Posted 02 June 2020 - 08:42 PM
Part of this was spurred by the fact that I missed a few doses and hated the withdrawals I was having and in general I dont like meds. Around March I dropped from 120 down to 60 and then today I dropped to 30mg. I have a prescription of 30mg that will last me 2 months. When i dropped from 120 to 60 i had no issues. My withdrawal symptoms if I miss a couple of doses are typically nausea, hot flashes, dizziness.
I have been on several different meds in the past with no issues with withdrawal or side effects.
I current take a mix of meds...topiramate(200mg), spronolactone(100mg), cymbalta, vit B3, Vit D ( I dont remember which is which but one is 1000 and the other 5000).
Posted 02 June 2020 - 08:52 PM
Hi Atok and welcome to the forum,
Missing doses will always make you feel off kilter due to the very short half life of Cymbalta - 50% of the drug is out of your system within 12 hours, then 25% within 24 hours, so a missed day will therefore feel like a mini withdrawal.
You might have a few more symptoms having now dropped from 60 to 30, but from this point I would consider putting the brakes on. Given that you have done well in the past that might bode well for you with this withdrawal. So if your move to 30 goes ok, then stabalise at this dose and drop to 20mg and again stabalise, but from this point I would strongly urge you to bead count.
If you are not familiar with bead counting, there are plenty of posts here, and you can find plenty of information in our eBook which you can download from the site from the Medical section (first post).
Quite how quickly you bead count will be determined by your progress from the initial drop. Any questions about the above, please ask.
Might be good if you could clarify the Vit B/D doses and your units of measure (microgram or milligram) - and have you been tested for deficiency in either? Vit D in large doses can be a problem, and vit B can be toxic more readily that vit D. It is worth checking. Too much can also reverse the effects of anxiety and can promote it rather than prevent...
Posted 02 June 2020 - 09:12 PM
I don't think I will ever understand why doctors prescribe doses over 60mg of this drug. Especially 120! WOW! I actually remember reading a research article stating that they could find no added benefit at doses over 60mg but a significantly higher incidence of side effects. Yeesh! Glad you're getting off it.
Just want to echo what IUN said about slowing down. I was on 60mg for 5 or 6 years and then made up my own taper schedule. I wasn't working with a doctor and didn't really appreciate how difficult this class of medication can be to come off of. Anyway I had literally no problems from 60mg to 30mg. Nada. Somewhere around 20mg I started getting withdrawal effects: brain zaps, VERY irritable and cranky about nothing in particular, are the ones I remember most. At this point I figured this was probably going to be the worst of it and I cold turkey'd the rest. 3 weeks went by where the zaps and irritability were slowly improving, then (my theory) I went to an intense exercise class and literally the next day went into a complete tail spin which basically lasted for 5 months. I'm still not 100% better because it is such a slow process, but I'm at least 90% back to my normal self.
So my advice is two-fold: definitely take it slow the rest of the way with the taper. IUN and FH can probably help you come up with a weaning schedule that will maximize your remaining pills. Second advice is for the remainder of the taper and even for a while after, try to avoid major stress and anything that might spike your adrenaline. The Cymbalta regulates your adrenaline for you so it takes time for your brain to readapt to doing the job itself.
Best of luck! Don't be a stranger here
Posted 02 June 2020 - 09:49 PM
The noreponephrine which is the active component in Cym which aids anxiety doesn't really kick in at the 60mg therapeutic dose, so this isn't surprising. 90mg is generally considered the go-to dose, with 120mg reserved for select cases, and as Frog said, this dose has been under scrutiny for its efficacy, but no real conclusion has since been drawn.
Much like a lot of these trials, they are very elusive. One can also never be sure of the sponsorship behind some of these papers. I don't like to speak ill of the research community as I am myself a researcher, but sadly, it does happen.
The FH Frog refers to is Fishing Hat - my partner in crime here on CW. He'll be by tomorrow to introduce himself.
Posted 02 June 2020 - 10:52 PM
I am also in the health field and have a understand of basic mental health meds which is why I get so much say when it comes to my medication.
Posted 03 June 2020 - 06:36 AM
You were absolutely right to start with the 90 before the 120. Sounds like the norepinephrine was key to your recovery. That will help should you need to supplement your withdrawal further down the line.
Useful that you have an understanding of the meds, but with all respect, understand AND experience is the more beneficial, which is why a forum with people like yourselves who also have an understanding is the best place to be. There are plenty of other groups - mainly on facebook - who offer advice, but they do not understand what they are doing, and this is what gives forums like ours a bad name. Hat and I are fortunate enough to be suitably educated in these matters and whilst we always state that our help is not in place of the medical professional, that often becomes the case!!
Posted 03 June 2020 - 08:22 AM
Hi and welcome Atok
You have already received good advice from IUN and Frog. It is definitely time to slow down. You will need to get a new script so you have plenty of doses.
I actually tend to agree with your dr to some extent. Research has shown that it takes your synapses around 2 years to fully recover from an antidepressant. So even though you may not have withdrawal symptoms right now there is healing going on in your nerves. A pause of at least 2 to 4 months might help reduce the withdrawal later. Just a guess mind you. Also if you have surgery later you don't want to be in the middle of withdrawal during that time. In addition, if you have a hospital stay they will not do partial doses on the Cymbalta. They would take you back up to the next higher dose and go from there. That would mean you would loose a lot of ground you already gained. I believe that the smallest available dose is 20 mg but that is not available in all countries. If your hospital has access to 20 mg then you might taper down to that level and stay there through your surgery/recovery time.
This is a lot to absorb so please do not hesitate to come back and ask questions. We are here to help.
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Posted 03 June 2020 - 04:17 PM
Posted 03 June 2020 - 04:44 PM
A compounding pharmacy can make a liquid form of Cymbalta BUT it is usually very expensive and very hard on the stomach. Cymbalta beads are enteric coated and are designed to dissolve in the small intestines and not the stomach. The liquid form will be in the dissolved form in the stomach which presents a problem as Cymbalta is converted to naphthol which is very hard on the GI tract.
Posted 04 June 2020 - 01:58 PM
I really had trouble finding specifics. I did find some of the research on benzo action on synapses (see below). I found a few antidepressant articles which focused on the antidepressant effects on transporters and development of new synapses. They frequently eould say something like "Of course we all know about the effects o antidepressants on synaptic structure) but there would be no clarification or bibliographical references. I remember my studies were in the 60s and 70s and centered around benzos and Tricyclic amines. And by the way, you don't get to ask me about my age.
alterations of receptors by benzos.
However, recently introduced antidepressants, such as the 5-HT-NE-reuptake inhibitors, have synaptic effects that differ from those of older compounds. These synaptic effects are important in explaining certain side effects and drug-drug interactions associated with all classes of antidepresants. This article reviews the synaptic effects of marketed antidepressant agents to elucidate the anticipated side effects and drug-interaction potential of these agents.
Posted 04 June 2020 - 04:49 PM
I tell you what. I just can't find anything specific on the subject. Maybe I am going (more) senile. lol
lol. its scary how willing they are to prescribe medication that causes permanent changes to the brain. when I fell into the pit of cymbalta withdrawal, my psychiatrist wanted me to take latuda. he was explaining that permanent facial tics can be a side effect. my first thought was that the tics are a visible sign of permanent brain alteration. what other brain changes that you couldn't see were permanent? I was also reading about another anxiety medication that said it may not work if you've ever taken benzos. that again says that there are some permanent changes to the brain by benzos. scary stuff.
Posted 11 June 2020 - 01:23 PM
That's great news and hopefully you're one of the lucky ones who gets through this unscathed.
To IUN's point, and in my personal experience, 60 to 30 was no problem at all. I had no symptoms of any kind. It was around 20mg that they started to be more prominent where I could definitively say this is withdrawal from Cymbalta.
I think it's best to do at least a week between drops due to how long it takes for the drug levels in your system to balance out. That way if any symptoms do eventually show up, you'll catch them before moving on to the next drop. The problem with going too fast through the drops if you start experiencing issues is that you end up just stacking the side effects one on top of the other rather than letting things restabilize and adjust before moving on.
Good luck! You can do this!
Posted 20 June 2020 - 05:54 PM
You will probably need to go slower after you get down to 10 mg more or less. Doing great so far. Patience my friend.
Absolutely. 10mg is usually "that point", but listen to your body. It will tell you when to slow. Don't get complacent, but you are doing well.
Posted 03 July 2020 - 10:59 PM
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