63 replies to this topic

[invalidusername]

OK... well as far as I can see it, you need to wait a little bit longer on this dose of 10mg. I would say at least another 2 weeks. If you still find you are not improving, or not seeing the odd extra good day, then considering upping the dose, but only by the one 5mg big bead. This will then take another 2-3 weeks to show improvement. But we'll cross that bridge when we come to it.

 

We need to get you back to being stable and I feel that will be done on the Cymbalta - don't go changing to another AD just now.

 

Then when it comes to the taper, we will do the powder route very slowly and you should find things go a lot more smoother. Stick with it.

 

Ah - Hat has just commented... yes, he feels the same. We often agree on these things.

 

IUN

 

p.s. names are in the blue bar not above the avatar!! I'm not quite God-like yet... I am invalidusername, but everyone calls me IUN for short...

[hatecymbalta1]

Do you honestly think I am going to stabilize? I am finding that my intellect /cognitive functions, memory processing things is very off at this time. Will that come back. I’m so afraid as I have to go back to work in 3 weeks. Do you think I have done irreversible brain damage. Can someone explain why after being off the cymbalta for 4 months and one month later reinstating at 10mg is a bad idea and what does it do the brain? Why wouldn’t it or can’t it start to work around the reinstatement ? Thank you.

Do you think if I slowly go off the cymbalta that my cognitive functions will return?

Do you think I will stabilize and get back my cognitive functions or am I brain damaged. How soon should I wait to see if I get back my functions before I start to do the powder taper off?

Thank you very much.

[hatecymbalta1]

Hi IUN and Fishinghat,


Do you honestly think I am going to stabilize? I am finding that my intellect /cognitive functions, memory processing things is very off at this time. Will that come back. I’m so afraid as I have to go back to work in 3 weeks. Do you think I have done irreversible brain damage. Can someone explain why after being off the cymbalta for 4 months and one month later reinstating at 10mg is a bad idea and what does it do the brain? Why wouldn’t it or can’t it start to work around the reinstatement ? Thank you.

Do you think if I slowly go off the cymbalta that my cognitive functions will return?

Do you think I will stabilize and get back my cognitive functions or am I brain damaged. How soon should I wait to see if I get back my functions before I start to do the powder taper off?

Thank you very much.

OK... well as far as I can see it, you need to wait a little bit longer on this dose of 10mg. I would say at least another 2 weeks. If you still find you are not improving, or not seeing the odd extra good day, then considering upping the dose, but only by the one 5mg big bead. This will then take another 2-3 weeks to show improvement. But we'll cross that bridge when we come to it.
 
We need to get you back to being stable and I feel that will be done on the Cymbalta - don't go changing to another AD just now.
 
Then when it comes to the taper, we will do the powder route very slowly and you should find things go a lot more smoother. Stick with it.
 
Ah - Hat has just commented... yes, he feels the same. We often agree on these things.
 
IUN
 
p.s. names are in the blue bar not above the avatar!! I'm not quite God-like yet... I am invalidusername, but everyone calls me IUN for short...

[fishinghat]

Here is the deal Marybetter.

Neurotransmitters 101 lol

When a signal is sent from the brain to a part of the body that signal is transmitted by a neurotransmitter. Example adrenaline. The adrenaline is carried across from the exit end of one nerve cell to the entrance end of the next nerve cell and that is repeated down the entire length of the nerve until the signal reaches its destination. The adrenaline is carried from one nerve cell to another by a protein called a "transporter". The purpose of the transporter is to carry the neurotransmitter from one nerve ending to the next nerve at a very fast pace. When it arrives at the end of the next nerve cell the neurotransmitter attached to a location called a synapse. It is a special little pocket on the nerve cell that the neurotransmitter, such as adrenaline, will fit into. Other neurotransmitters like serotonin, histamine etc. will not fit in the synapse that is designed for adrenaline.


When you first start on a antidepressant like Cymbalta it will not properly fit the synapses on the nerve endings. Over the first few weeks these synapses will change shape so that the Cymbalta will attach to the nerve. Once the synapse has changed shape to fit the Cymbalta the anridepressant "kicks in" and you feel releif as it now controls the synapses and effects the strength of the signal from nerve cell to nerve cell. Cymbalta controls serotonin and norepinephrine (similar to adrealine) which are both stimulants. when the Cymbalta kicks in these two neurotransmitters have less effect on the body and emotions tend to level out.


Now comes the interesting part. when the Cymbalta is removed from the body the synapses now much change again so that the neurotransmitter will one again "fit" into the synapses. As I am sure you are aware nerves "heal" very slowly. It can take up to 2 years for all these synapses to return to their normal shape and normal bosy function. It is just a matter of time. No permanent brain damage, just a long time to readapt.


I must be honest and admit that there does appear to be some residual effects in a small percentage of members. Things like tinnitus (ringing in the ears but most residual effects are very limited in nature and cognative function usually returns to normal.
 

[invalidusername]

I can completely understand your position and you are in a situation now whereby you are considering whether you should have reinstated, and now whether you should come back off. 

 

You need to stabalise. If you now decide to taper again, it will throw you into a tailspin. You will not have had the opportunity for your system to re-adapt back to its original state that it was in before you tapered. As Hat has explained extremely well above (deserves a like Hat, but I'm out for today!), your brain has just been thrown a curve ball being told one thing with the taper, and then another with the reinstating. 

 

Personally I would continue with the way things are and let your system get back to a point of stability, which WILL happen, but will take time. It takes a lot of patience and we all here know how much it takes... which is why we are here to offer the support. Even in my present state of a silly alcohol incident making me feel like nothing on earth, I know how people like you are feeling which brings me here to help...

 

You will be OK - your brain will be OK. But feel free to continue asking any questions or concerns...

 

IUN

[gail]

Nothing wrong with that scale. Many have used that model. Lets take an example. Lets say you weight a 10 mg bead and it weights say 43 mg. That means it is 4.3 mg per mg of Cymbalta. So for 9 mg you would take 8 times the 4.3 mg and get 38.7 mg of powder would give you a 8 mg dose. If you decide to go this route you can weight out one of the 10 mg beads and we can do the math for you.I am concerned with your trying to wean directly from Cymbalta. You mentioned that symptoms hit you 3 months after you stopped the wean. That is very rare and makes me think it might be better to switch to another antidepressant and wean off of that. Many members have done that in the past. The favorites are Prozac, Zoloft and Lexapro but others can work as well. I must state at this point that if you switch the new antidepressant may or may not work even if you used it before. I had to try 4 different ones before I found on that worked. You may be lucky and get the right one on the first try. The final decision is yours and you can bet whatever you decide we will be there for you all the way.

I'm with Hat here, switch to another ad while lowering cymbalta. It will be much easier for you. Zoloft and Prozac , they have a long half life. Lexapro, a little less.love!

[hatecymbalta1]

I have been reading that so many people who have reinstated late have kindling and have committed Suicide or never healed. I’m so afraid that I will be brain damaged. All I want to do is sleep and I have no hope. Am I going to never recover? Omg please tell me I will I am crying all day long.

[fishinghat]

Hi Marybetter.

You won't die although the fear is overwhelming, I know about the fear. It is not tolerance, it is simply withdrawal effects from no more Cymbalta. You will adapt. It will get better. It can take, sorry to say, months and even maybe a year after your last dose. I have never heard of anyone committing suicide after updosing. I find no indication of that on any of the research on updosing. It however, is common to have heavy brain fog and dizziness. You will recover but it will take all your patience to do that.
What supplements/drugs have you tried to get relief?

[hatecymbalta1]

But this is not updosing this is a reinstatement after being off for 4 months. I was so stupid to do this. I don’t have dizziness but rather major cognitive issues like I don’t know what to do or how to do it - also have no real emotions or any joy. I can’t even watch tv because it upsets me and I have no interest.

I don’t take many suppl,ents because I am afraid to take any. I take biotin, collagen and vitamin D3.

Thank you fishing hat and IUN always.

[fishinghat]

The same thing applies to re-instatement. The cognitive issues will fade. Those symptoms you mentioned are common with regular withdrawal as well. The issue is how to proceed from here.

How many beads/mg are you on right now?

What time of day do you take your Cymbalta and what is the timing of your symptoms? What symptoms get worse at what time of day?

[hatecymbalta1]

I am currently taking 10mg of the big beads and I take it at 7am every morning. My plan would be to decrease by crushing the beads and weighing them and then place them in an acid resistant enteric coated capsule. Do you think I should increase the cymbalta or start going down in dose or just sit and wait. I am at my sisters house and don’t have the equipment to do any tapering. I will go home on Thursday or Friday.

Right now I also just crossed over from 1mg Xanax to Valium. Today is my first day dosing twice a day with the Valium - morning was 7.5mg and tonight will be 7.5mg (total 15mg). Do you think that is a good equivalence?

My symptoms are no enjoy,Ebg, I have nothing to look forward to and the cognitive issues. Confusion, not sure what I should or how to do things, a bit of memory issues, no interest in anything.

[invalidusername]

Hi Mary...

 

It worries me that you have read a lot of the wrong things on the Internet. The wrong word spreads like wild fire and can - and clearly does - scare the crap out of people. Not to put other people down, but both Hat and myself are qualified in our respective neurological fields, so what we say tends to be the truth. Hat also has nearly 7 years worth of this forum behind him of people going through Cymbalta withdrawal. Take a deep breath... relax... the chances of your brain being "broken" as a result of reinstating/updosing Cymbalta is that slim that after 10,000-odd people we have not heard of it.

 

I do think you should give the 10mg a little while longer if you can, and then go to 15mg if you find no benefit... but this will take time and you will be getting the start-up effects that you once got (potentially worse) when you started the Cymbalta. The fact that you are feeling it worse is the subject of kindling. But this is a very controversial subject with very little evidence backed up by peer-reviewed research. 

 

As I said before, you brain has been pulled back and forth in directions and the upshot is EXACTLY what you are feeling. The chemistry in your head had only just started to recalibrate, so by putting the meds back in again is going to have confused what was going on. It is frustrating, and going through my withdrawal whilst trying to continue my research was a nightmare. I questioned whether I would be able to continue in thinking my brain will have suffered just like you. But here I am still going. 

 

I really feel for you, but you need to understand that the brain is perfectly capable of changing to suit whatever is thrown at it, but it is the slowest organ to heal because it is so complex. It is not as simple as a cut on your finger, or even a broken arm. But the bottom line is... your body heals, and that includes the brain. Research into neuroplasticity has gone a long way to showing us that the brain cannot "forget" how to heal... sure it can appear to have unlearnt something, but its ability to learn never diminishes.

 

Feel free to continue to ask questions as it will help you, but take solace in knowing that what you are told here is the truth. If we are ever unsure of something, we will tell you... and then we find the answers!

 

Regarding the valium, if you feel you need this dose, then by all means take it, but do not take it from habit. Valium is fine used on an as and when basis. Also remember that valium - like all benzos - have their own withdrawal, and must be done very gradually assuming you have been taking it continuously for 2-3 months.

 

IUN  

[hatecymbalta1]

Hi IUN, I’m so scared. I have been on Xanax (1mg) per day for 8 years. I want to get off it so I have just finished the crossover to Valium. I was dosing Xanax four times a day .25mg and now that I am fully crossed over to Valium today is the first day I will dose only twice a day. I did 7.5mg this morning and I will do 7pm at 7.5mg. I’m hoping that the equivalence of 1mg Xanax should be about 15mg Valium.

I’m not feeling good still on the 10mg cymbalta and it’s almost 6 weeks back on. How much longer would you suggest I wait until I start to feel better? Do you think I should try another antidepressant, wait longer to see if the cymbalta starts to work or start to taper off? I would consider celexa or Prozac. I’m just not sure if further kindling my system is a good idea though. I don’t know what to do but I want to feel better. Nothing gives me pleasure or enjoyment. Thank you for being so kind. Yes, I hear so many horror stories about reinstatement’s that are done many months later as well as adverse reactions where people have horrible debilitating permanent disabilities. I am so so so so afraid.

I don’t know what to do about the cymbalta.

Thank you so much for being here and helping me in such a difficult time. God please pray for me to get better. Thank you.

[invalidusername]

Hi Mary - it is OK to be scared - we all were at some point. Let me tell you what I went through...

 

I was on a "maintenance" dose of Celexa for 10 years with nothing wrong with me - it was originally prescribed for PTSD following a nasty car accident. But the doc kept me on 20mg all the same. When I told him I wanted off, he gave me a 2 week plan to come off..yes 2 weeks... after 12 years on the drug. Needless to say I went into relapse, and after 3 months, I was back on the same dose again. That was 2 years ago. I have since been on Sertraline, Cymbalta, Lexapro... and another I forget. At one point I went from Cymbalta to Celexa and to Lexapro within 6 weeks. That was a nightmare I don't mind telling you. So if I can get through that with my brain in one piece, you will be fine!! It is all documented here on the forum if you wanted to read! Hat did the same over a period of around a year switching from one to another.

 

Regarding the dose equivalency, the 15mg Valium is about right for 1mg Xanax. Whilst there can be slight difference, this is where I would start. Small adjustments might be necessary, but only once you have been on them for a few days.

 

Given that the Cymbalta has worked before, I would argue for continuing the course with a potential of stabalising. If kindling is a factor, it will simply be not as efficient as it was in the first place. At 6 weeks, I would say it is time for another 5mg now, and let this run a course of another 4 weeks. I would expect something to have made a difference at that point. Switching to another AD at this point is really going to throw your system into a tailspin. 

 

If we get to the point whereby the Cymbalta is showing not to work, you can do a dross-taper to Prozac or similar, so there will be nothing to lose, but your system will be in a better place to adapt at the 10 week mark than at present. It simply may be that another 5mg will be sufficient. 

 

Can you remind me once again of your original dose of Cymbalta prior to your first taper?

[hatecymbalta1]

Actually, regarding the Xanax and Valium I’ve been using 5mg for each of my .25mg so it’s actually been 20mg. Tomorrow I am going to take 9mg in morning and 10mg in the evening and hold for 2 weeks until I make another drop to 18mg.

My original dose of cymbalta was 30mg. I just don’t understand why the 10mg reinstatement hasn’t kicked in and is actually making me a little worse unless it’s the withdrawals from the fast taper back in May-July. Thank you for your story. Also, I want to say if I haven’t already I have had 2 failed attempts at getting off cymbalta once in October 2017 and one in May 2018.

Thank you.

[invalidusername]

20mg of valium is quite a dose for the day... I don't think my doctor would let me near anything quite like that! Why did you switch? And if you have only just taken the 20mg dose today, you will be able to drop to the 15mg overnight without any issues - you are more likely to have issues holding at 20mg for 2 weeks and then dropping.

 

I remember you had tried to taper before with the Cymbalta, but potentially at a rate too quick because of the big beads. If you had stabalised on a dose of 30mg before, then I would hope that a 15 or 20mg would give you the same balance and then we can usher in the "powder" plan as discussed... but only when you are stable again.

[fishinghat]

I pretty much agree with IUN but would add 'Don't screw with the benzo'. If you are on Xanax then stay there until the Cymbalta is done. One disaster at a time. The Xanax, having been on it for 8 years, may be causing some issues but they won't get any worse.

Now if my memory is correct you were off Cymbalta for 3 months before the withdrawal hit and recently went back up to 10 mg. That is way too big a jump up from zero. Normally someone will go back up to 0.25 or 0.5 mg to updose. This is too big a jump and your body is having to readjust to this large a jump. I think this is particularly obvious after you have been on that dose for 6 weeks. It normally takes 4 to 7 days to stabilize on an updose. If you are not stable now you won't improve any time soon. That really leaves you a few choices...

Drop 5 mg on the Cymbalta nd see how you feel a few days later
Cross over to a different antidepressant (it may or may not work or even complicate the issue and it takes weeks for a new one to kick in)
Or lean on other prescriptions/supplements to provide help until this passes.

[fishinghat]

I just wanted to add that this is based on 7 tears of being on this site and not from some deep knowledge of medical research as little research ahs been done on updosing and reinstatement.

[invalidusername]

We're going to confuse the poor lass here Hat as you have advised to drop 5mg, and I have suggested to move up. 

 

The perspective I am taking here is that she has had to resinstate twice already to stabalise, so therein lies the evidence for my decision. Hitting the 6 week mark should have shown some change in the symptoms by now despite it being a big jump.. which it was. This is why I suggested she hold out a little longer when she first detailed her present situation.

 

The 4 to 7 days would have been accurate on an updose, but this is closer to the mark of reinstating as opposed to an updose. I worry that changing to another AD is only going to bring a whole host of new problems. Dropping from the big bead is the issue here I am sure. If done over a much longer period of time, I am sure that she will enjoy better success as a result. But this needs to be done from a position of stability....

[fishinghat]

It is my understanding that she has not stabilized since reinstating.

My thoughts were that the reinstating was more like an updosing as the synapses were far from recovering from the Cymbalta withdrawal and should adapt more quickly to the Cymbalta, but, like you said, in either cases 6 weeks is enough to see some effect from the re-instatement if it were going to work.

I also worry about cross tapering confusing the issue but it is an option if she wants to consider it. Some get lucky and the first cross taper works and some do not. Of course either way we will be there for her.

I do agree that the big beads are an issue. Her idea of grinding the beads and weighting the poser into an acid resistant capsule would be a better step forward in the future.

One of the main issue for you and me is the lack of sound research into updosing and reinstatement. The only real solid study I have seen is one that indicated if you have been on 5 or more ADs in your life then reinstatement or cross tapering is less likely to work on the first shot. That is not much help in most cases.

As always, I am glad you challenged me on my point of view when you feel it is necessary. We want only the best for our members.

[invalidusername]

Absolutely - this is quite a conundrum, and there is no way of knowing which of the options would yield the best result. I agree that your position is of equal potential, but like you say, without the research to back it up it is one of those "flip a coin" moments again!

 

Mary... apologies for the brief discussion between Hat and myself here - as he said, we only want what is best for you, and ultimately the decision will be your own as to which you feel would be the best way to go... and again, we are here for you whichever way you feel would be better...

 

Please feel free to ask any further questions or raise any concerns you might have.

 

IUN

[hatecymbalta1]

Good morning

Regarding the Xanax/Valium I was experience Xanax tolerance symptoms so I’m in a group on fbook where they suggested I switch and I have already crossed over completely and and taking 15mg per day (10mg in the morning and 5mg at night). I seem fine with this so far but the Ashton manual suggests 1mg Xanax is equivalent to 20mg Valium. I will story to stabilize on the 15mg for two weeks and then drop 1mg.

I received the mortar and pestle and tried to crush the cymbalta and it was a horror. Didn’t work well at all. So I have a pill cutter and I’m splitting a 5mg in half and putting that half plus a 5mg in the acid resistant enteric coated capsule so today I took 7.5mg rather than the 10mg. I will admit that I have been feeling better since the reinstatement. I was able to take a bus to see my sister which was 1 hour away and we went shopping and got nails done and lots of things. Yesterday I took the bus back home and did things around the apartment. I still have fear and low mood but it’s not completely the whole the day. I’m definitely not my cheery self as I was before the fast taper in May-July. I’m not sure I should be reducing the cymbalta but today I took a bit less.

What are your thoughts on splitting the 5mg bead instead of crushing. It’s still the same concept but I’m getting more of the cymbalta then I would if I crush. When I tried to crush the cymbalta I had to use like 4 beads to get 0.040. It was a waste of the medication.

What are your thoughts- should in,over the dose to eventually get off or continue to stay on the 10mg. Although today I did take approximately 7.5mg.

Thank you always for your kind support and help.

Warm regards,

[fishinghat]

No problem with the cutting of the beads as long as you use an acid resistant capsule. My only concern is that means you will be making 2.5 mg drops and that will probably be way too fast.

[invalidusername]

Agreed, but as Mary said that she has tried the small bead equivalent capsules and not go on with them at all... so it is a really difficult situation....

 

From what you managed to do, I would say that you are doing very well indeed. Just remember to take rest when you need to...

[hatecymbalta1]

Do you think I should increase the cymbalta instead of going down at this time. Maybe go to 15mg for a week and then to 20mg and see how I do. I just know I am not myself like I was before the fast taper in the summer. I’m scared that I’m so kindled that I destroyed cells in my brain. Things are still confusing to me. I see my doctor on Monday and will decide whether to return to work. I don’t want to sit here at home but I also don’t know if I’m functional enough to perform my job duties.

What are your thoughts? Th am you.

[fishinghat]

The further up you go then the further down you have to go later. It really depends on if this is more than you can handle or just very uncomfortable. anytime you withdraw from Cymbalta you will have to endure some suffering. The key is how much can you stand and how much you can tolerate. That is a decision only you can make.

 

I have told people before, that if I had to do it over again I would plan on a 3 to 5 year withdrawal.  

[hatecymbalta1]

All I can say is that I have tried so many ways to get off this drug and I’m feeling the only option is to find an appropriate dose where I can stabilize and just stay there. I feel defeated. I need /must get to a place where I am functional and in the summer or throughout my time on cymbalta I was absolutely functional and happy. I wanted to try to get off to use my own god given brain but big but I have tried so many times to get off and all seems impossible! What can I do. I feel trapped....

[fishinghat]

If that is the situation then "go to 15mg for a week and then to 20mg and see how I do." is a good idea. If you can stabilize )stay at each dose at least a week to see how it goes) then stay at that dose for several months. I would even suggest 6 months to let your body heal some. Then id still doing well try to slowly drop to half that dose and then stay there for a few months. If that is what it takes then so be it. No matter what you choose we will be there for you. We can beat this, don't give up.

[invalidusername]

Yes - I agree here. You need to get yourself back to where you were so you can work etc. If that means going back up, then so be it. 

 

I know it is tempting to just stay on these drugs for the rest of your life and forget trying to come off them, but the sad fact is there is very little knowledge about the long term effects of staying on them, but one thing we have seen recently is that they can cause things like Parkinson's and a recent study showed a 30% increase for the risk of getting dementia, so I would advise you still hold firm with a plan in coming off them, but I think a cross-taper might be your way forward if you can get on with the powder methods we suggested. 

[hatecymbalta1]

I want off cymbalta so bad and have tried for 2 years and am on my second leave of absence from work because of these debilitating symptoms which no one outside these groups recognize. They think we are mentally ill and I never was depressed in my whole life before trying to come off cymbalta. Never! I tried the power and used 5 beads to try to get one capsule. How can I get off this disgusting poison. I’m also so afraid of going to another antidepressant because I was in horrific withdrawals and am afraid I will be so kindled and permanently kill my brain cells. What can I do. I don’t want to increase the cymbalta and I did today but don’t have to take 15mg tomorrow. I’m so scared actually traumatized to the point of PTSD. What can I do? I’m sobbing and crying because it feels like my life is over. I had a beautiful happy fearless wonderful life before I started to play with coming off cymbalta. I, sobbing!!!!!!