it may amp you up.

The brain fog is a classic symptom of withdrawal and will slowly fade. Nothing unusual there at all. People have had good luck with high EPA/DHA Omega 3 for the brain fog. 2-3,000 mg/day.

The 5htp and SAM-e approach is commonly used by naturopaths and I am a lot less concerned about Serotonin Syndrome at 200 on the SAM-e.

Actually you are in pretty good shape at this point considering everything.

#7 Driven

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Posted 11 September 2019 - 12:27 AM

IUN,

Thank you for the input.  What you say makes sense in regarding everyone's chemistry being unique and the blood brain barrier being a bit different.  I'm not sure what to think about the SAM-e and 5-HTP at this point.  It seemed like a solid withdrawal approach when she explained it to me, but i am so confused and gun shy about any meds dealing with the BBB at this point.  I will definitely talk to her about it during my blood work appt next week.

Fishinghat,
I would say the anxiety increases pretty quickly after waking up and before taking any supplements.  I can work past it somewhat easily but this is all new to me and it's a bit scary.  I've been sleeping relatively okay, but after I wake up I sense it coming as I realize i'm tackling another day of this withdrawal.  This ebbs and flows a but but has been happening most mornings in last 1-2 weeks.   I was right in line with what you suggested on staggering the SAM-e and 5-HTP.  I have tried that the last couple days it might suggest the 5-HTP is aligning a bit with the dizziness but can't say for sure.  I will experiment a bit more in next couple of days.

 

All in all, the anxiety has lessened a bit in last couple days but the light brain fog and dizziness has been pretty constant with a few short breaks here and there.  Mostly in the evening.  I am hoping this is at least a sign that healing is happening.  The symptoms are changing quite a bit.  Anxiety passes as quick as it starts, sadness comes and goes for no reason, and the dizziness comes and goes, and sometimes the frontal frontal lobe of my brain just feels disoriented and confused.  

I do not have a BP cuff but will talk to doctor about it next week too when i get checked.  I do think there is also something with the blood sugar levels. I notice symptoms seem best in the evening after dinner or any larger meal.  I eat pretty clean with lots of whole foods, fruits, and leafy greens. 

 

Thank you! 


#8 fishinghat

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Posted 11 September 2019 - 07:09 AM

Fruit are a good source of sugar so next time you feel the dizziness coming on have an orange!!

I don't have a problem with the SAM-e and 5htp at hose levels especially if you have a dr monitoring your symptoms. Actually you are doing very well at this stage. I would suggest holding where you are at for a few weeks and see how you are doing.

#9 invalidusername

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Posted 11 September 2019 - 04:14 PM

Agree with Hat here that you should hold for a while so you can objectively measure the relative effects of each source of the withdrawal before going further ahead. Chopping and changing the withdrawal strategy whilst dropping the dose of the Cym at the same time muddies the waters. Give yourself time to evaluate what is working with the supplements first. 


#10 Driven

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Posted Yesterday, 06:23 PM

Guys,

 

Ugh….I need some suggestions.  I am afraid to say that I’m struggling pretty badly the last couple of days.  Today is 11 weeks completely off of Cymbalta and I’m finding the anxiety to be pretty crippling (as in the worst I’ve ever had).  I keep telling myself that better days are coming but, man…this is tough!

 

The last couple of nights sleep have been rough and I know that is part of the cause.  Last night I slept very little based on our busy schedule with our kids, sports, etc.  I don’t know exactly how to explain it but I’ve had two anxiety/panic attacks today that are unlike anything I’ve ever experienced.  Both times were instigated by trying to get some sleep during separate times of the day.  Both times I fell asleep for maybe 5 minutes and basically exploded awake in panic and my heart and mind starts racing uncontrollably.  A lot of fear involved but I can’t even really explain why I’m fearful?  It takes a ton of work to calm myself down. 

 

I so scared that I’m starting down this path.  I’ve felt overall better about the physical symptoms getting slightly better but the emotional symptoms are getting worse.  What would you recommend at this point?  I’ve been so focused on trying to muscle this out with the help of my functional medicine doctor.  You have my supplement list above.  Some things on  my mind as follows.  I believe I can control the anxiety during the day but going down this path with sleep has me completely out of sorts.

 

  1. Do you think I should consider dropping the SAM-e or 5-HTP to see how I react?  My doc recommends me trying to drop the SAM-e to see how I respond but I’m so paranoid about juggling things.
  2. I have some Ativan, Klonopin that I took to help with the sleep before I started Cymbalta  earlier in the year.  I took it very sparingly and it helped but I know that being it is a benzo, i’m scared as hell to take it at this point.  If in dire need, can I use Ativan sparingly and not have any addiction issues? 
  3. I did talk to my functional med doctor last week and asked about Hydroxize and Clonidine and she was somewhat open to it but acted puzzled since I’ve been so focused on beating this withdrawal naturally.  She said she’d recommend Hydroxizine first but I don’t think she has that much experience with it. 
  4. I do have my first appointment with a therapist this upcoming Tuesday.  She specializes in CBT and EMDR which my doctor recommended. 
  5. I’m so frustrated that my wife is being impacted by this crap.  We have a busy lifestyle and she is wondering where the hell her husband has gone.
  6. I guess, lastly, does this all sound like Cymbalta withdrawal stuff?  In addition to the emotional stuff, the physical symptoms are still some pretty decent brain fog and odd vision issues where it just feels like my head is heavy and that I've just walked out of a dark movie theater and my eyes/head is trying to adjust (which pretty much hangs with me most of the day).
  7. Per above, I do take testosterone injections and today was "shot day".  There seems to be a correlation between shot day and anxiety.  Maybe today has been so rough since I also got very little sleep last night and I'm in a state of overdrive.  I don't know...confusing.  

 

I’m fighting but I could use some input from you.  You’ve been very helpful thus far.  Thanks!


#11 invalidusername

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Posted Yesterday, 09:20 PM

I remember going through some of the worst periods of anxiety I'd ever known a few weeks after my last dose - this is absolutely related to the meds, and it can be quite relentless in its execution. 

 

There is a chance that your SAMe along with the 5HTP could be triggering some unwanted effect, but it is not a dose that would concern me to be sufficient to do so. I think it is wise to want to stay med free and benzos are not your best bet for sleeping aid either way. A high dose will be required to knock you out and there is of course the addictive qualities of them.

 

I would suggest melatonin, KSM-66 ashwagandha, CBD or even Kratom. All of these have the potential to get you off to a good sleep. Melatonin is a favourite as it also doubles to reduce anxiety effects, KSM is a nice and gentle option, but can easily cause a tolerance quite quickly - CBD doesn't work for all, but is a very good natural choice and Kratom, if you can see past the stereotyping of the recreational drug element (which is very much over-rated in my opinion) is a very good option - of which I have been using for the past 9 months with great success

 

If you would like any more info on any of the above just let me know, but this is perfectly do-able and along with all the other issues, this again will pass in time, but meanwhile, we'll try and make things more comfortable for you...

 

IUN


#12 fishinghat

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Posted Today, 08:37 AM

1, Stopping the SAM-e can cause its own withdrawal symptoms.
2. Sparingly should not be an issue but a few drops of sublingual melatonin can be done a lot safer and provide good results for many.
3. Hydroxyzine is good for sleep and does not have withdrawal or addiction. 50 mg ay bed time as needed.
4. Excellent but it will take time.
5. Just more pressure on you and that is not what you need but we all went through that as well.
6. Classic withdrawal, right now you are in the middle of the worst part but it will get better.
7. It will be interesting to see if the next 24 hours will make things better or worse now that your testosterone levels have been raised. Please let me know what you think. You said you were in overdrive. That is called a chronic adrenergic state or in other words too high levels of adrenaline output. That is specifically what clonidine is used to treat. Very effective.

 

Come back any time with your questions and hang in there. It will get better.





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