• Bead Counting
The third choice, bead counting, is where you open the cymbalta capsule each day and remove a few beads, usually 2 or 3 (1%). So the first day you remove 3 beads, the next day 6 beads, the next 9 beads etc. This provides for a slow steady withdrawal. If symptoms get to bad you just hold at that dosage for a while until you stabilize. Then start dropping again. Be aware that for most the last few beads give the worse withdrawal. Be prepared to slow down when you get to the very end. Now this is just an example. Some can only remove 1 bead a day and others 7 or 8 beads a day. You will have to play with it a little bit to find what works for you. This doesn't mean you won't have withdrawal but it will be lighter and you will have some control over it.
Scuffy1209 - Just wanted to reiterate really helpful info i found on a forum here -- I discovered that Lupin brand generic cymbalta is actually filled wtih tiny 5mg minipills instead of hundreds of little grains of "cymablta sand"
Maybeceejay - My 30mg capsule had 56 beads, and my 60mg capsule had roughly 88 beads (some flew away and I think I lost count once). my box of 60mgs are Tixol and my box of 30mgs are Cymbalta. For those that don't know Andepra AN is the name for Cymbalta in Australia.
mamma1st - The manufacturer of her current bottle is Ajanta Pharma. I opened up one of the capsules earlier and there were 70 beads inside.
Ayla65 - Mum's Cymgen here in South Africa come in capsules (blue and green) and have 569 tiny white balls (of poison) in each capsule.
Gardenlady - I counted beads in my Teva brand 60 mg capsules and they all had varying numbers. The average was 315 beads.
Noush - There are 50 ish beads less in the capsules I got this month, than the ones that I got last month! If I wasn't bead counting, to make sure my beads stay the same, I would've dropped 50 beads (approx 8mg) in one go, without even knowing it!
FH - Eli Lilley had 6 different manufacturing facilities the last time I researched it. Each facility must follow the patent but it only specifies a range of sizes so some facilities produce smaller beads than others.
FH - This is the first time I have seen such a large variation in bead count with the same manufacturer but what concerns me is how often does this happen? Is it just a matter that one batch comes from one facility and the next batch comes from a different facility OR does the number of beads differ from one day to the next. When I talked to Eli Lilly a couple of years ago they said they fill the capsules by weight. That is fine BUT we know some beads in the capsule will be slightly smaller than others. Larger beads will have more medicine per mg of bead because size of the bead is geometric in relation to weight.
KFL -Someone told me that they put their beads in the freezer and that stopped static cling, but do that after opening the capsules and putting the beads in a different container. I found that the capsules were difficult to open if they had been stored in the freezer.
FH - I personally agree with your decision to take 1/2 the dose in the AM and 1/2 in the PM to keep a stable blood serum level.
You have already tried 1 bead a day so I would recommend going to 1 bead a week for one week and if no symptoms then 1 bead every 3 days for a week, then 1 bead every 2 days for a week until you find her limit and then back off a little. Also the last 5 mg is by far the hardest so plan on 1 bead a week or even less if she is sensitive to the withdrawal.
Juli - Put the pills on a black t-shirt and use a toothpick to separate into piles of ten.
Tapering of SSRI treatment to mitigate withdrawal symptoms.
Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms. Other types of medication associated with withdrawal, such as benzodiazepenes, are tapered to reduce their biological effect at receptors by fixed amounts to minimise withdrawal symptoms. These dose reductions are done with exponential tapering programmes that reach very small doses. This method could have relevance for tapering of SSRIs. We examined the PET imaging data of serotonin transporter occupancy by SSRIs and found that hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums, in line with tapering regimens for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised.
How long to stabilize after updosing?
The following research shows how fast the body responds to reinstating a ssri/snri shortly after withdrawal.
The SSRI discontinuation syndrome.
SSRI reinstatement leads to resolution within 48 h.
Selective serotonin reuptake inhibitor discontinuation syndrome: a review.
These self-limiting symptoms resolve on reintroduction of the drug and cannot be explained as a remanifestation of the original disorder.
Antidepressant discontinuation syndromes.
Severe cases can be treated symptomatically or the antidepressant can be reinstated before being gradually withdrawn. Reinstatement usually leads to symptom resolution within 24 hours. Some individuals require very conservative tapering schedules to prevent the re-emergence of symptoms.
FH - We recently had a discussion on one of the threads the other day about how long to stabilize after updosing. The following research shows how fast the body responds to reinstating a ssri/snri shortly after withdrawal.
Eli Lilley Patent Information on the manufacturing of Cymbalta.
1996 patient of Cymbalta pellets by Eli Lilley.
This document is a very detailed description of how Eli Lilley makes the little "pellets" (what we call beads).
Clarification - In this patent it states that Eli Lilley uses small "beads" of starch and sucrose for the center of each pellet. The pellet id then coated with Cymbalta and then enteric coating. What Eli Lilley calls a pellet is what we refer tp as a bead.
"A preferred core for the pellet is prepared by applying a duloxetine-containing layer to an inert bead. Such inert beads are conventionally used in pharmaceutical science, and are readily purchased in all industrial countries. The most preferred bead is one prepared from starch and sucrose, for use in confectionery as well as in pharmaceutical manufacturing."
"In general, pellets can be as small as 0.1 mm, or as large as 2 mm. Preferred beads are from about 0.3 to about 0.8 mm, in order to provide finished pellets in the desired preferred size range of from about 0.5 to about 1.5 mm in diameter."
Note - So this means that some beads are 3 times bigger than other beads.