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Esroar's Cymbalta Taper


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#1 ESRoar

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Posted 13 May 2020 - 02:32 PM

Hi All,

I wanted to get some advice on my Cymbalta tapering.  I have been tapering off of 90mg since July 2018 by bead counting.  I'm currently on 43mg.  I originally started tapering at a rate of 5% dose drop every 2 weeks.  I haven't been able to handle that high of a drop in a long time.  I had nausea, a jittery feeling, anxiety, headaches, brain fog and was crying non-stop.  I kept reducing my % drop to see if I could better handle it.  Lately I have been dropping by 1.5%.  This still gives me withdrawal, but I'm not crying all day after a drop.  By keeping with this schedule, I will be cymbalta-free in April of 2026.  :( :( :(  I was wondering if anyone has any advice or strategies on this method of tapering?  Is there a better way?  

 

I saw a psychiatrist who was very understanding about how hard it is to come off of cymbalta.  He recommended adding zoloft to help me taper.  I wasn't too keen on adding another drug because I'm breastfeeding my daughter, so I declined the prescription.

 

Thank you.


#2 fishinghat

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Posted 13 May 2020 - 04:03 PM

Normally people don't have much problem until they drop below 30 mg so it is easy to see you are one of the lucky sensitive ones lol. I know that there have been some members that have had to drop a bead or 2  (+/-0.5%) a month.  Have you looked through our ebook. There are a lot of tips in there from members on what to do and not to do and includes a lot of info on supplements as well. There are a list of things in there that can make the symptoms worse as well (caffeine, salt, sugar, etc). You might give it a look.


#3 invalidusername

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Posted 13 May 2020 - 05:25 PM

In addition to what Hat has said, I agree that you don't want to be replacing one poison with another. But the means to expediting a taper from one that slow will be supplementation. Again, a lot of information in the eBook which you can cross-reference to your particular circumstances, and you can always ask us for help.

 

If you can divulge the specific symptoms that are causing the most issues when tapering faster than you are at present, we can suggest some supplements which may combat them for you. 


#4 frog

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Posted 13 May 2020 - 05:51 PM

Hi ESroar! 

I thought your name looked familiar so I looked through your old posts. In late December you wrote that you were down to 46mg at a 2.5% drop rate and doing well. Did something change since then? 

These past few months have been really hard on everyone, flaring up anxiety and depression, so it's always possible these outside factors are making any withdrawal effects seem worse.

Just something to consider. 

 

Also I know when I was in a really bad state after I cold turkey'd, and felt like I had no guidance on what to do next, I read some people here seemingly had success going on SSRIs, and I debated with myself extensively on whether I should do the same or just try to grit my teeth and tough it out. Ultimately I stayed strong and I'll be totally honest, I'm so glad I did. Sadly I did end up taking a couple other medications to help get through some of the hardest side effects (panic attacks and insomnia), and I would never begrudge anyone for needing that help, but if you think you can push past it without taking anything else, I would encourage you to do that. You will eventually get to the other side. 


#5 ESRoar

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Posted 13 May 2020 - 09:00 PM

Thanks All for your responses and feedback.  I was doing 2.5%, but really struggling with the days of anxiety and crying following a drop, so I went down to 2% and ended up at 1.5% drops.  The anxiety and crying is what bothers me the worst after a drop.  Today, I am on day #6 following a drop and my mood has started to lift.  It hit me on days 4 and 5 this time.  

 

I have read through some of the ebook, and I need to read more of it.  So much information!  

 

As for supplements, here's what I'm taking now:

AM - Vitamin C, Vitamin D, Prenatal vitamin

PM - Probiotics (I just bought Life Extension Mood Boost probiotics and will be starting those soon), life Extension Mega EPA/DHA, and Life Extension Magnesium Neuro-Mag (Magnesium L-Threonate)


#6 fishinghat

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Posted 14 May 2020 - 09:15 AM

Vitamin C should not exceed 1000 mg/day. Vitamin C is also used in the production of adrenaline which m ay or may not be an issue depending on serum levels.

 

Vitamin D only if there is a deficiency. Vitamin D toxicity is on the rise in the US due to excessive supplement usage. Monitor serum vitamin D levels during use of supplements.

 

Prenatal vitamins - There are serious concerns of the use of vitamins especially if they contain vitamin B6. Many vitamin formulas have way too much of this vitamin in them and it is increasingly leading to vitamin B6 toxicity.

 

Good choice on the probiotics and SPA/DHA. Magnesium however should never be taken unless a deficiency is found. High levels of magnesium can lead to increases in anxiety as many members of our group have found out. Magnesium also decreases calcium in the body and in addition effects copper, iron and other minerals. Serum levels of magnesium should be checked every 6 months when taking supplements.


#7 invalidusername

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Posted 14 May 2020 - 05:36 PM

Fantastic advice from Hat - as always.

 

What you have there is purely vitamins which will assist the body in replenishing and keeping demand, but I would suggest something that is more in tune with actively reducing anxiety. Sure magnesium can aid this, but it all depends on the chemistry in the body, and that little too much can have the opposite effect.

 

I would therefore suggest a look at Suntheanine, Ashwagandha and similar... unless you have already tried them.


#8 ESRoar

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Posted 26 May 2020 - 12:39 PM

I had blood work done in Feb and it all came back good.  I honestly don't know everything that I was tested for though.  I will look into levels being tested once things start opening up more.  I haven't tried Suntheanine or Ashwagandha.  I will have to check and see if I can take them while breastfeeding, not that Cymbalta is good for breastfeeding.  UGH. 

 

I dropped 3 beads instead of 4 last Thursday.  I'm feeling fatigued and having some anxiety, but no crying spells so that's good. 


#9 frog

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Posted 26 May 2020 - 01:15 PM

You got this! 

I'm sure it weighs on you that you're still on Cymbalta while breastfeeding but it is what it is at this point and with the stresses of a baby PLUS the stresses of the world right now, I think you should just continue to taper at whatever rate allows you to be the most functional and least impacted. No shame in it at all. You're still making progress. I'm willing to bet that you've got all sorts of hormones going on too which could be making you more sensitive to the drops at the moment. Down the line maybe you'll feel stronger and you can go a little faster. It's a marathon not a race :) 

 

BTW I did do a very quick google on ash and suntheanine for breastfeeding. Unfortunately it looks like neither one has been studied in that respect so since they don't know one way or another it's not considered advisable to take them while breastfeeding. 


#10 ESRoar

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Posted 27 May 2020 - 07:36 AM

Fantastic advice from Hat - as always.

 

What you have there is purely vitamins which will assist the body in replenishing and keeping demand, but I would suggest something that is more in tune with actively reducing anxiety. Sure magnesium can aid this, but it all depends on the chemistry in the body, and that little too much can have the opposite effect.

 

I would therefore suggest a look at Suntheanine, Ashwagandha and similar... unless you have already tried them.

IUN, 

I was curious about the cross taper you have listed at the bottom of your post.  Is this how you got off Cymbalta?


#11 invalidusername

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Posted 27 May 2020 - 06:39 PM

Long story my friend, but the short version was the mental health team screwed things up for me by first telling me to taper back to Citalopram, and then changed their mind and go with Lexapro. So I was withdrawing from Cymbalta, Citalopram (Celexa) and Pregabalin all at the same time whilst switching to Lexapro.

 

Wouldn't wish it on my worst enemy.

 

For the record I am still on Citalopram but about to start my withdrawal from that.


#12 ESRoar

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Posted 21 October 2020 - 08:43 AM

Hi All,

I've made it down to 39mg.  I'm not sure if it's side effects or withdrawal effects, but every morning I deal with anxiety, diarrhea, and nausea.  I feel awful until the afternoon!  I currently take my cymbalta at bedtime.  My question is, is there any benefit to splitting the dose into 2 and taking every 12 hours?  Will this help with these side effects?  Thank you.


#13 fishinghat

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Posted 21 October 2020 - 09:11 AM

That certainly sounds like withdrawal symptoms to me. Usually splitting the dose 'smooths out' the withdrawal symptoms. Instead of say 12 hours of symptoms and 12 hours of feeling decent  that is replaced by 24 hours of symptoms that are 50% less. In other words less dramatic swings in symptoms. 

 

Sounds like it is time to hold on your dosage until you get feeling better.


#14 invalidusername

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Posted 21 October 2020 - 05:41 PM

I would suggest that you split the dose, but note that by splitting the dose, the peak plasma level is decreased, so going from 39mg daily to 19.5mg twice a day is a drop in itself, so be prepared to level out over a few days.


#15 ESRoar

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Posted 03 November 2020 - 09:18 AM

It's so hard to know what to do with this drug.  I am very sensitive to it.  I changed the time I was taking it from bedtime to dinner time to see if that would alleviate the nausea and diarrhea.  Now I think my last few drops in dose (only 2% and holding for 10 days) may have hit me all at once.  I'm waking up with my heart pounding, inner jittery feeling like I want to jump out of my skin, anxiety, panic, crying, and can barely function.  I'm seeing a new psychiatrist tomorrow who believes in trying to find the root cause of your problem and does a lot of bloodwork to check hormones, vitamin levels, etc.  Doesn't sound like I'll get quick relief, but hopefully a path forward.  :( 


#16 fishinghat

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Posted 03 November 2020 - 10:22 AM

The digestive symptoms usually last only 1 to 2 months before fading. At this time I would strongly recommend no more drops until you feel strong enough.

 

I agree with the blood sampling. In the ebook is a list of possible blood analysis to check for things that the medical research has linked to withdrawals, anxiety and/or depression. You might check that out.


#17 ESRoar

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Posted 04 November 2020 - 02:59 PM

Need advice, because I am so scared.

 

I met with the new psychiatrist today.  She is going to do bloodwork looking for all kinds of causes of depression and anxiety (vitamin levels, thyroid, MTHFR gene, hormones).  She thinks I'm reacting poorly to the Cymbalta and wants to get me off of it ASAP.  She wants to do this by adding Remeron and Prozac and then dropping the Prozac and Cymbalta after 2 weeks.  She also wants to give me gapapentin and hydroxine for anxiety PRN.  She wants me to stop breastfeeding immediately because of adding all of these drugs.  I'm so scared of all of this and of the Cymbalta withdrawals, but I'm pretty much at my lowest now, so maybe it can't get worse?


#18 fishinghat

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Posted 04 November 2020 - 03:59 PM

You should NOT be breast feeding while on Cymbalta. I will post a link to additional information.

 

Your drs idea is pretty good. Myself I would recommend hydroxyzine and clonidine to start as they do not have a withdrawal. Then if that is not enough go to the Prozac which has worked for many members. Prozac also has a withdrawal but a lot less than Cymbalta. If the Prozac is not enough you can always consider the Remeron and gabapentin. Both of these also have significant withdrawals.


#19 fishinghat

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Posted 04 November 2020 - 04:03 PM

Breast feeding and Cymbalta research

https://www.cymbalta...breast-feeding/

 

In addition there has been an established link between antidepressants and autism. The ebook has details.
 


#20 ESRoar

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Posted 04 November 2020 - 04:19 PM

You should NOT be breast feeding while on Cymbalta. I will post a link to additional information.

 

Your drs idea is pretty good. Myself I would recommend hydroxyzine and clonidine to start as they do not have a withdrawal. Then if that is not enough go to the Prozac which has worked for many members. Prozac also has a withdrawal but a lot less than Cymbalta. If the Prozac is not enough you can always consider the Remeron and gabapentin. Both of these also have significant withdrawals.

My baby is 13 months and I've breastfed her while tapering.  Drs thought the good outweighed the bad with it, but this Dr. is telling me to stop so that she isn't exposed to additional drugs.  I'm OK with that since she's not breastfeeding very frequently anymore.

 

She wants me to take the Remeron and Prozac with Cymbalta and then drop the Cymbalta and Prozac.  I asked her to write it all down because my brain fogged brain cannot keep it all straight.  She also recommended GABA Max as a good supplement.  I'm so afraid of all of the withdrawals.


#21 frog

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Posted 04 November 2020 - 05:01 PM

Is it possible this could be postpartum depression? I assume you're a new mom if you're breastfeeding. I'm not a mom but I know postpartum is common and can definitely present as anxiety and intense mood swings. I kind of feel like adding this whole cocktail of drugs is just going to make things worse not better given how fragile you're feeling right now. Just a thought. I truly understand the feeling of going through the rollercoaster of emotions and my heart goes out to you as I just battled this myself for close to a year, but just wondering if there could be other factors in play too before you take on all these mood-regulators that will further confuse everything. 

 

Do you have a good therapist you trust that you are able to talk to about what you're going through? And more importantly do you have a good support system with your baby? 

 

I just find that psychiatrists like to fix problems with drugs. That's what they're trained to do. But drugs aren't always the best answer. 


#22 ESRoar

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Posted 04 November 2020 - 05:13 PM

Is it possible this could be postpartum depression? I assume you're a new mom if you're breastfeeding. I'm not a mom but I know postpartum is common and can definitely present as anxiety and intense mood swings. I kind of feel like adding this whole cocktail of drugs is just going to make things worse not better given how fragile you're feeling right now. Just a thought. I truly understand the feeling of going through the rollercoaster of emotions and my heart goes out to you as I just battled this myself for close to a year, but just wondering if there could be other factors in play too before you take on all these mood-regulators that will further confuse everything. 

 

Do you have a good therapist you trust that you are able to talk to about what you're going through? And more importantly do you have a good support system with your baby? 

 

I just find that psychiatrists like to fix problems with drugs. That's what they're trained to do. But drugs aren't always the best answer. 

Thank you for responding!  Yes, I definitely think I've experienced PPD on and off since 2 months post partum.  I have an appt. with a therapist on Friday.  I was seeing one back in March, but discontinued because I didn't think I was getting anything out of it.  I luckily do have a good support system for the baby.  My husband and my parents are 1 mile away.  I have a lot of guilt because I wish I wasn't dealing with this and wasn't crying in front of my daughter.  I'm still waiting for the lab orders and prescriptions from the Dr., so I'm not going to start taking anything immediately.  


#23 fishinghat

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Posted 04 November 2020 - 05:36 PM

There is a significant risk to going on multiple drugs at the same time. what if one doesn't even help. You wouldn't know it. More importantly, if you have side effects from one of the drugs which one is causing the side effects. Starting one drug at a time is a slower process but more successful in the long run. If you want to consider going on the Prozac it takes 6 to 8 weeks to kick in. After 2 weeks if you drop the Cymbalta completely you will certainly have worsening withdrawal for nearly a month 1until the Prozac kicks in . I can tell you from being involved with this site as well as my personal experience that going on another antidepressant is only successful in handling the withdrawal in about 1/3 to 1/2 the cases. In my case the drs tried 6 different antidepressants (including Prozac, before they found one that worked. The nice thing about both clonidine and hydroxyzine is the only take less than one day to kick in so if they don't work or cause side effects you can know right away and make a move to another option.

 

Besure that no matter what you decide we will be here to support you. You are not in this alone. 


#24 invalidusername

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Posted 04 November 2020 - 06:37 PM

I just find that psychiatrists like to fix problems with drugs. That's what they're trained to do. But drugs aren't always the best answer. 

 

EXACTLY what I was thinking as I was reading my way through this. Couldn't agree with Hat more. 

 

"She wants to do this by adding Remeron and Prozac and then dropping the Prozac and Cymbalta after 2 weeks."

 

Am I reading this right? She wants to put you on Prozac for two weeks and then come off it?! That will do nothing but mess you up further. Remeron is usually a med added to a patients existing anti-depressant when it is quite doing the job, but I would wait until the blood work comes back negative before considering any more meds.

 

"She also wants to give me gapapentin and hydroxine for anxiety PRN."

 

Hydrox, as Hat said, is a good med for anxiety PRN, but there is no need to supplement that with Gabapentin AS WELL. That is over kill. No need for all of these at the same time. Plus - as Hat said, you need to know which is working and there is no way of knowing that when you are taking more than one at the same time. That is just common sense - even a Doctor should know that.. I can hear Hat laughing as he reads that!!

 

Gabapentin can have quite a nasty withdrawal with those with a depressive disposition. Bear in mind that this is used off-label for anxiety and sometimes depression. It was never made for these symptoms. Pregabalin is very similar.

 

Would also like to echo that what ever your decide, we are here. But if you are not sure, take a step back. Not saying anything derogatory about Doctors in general, but for people like Hat and myself who have had the time and experience of a forum, we get to see a lot more cases. Doctors don't ask the questions we do, nor do we stick to what we consider is going to work because we have been told, or because it has worked for someone else. 

 

Please feel free to continue to ask if you have any other questions or concerns.

 

IUN


#25 ESRoar

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Posted 05 November 2020 - 01:04 PM

Well the Dr. never called any of these meds into the pharmacy, so I had to call today to see what was going on.  They're supposed to be calling them in this afternoon.  I also asked for her to send detailed instructions - because my brain cannot make sense of a lot of what she said yesterday.  I'm VERY concerned about going from 1 med to 4.  Honestly, I think that if there was something PRN that I could take for anxiety, it would help a lot to get me through this.  

 

Has anyone ever added something to Cymbalta and then instead of dropping the Cymbalta, continuing with a slow bead count?  I guess it would be a cross taper, but a very long one.  

 

There is a significant risk to going on multiple drugs at the same time. what if one doesn't even help. You wouldn't know it. More importantly, if you have side effects from one of the drugs which one is causing the side effects. Starting one drug at a time is a slower process but more successful in the long run. If you want to consider going on the Prozac it takes 6 to 8 weeks to kick in. After 2 weeks if you drop the Cymbalta completely you will certainly have worsening withdrawal for nearly a month 1until the Prozac kicks in . I can tell you from being involved with this site as well as my personal experience that going on another antidepressant is only successful in handling the withdrawal in about 1/3 to 1/2 the cases. In my case the drs tried 6 different antidepressants (including Prozac, before they found one that worked. The nice thing about both clonidine and hydroxyzine is the only take less than one day to kick in so if they don't work or cause side effects you can know right away and make a move to another option.

 

Besure that no matter what you decide we will be here to support you. You are not in this alone. 

Yes, this is what I'm scared about.  I need to somehow remain functioning for my daughter and full time job.  :( :(  I'm trying to see if I can meet with a different psychiatrist through telehealth to get a 2nd opinion before changing anything.


#26 frog

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Posted 05 November 2020 - 02:12 PM

Thank you for responding!  Yes, I definitely think I've experienced PPD on and off since 2 months post partum.  I have an appt. with a therapist on Friday.  I was seeing one back in March, but discontinued because I didn't think I was getting anything out of it.  I luckily do have a good support system for the baby.  My husband and my parents are 1 mile away.  I have a lot of guilt because I wish I wasn't dealing with this and wasn't crying in front of my daughter.  I'm still waiting for the lab orders and prescriptions from the Dr., so I'm not going to start taking anything immediately.  

 

Absolutely! Just based on observation it seems like PPD is SO often ignored or played down. Maybe it would be worth seeking out a doctor who is specifically experienced in recognizing and treating women with PPD? 

 

I'm so glad to hear that you have help with your baby and that you're giving a new therapist a try. Sorry to hear that your first attempt wasn't a good fit but I do think sometimes it takes a few tries to get someone you really connect with so I hope this new person works out! I think if nothing else it can help you deal with the guilt you have over your ability to be there for your daughter. There's another member on here Mxpro who is a dad of 2 small kids with a baby on the way and I know he's voiced a lot of the same shame and guilt that I'm sure you're experiencing. 

 

I'll let IUN and FH advise on the specific drugs. I'm not experienced in that stuff at all. But just on its face it sounds like A LOT of things to add on at once. You should at least wait to hear all the bloodwork results back before diving into any of this stuff. Just curious is the anxiety you're experiencing more physical? Like panicky type of symptoms? Or is it more anxious thoughts? 


#27 ESRoar

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Posted 05 November 2020 - 03:07 PM

Absolutely! Just based on observation it seems like PPD is SO often ignored or played down. Maybe it would be worth seeking out a doctor who is specifically experienced in recognizing and treating women with PPD? 

 

I'm so glad to hear that you have help with your baby and that you're giving a new therapist a try. Sorry to hear that your first attempt wasn't a good fit but I do think sometimes it takes a few tries to get someone you really connect with so I hope this new person works out! I think if nothing else it can help you deal with the guilt you have over your ability to be there for your daughter. There's another member on here Mxpro who is a dad of 2 small kids with a baby on the way and I know he's voiced a lot of the same shame and guilt that I'm sure you're experiencing. 

 

I'll let IUN and FH advise on the specific drugs. I'm not experienced in that stuff at all. But just on its face it sounds like A LOT of things to add on at once. You should at least wait to hear all the bloodwork results back before diving into any of this stuff. Just curious is the anxiety you're experiencing more physical? Like panicky type of symptoms? Or is it more anxious thoughts? 

Well the psychiatrist I went to yesterday originally trained as a OB/GYN and then went back to school for psychiatry, so I thought it would be a good fit.  

 

My brain is foggy, my chest feels like a weight is on it, I'm nauseous, diarrhea, inner-jittery feeling.  I feel overwhelmed by everything.  I just want to stay in bed, but I can't.

 

I was able to schedule a telehealth appointment with a different psychiatrist for tonight.  I want to get a 2nd opinion before I do anything.

 

This is what the psychiatrist from yesterday prescribed:

1.  Take all 3 medicines for 7 days (remeron, cymbalta, prozac).

2.  After 7 days, stop the cymbalta completely.  If you have rebound problems, then go back on cymbalta and call the Dr.

3.  Continue to take prozac for a total of 10 days.

*  She also prescribed gapapentin for anxiety.

 

Based on what FH reported above, this is a TERRIBLE plan.  :( 


#28 frog

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Posted 05 November 2020 - 04:43 PM

I wonder if FH and IUN would agree with me, but your symptoms sounds an awful lot like excess adrenaline causing fight or flight panic type effects. I dealt with this A LOT and it slowly improved over a long period of time (I've been off for about a year). If that is indeed the case then Prozac and that type of stuff won't help. They don't have anything to do with adrenaline, only serotonin. You want to focus instead on addressing the excess adrenaline. If you're able to, one thing that helps with excess adrenaline is exercise. No intense cardio or that will just increase the adrenaline but some mild to moderate activity depending on what your fitness level is actually burns up extra stress hormones in the body like adrenaline and cortisol and also releases mood elevating chemicals! Easy win. 

 

You can also look into some medications that block you from feeling the effects of the adrenaline. So while your body might continue to overproduce, it won't make you feel crazy. I think the clonidine FH mentioned would work in that way. Beta blockers help with this too. When I was experiencing terrible daily panic attacks I was taking Propranolol twice a day to calm things down. It's a blood pressure drug so be careful if you're on any other blood pressure reducing drugs or if you have low pressure already, but you should be able to take it as needed and it has little to no withdrawal if you wean off of it when you're ready. You can only get these through a prescription though.  


#29 fishinghat

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Posted 05 November 2020 - 06:01 PM

You are right frog. Classic adrenaline symptoms and of course that is common with a reduction in Cymbalta. In fact all those symptoms are typical for Cymbalta withdrawal. 

 

Yea, I am afraid that recommendation sucks in my view point. The hydroxyzine, clonidine and even the propranolol or atenolol can all be takes PRN or at low levels all day if needed. It will be interesting to see what the tele doctor says.


#30 invalidusername

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Posted 05 November 2020 - 06:37 PM

Yes, Frog's hypothesis sounds about right to me too. Select few come off Cymbata without having some sort of adrenal after-effects. This is the norepinephrine being removed from your system.

 

My brain is foggy, my chest feels like a weight is on it, I'm nauseous, diarrhea, inner-jittery feeling.  I feel overwhelmed by everything.  I just want to stay in bed, but I can't.

 

This is what the psychiatrist from yesterday prescribed:

1.  Take all 3 medicines for 7 days (remeron, cymbalta, prozac).

2.  After 7 days, stop the cymbalta completely.  If you have rebound problems, then go back on cymbalta and call the Dr.

3.  Continue to take prozac for a total of 10 days.

*  She also prescribed gapapentin for anxiety.

 

All that you have described is what Frog is stating as the physical symptoms - the overwhelming part is fed by the former. Once the physical symptoms start to tone down - and they WILL - this will reduce what is going on in your head in terms of wanting to stay in bed. This is withdrawal and adding prozac is just not on the cards. Least of all for 10 days. That is absolute nonsense. This doctor doesn't have a clue - to be put bluntly. 

 

If the PPD continues and fails to clear or show signs of improving, then the Remeron might be called for, but again, await the bloods.

 

Gaba-based anything PRN is not a good idea. They have not been suitably studied for their anxiolytic effects. Beta blockers as Frog said may well help. There is no harm in trying them, and typically you will see improvements within the first 1-3 days of dosing.

 

IUN





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