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#1 kfwach

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Posted 02 November 2019 - 10:33 AM

Hi,

I am new to this site.  Am hoping someone has some information that can help me in my decision process.

I developed a chronic pelvic pain issue 2 1/2 yrs. ago and was eventually prescribed gabapentin and cymbalta for the nerve pain.  I didn't think that either were helping with the pain so first started to wean off gabapentin and finished that last November.  I had been on Cymbalta for about 18 months when I started to wean off in February.  I was finally seeing relief from the pain.  But did not attribute it to Cymbalta as I had been on it for so long and still in pain.  I was meditating every day (using positive visualization), on a vegan diet and walking in the woods a lot.  I really felt like I was on the right track.  So over 4 months I tapered off the Cymbalta 60mg down to 0mg.  I didn't feel much for withdrawal effects, just a little restless leg syndrome for a few days after decreasing each dose (I went down 10 mg at a time - did not know about counting beads). My last pill was mid July and I was really good for a month.  Then wham- my pelvic pain came back with a vengeance.  I was moody and irritable and maybe a little ringing in my ears.  I have been in pain for 21/2 months and was so desperate the other day, I decided to go back on 20mg of Cymbalta to see if I could get back to where I was at.  After 5 days, I was so nauseous, headache, and dizzy (I don't remember any side effects the first time around).  I started researching cymbalta side effects and withdrawal and really do not want to go back on this drug.  Wondering if I still need to taper down, I took about 10mg last night.  I guess I am wondering if after feeling good for a month after my last dose, if my pain could be a discontinuation syndrome or more likely to be another cause (stress? anxiety?)  And any advice if I can just go off it again after only 6 days back on.  

There must be a better way to handle this nerve pain!!

Thank you for any help you can give ...


#2 invalidusername

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Posted 02 November 2019 - 11:06 AM

Hi kfwach and welcome to the site....

 

I'll first address the taper question. So if I read correctly you have had 5 days on 20mg and 1 day (last night) on 10mg? This is long enough to have initiated a change in the neurochemistry of your brain, but there will be little difference in whether you cold turkey it from this point or reduce. There may be a very slight reduction in discomfort should you for example, take another 2-3 days on 10mg and then the same on 5mg. Nothing more than that should be of any emotional or physical benefit.

 

Nausea, headache and dizziness are textbook symptoms of start-up and it is commonly understood that each time an anti-depressant is re-introduced, the effects will be worse, so it doesn't surprise me that you experienced these this time around.

 

With regards to the pain, there is a possibility that this is a re-bound pain that may in turn abate, but the truth is I cannot tell you for sure and can only go by prior experiences from those on the forum. I would tend to agree with you that it wouldn't have been the Cymbalta after so long, and thus can understand your reason for opting for the withdrawal. However, your brain's pain receptors will have been used to being managed by the medication and thereby removing it, they need to once again understand how to work off their own "initiative" as it were. It is like having a nicotine patch "suddenly" start to work after 3 months. You remove that patch and whether or not it was the patch that did the work, your system was used to that level in your system. So what you have here is an imbalance of neuron/transmitter activity that was previously being controlled by the cymbalta. By introducing it again may not reinstate what was once there as your brain will now have changed since reducing the dose.

 

Apologies if this is a bit "technical", but it sometimes helps people to fully understand what is going on.

 

FishingHat will have more experience of such issues than I having been here longer. No doubt he will be along later today with his own take on your situation. Meanwhile, hang tight, keep going with that wonderful stress reduction practice you have and feel free to shoot back with any questions.

 

IUN


#3 fishinghat

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Posted 02 November 2019 - 11:55 AM

Welcome kfwach

I pretty much agree with IUN but would add one thing. The higher you go back up on dose the more likely you are to have that "nauseous, headache, and dizzy ". Also the higher you go back up the farther you will have to wean down. My normal recommendation is to go up one bead the first day, if not enough help then 2 beads the second, day and three the third day until relief shows up. This minimizes how much you have to wean off of later as well.

#4 kfwach

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Posted 02 November 2019 - 02:18 PM

Thank you so much for your comments.  I am still so conflicted though as whether to go back on Cymbalta or just taper off again now.  The sad thing is, I don't think it was helping my pain to begin with.  And to have the withdrawal cause a flair up now is so frustrating.  Also, I read that the reinstatement period is 2-3 weeks after stopping and now I have been off for 3 1/2 months before restarting.  Is this a good idea to continue tapering off now after 6 days - it seems like these next few days are critical.


#5 invalidusername

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Posted 02 November 2019 - 04:03 PM

The reinstatement period is subject to much debate and is purely subjective. How long one can be off an anti-depressant before returning back on it opens so many questions. It is assumed that this means the period whereby one can return and have a return of the benefits the drug gave prior to taper. The 2-3 weeks is merely an educated guideline whereas in reality, anything can happen. Years can lapse and a repeat of the drug could have the same effect. Alternatively - and in my case - you can be on the same drug for 10 years - have 3 months off - reinstate only to find it does nothing. 

 

This is a difficult one to answer and really frustrating I agree, but as I said, being such a complex and subjective organ, there is really no knowing how one person will react as a result of another.

 

Hat - can you recall any previous members that had this dilemma?


#6 fishinghat

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Posted 02 November 2019 - 05:14 PM

Several. One thing that came to mind was that you were off Cymbalta for ab out a month before things turned ugly. Most members who experienced that kind of delay also experienced the "nauseous, headache, and dizzy " when reinstating. Most were able to drop down to a smaller dose pretty easy and get rid of the "nauseous, headache, and dizzy " but getting relief from the withdrawal symptoms were variable. Some would recover quickly on a low dose (a few days) and some others would only partly recover no matter how long they stayed on that dose. The normal response to reinstating is 3 to 5 days IF you have only been off a few days at the most. As long as you were off it seems to be a different ballgame.

If you are on another antidepressant (say Zoloft for example) and decide to switch to Cymbalta then the 2 to 3 weeks to begin to benefit is appropriate. Unluckily there is NO medical research on this and we can only go by what others experienced.

#7 kfwach

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Posted 04 November 2019 - 05:41 PM

Fishinghat,

Thank you so much for your comments and support.

I just have one more question for you,

do you agree with IUN that there is little difference at this point if I reduce or go cold turkey?.  I did 5days at 20mg and now 3days at 10mg.  

My original use of Cymbalta was for 14 months (60mg) then took 4 months to taper off.  Until last week, was off Cymbalta for 3 1/2 months.

I did not have any withdrawal effects when tapering down the first time and am unsure if this new bout of pain is withdrawal or a relapse of my original pelvic pain syndrome.  I was good for one month before experiencing any symptoms other than a little ringing in my ears and irritability.

I am just really nervous about going off again.  I feel fortunate now that I don't have more symptoms, but certainly don't want to make things worse!

Would appreciate your input ... thank you!!


#8 fishinghat

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Posted 04 November 2019 - 06:02 PM

That is such a hard call to make. Is this a return of your origin al pain or rebound pain? Rebound pain is a reoccurrence of pain when coming off of a pain med and is worse than the original pain for a period before returning to premed levels. If the 5days at 20mg and 3days at 10mg did not help your pain then I would say that IUN is probably correct.

#9 kfwach

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Posted 05 November 2019 - 01:52 AM

Hmm ..

that is a difficult question.  When I went off the Cymbalta I was in very little pain.  So my pain now is definitely worse, probably more like my initial pre-med pain.  But I was on the Cymbalta for a year+ before I saw improvements to my pain. (I attribute getting better to other more natural things I was doing).  The only reason I took so long to come off the Cymbalta is because I wanted to wean myself off a high dose of gabapentin first and I think it was helping with my mood.  And no, going back on the drug has not helped with the pain yet.  It has, perhaps, helped my anxiety.

 

So in summary, it appears my two options are:

1) go back up on the Cymbalta, slowly as side effects allow, and see if it will help my pain. Stabilize for a period of time and then begin the slow taper process

 

2) wean off completely over the next few days (I assume there is no use in slow tapering at this point since I have already jumped from 20-10)

 

IUN - if you are still reading this- when you went back on a drug after being off for 3 months, how long did you stay on it and then did you do the very slow tapering to come off?

 

Thank you both for taking the time to listen!


#10 kfwach

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Posted 05 November 2019 - 02:11 AM

I was just reading in another post that most of the Cymbalta withdrawal symptoms start after you drop below 10 mg.  Yikes- maybe I should be doing the slow taper from here on out.  So confusing!


#11 fishinghat

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Posted 05 November 2019 - 08:25 AM

I lean more toward option 2 but that is just an educated guess.

#12 invalidusername

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Posted 05 November 2019 - 01:02 PM

I was only ever completely off Citalopram for about 6 weeks or so before going back on, and that was in summer of 2017. Ill-advised doctor told me to taper over 2 weeks after being on it for over 10 years, so naturally I went into a nasty relapse. I went back on it for almost a year, and since then, had a cocktail of different SSRI/SNRI's - none of which have worked, so I am now back on the Citalopram as I have least side effects on it, but it still isn't working. But I do not want to try any more pills as they all make me ill.


#13 kfwach

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Posted 06 November 2019 - 07:36 PM

I'm sorry to hear you are still dealing with this. I also had no guidance on getting off my medications.  I never even had depression.  Was given Cymbalta for nerve pain alone.  It's quite scary how general physicians are prescribing these meds off label for pain.

 

Today is my last dose of the Cymbalta.  I am crossing my fingers that symptoms don't get any worse.  thanks to this site, I will put together a recovery plan for myself and move forward.  I have to add, and I will post about this at some point, I feel like Meditation and Reiki were absolutely instrumental in getting out of pain the first time.  I will definitely be counting on them this time around as well.  It is amazing what our bodies can do and how we can heal ourselves.

 

Sending good energy .... 


#14 invalidusername

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Posted 06 November 2019 - 08:31 PM

I completely agree with you about bodies healing themselves. I meditate every day - some more than others, but it certainly helps me, no question. 

 

Unfortunately, you are one of many who started taking Cymbalta for pain and ended up with depression as a result. It is so wrong that this should happen. A recovery plan is a great idea and shows just how motivated you are to get the job done right. Whether the symptoms get worse or not is a bit of a lottery. Some find the worst appear in the last few beads, whilst others can go a month after the last bead before it reaches a climax. The most common symptoms post-last dose are adrenal issues and stress tolerance.

 

Whatever is in line for your fate, you have our support and care. Whatever befalls over the next few weeks, there are always things which can be done. Please keep in touch and remember to keep those stress levels to an absolute minimum!


#15 frog

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Posted 06 November 2019 - 10:25 PM

Hi,

I have nothing to offer regarding the Cymbalta itself (I'm here for the same reasons), but I was also originally prescribed the drug to treat chronic pelvic pain. Obviously I don't know what you're dealing with, but while the Cymbalta did take the edge off it definitely was just a bandaid masking the pain and I would still get flare ups more frequently than I would like. But honestly I was just happy that it gave me my normal life back because prior to it I was in constant pain and unable to really enjoy anything. The reason I decided to quit taking it is because I started going to a physical therapy office that specialized in pelvic pain and it truly helped! I'm not 100% cured but the improvements actually seem lasting and she taught me some breathing and stretching exercises that help to speed up recovery from any flare ups. Depending on how long you've been dealing with the pain, it can take a long time for your body to really reverse the cycle of pain and muscle tension. I was really sad to leave her when I moved out of state recently but I plan on finding a new PT here and going again soon. I really recommend it if your insurance helps cover it, unfortunately it can be pretty expensive otherwise, but it was so exciting to feel better naturally for the first time ever and actually really address the core of the problem!


#16 kfwach

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Posted 07 November 2019 - 02:00 PM

Thank you for sharing your experience.  I too have a pelvic floor PT.  I stuck with her for about 8-9 months but was not seeing much relief so I stopped (you are right, very expensive without insurance).  I ended up getting better on my own ... I started a regimen of meditating, exercise, Vegan diet and for whatever reason started to feel much better last February.  I had weaned off the Cymbalta by July and was thrown back into this very unexpected pain cycle again a month later.  I am starting to work with the PT again though.  She has a new technique that she is trying called sacral dry needling, which is supposed to stimulate your body's own natural healing response.  We'll see how it goes.

Did your pelvic pain return as well when you stopped the Cymbalta?


#17 frog

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Posted 07 November 2019 - 03:55 PM

I had to try a few PTs before I really found someone that worked. The method they used at the PT I liked was to primarily address the peripheral muscles that have been affected by the pain and that have basically overcompensated and gotten tighter trying to do the job of the muscles that had the 'trauma'. Since the pelvic floor is SO interconnected with everything it made a lot of sense to me. She mostly did massage on my upper legs and on my abdomen working to get these muscles to 'let go' in order to retrain the muscles that were supposed to be doing the work in the first place, to do so again. I still have some pain when sitting for a long time or just random flare ups, but I no longer feel that tightness from the other muscles that made everything worse. And when I do I have a few stretches and exercises to take care of the rest of it. 

My first PT was more of a naturopath and I just did not find that to address the issue for me at all because the core of my problem was definitely muscle tension and tightness and without massage and stretching, it's not something that your body can fix itself once it gets stuck that way. That was my take away! But I'm glad you had found things that worked for you, I think that means that you will find relief again!

 

I've been lucky so far in that the pelvic pain is one of the few symptoms that I haven't dealt with during the withdrawal. Really really hoping to keep it that way!





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