23 replies to this topic

[Rainbow]

Hello all – I have been referring this site for months through my Cymbalta wean and greatly respect the community.

 

My background: I was on Cymbalta 60mg for depression and chronic pain for 12 years. I have always been sensitive to withdrawal as if I forgot to take a dose, hours later I would have a terrible headache and nausea. I tried to wean off 6 years ago, got down to 40mg, experienced withdrawal (worsened depression and lots of crying) and stopped as I had a life change and didn’t feel it was the right time. I was scared to try weaning off again, but decided last year that it was the right “time” to try as I felt my life was good and stable (was in a relationship, happy, didn’t feel I needed talk therapy anymore). I knew it was going to take a while to wean off the Cymbalta and I want children, so I bit the bullet.

 

Starting April 2019, I weaned from 60mg to 50mg in about 2 weeks, to 40mg in about 2 weeks, then started experiencing the same emotional withdrawal issues I had the first time around. I then went to the bead counting strategy and dropped 1mg every few days. I struggled through this with depression, anxiety, and just not feeling happy. It was affecting my relationship and partner was not supportive at all (just told me to get off of the stuff already). My psychiatrist presumed my underlying depression and anxiety were coming through as less and less Cymbalta was in my system, yet I opted not to do a cross taper. Once I hit December 2019 and was on 6mg and struggling even more emotionally, I started on Trintellex 5mg and halted the Cymbalta wean. I then had a mental breakdown of sorts in January 2020 while I was both struggling with major jetlag (Asia to NY) and finding out my job was changing. I increased to Trintellex 10mg and upped the Cymbalta by 1mg. 2 weeks later, I started weaning off the Cymbalta again mg by mg every few days/dependent on how I was feeling. When I hit 1mg I started reducing by bead every few days only. End of February, I got down to 3 beads and was a wreck emotionally. Psychiatrist suggested I go back up to when I felt “fine” and based on my log, I increased to 17 beads. Once stable after about a week, I reduced bead by bead every few days.

 

Then my life situation drastically changed – 2 weeks before I was to move in with my now ex in mid March, I was blindsided and broken up with. I am from NYC and Coronavirus was about to explode, and so I temporarily moved down to my parents in Florida to have support and safety during that time. 3 weeks later, I was furloughed from my job. No relationship, no work. The Florida sun helped but with these 2 things compounded by Coronavirus, suffice to say my situation was extremely difficult. I increased to Trintellex 20mg.

 

I am now back down to 3 beads and not doing well (will find out if/when I get the job back this week). My issue now, besides being depressed, is I have more anxiety than I have ever had. I now wake up with it. It tends to go on and off in severity during the day. I’m crying more lately, irritable, and generally struggling emotionally, but the anxiety is what’s really making me uncomfortable. I’d love to get Fishinghat’s and IUN’s advice about staying on 3 beads until I feel “better” and not dropping to 2 beads until that happens? Separately, could “better” take months, and then once I’m on 2 beads, same thing for months?

 

Supplement and medication-wise, I am taking the following, in addition to my 3 beads   :     

Trintellex 20mg

Hydroxyzine 10mg for sleep – I understand can take as much as 100mg/day split into 4 doses for anxiety but it makes me very drowsy

Xanax .25mg as needed for anxiety

SAM-E 400mg

Fish oil

L-Methyfolate 15mg (I have both MTHFR gene mutations)              

Vitamin B12 Complex (my level is 1,157 pg/mL and Fishinghat I’ve read you have some B12 concerns)

Vitamin C

Vitamin D

Magnesium Citrate (just read here last night from Fishinghat that Magnesium Oxide can react with Cymbalta, and I had been on Oxide for many months during the beginning of my wean and likely suffered from that. Citrate is ok, or no?)

Calcium

Turmeric

CoQ10

 

Many, many thanks for your help and for making this forum available to those who need help beyond what the psychiatrists are able to do.

 

[fishinghat]

Welcome Rainbow

 

Thank you for all the details. It helps. Weaning off the Cymbalta is tough enough without all the other chaos in your life. 

 

First of all I would stay at the 3 beads until stable which may take a dew months (sorry).

 

When did you raise the Trintellix to 20 mg.

 

Trintellix helps stabilize serotonin where  as Cymbalta controls serotonin and norepinephrine. While the Trintellix will help it will not control the norepinephrine which is a stimulant related to adrenaline. Anxiety will be with you for a while but will eventually settle down. 

 

Hydroxyzine is very effective for anxiety. The standard dose is 25 mg 3 times a day and 50 mg at bed time. If sleepiness is an issue then half doses as needed may help take the edge off. In addition many have found help for the anxiety with around 0.5 to 1 mg of melatonin as well. Also Suntheanine may help as well. 

 

SAM-e is usually helpful but has a withdrawal nearly as bad as an antidepressant.

 

Vitamin B12 levels are low when they are below 200 ng/ml. Your level of 1,157 pg/ml (equals 1.157 ng/ml) and is far below the normal. Isn't your dr concerned about this? This could be the cause of your depression. Our ebook contains links to research articles that link low B12 to depression. You might want to check that out.

 

Magnesium and calcium supplements should not be taken unless blood tests show a deficiency in one or the other. Calcium and magnesium both interfere with the absorption of Cymbalta (and many other meds). They also compete with each other in the body and effect the concentration of other minerals as well. High levels of calcium have been linked to depression and high levels of magnesium have been linked to anxiety. Several of our members have had that issue. 

 

What level of Vitamin D are you taking?

[Rainbow]

Thanks Fishinghat for the quick response and all the information!

 

I raised the Trintellex from 10mg to 20mg in early April, and was taking about 15 beads of Cymbalta then. I'm not very familiar with norepinephrine. Would you recommend that I try to increase the norepinephrine at all, if so how, with diet for example? 

 

In December, my Vitamin D level was 45.8 ng/mL. I was at the pool in the Florida sun practically everyday from mid-March to June, and so I took 5000iu every other day. I just got back to the northeast now and won't be outside nearly as much, and I was thinking of taking the 5000iu about 5 days a week now.

[fishinghat]

From the ebook

 

"The cycle is: tyrosine converts to L-Dopa to dopamine to norepinephrine and then epinephrine."

 

Each has its own function.  It should be noted that the effect of norepinephrine are similar to epinephrine (also known as adrenaline, causes most symptoms of anxiety). Now that the Cymbalta is no longer regulating norepinephrine it is overwhelming your brain/body and causing the exceptional anxiety. It usually takes the body  a few months to adjust. During that time you need to try and reduce stress as much as possible as it will only make the anxiety worse. In addition get plenty of rest. Also, try and minimize/eliminate the use of any stimulants such as caffeine, sugar, salt, etc. There is a complete list of these things in the ebook.

 

What about the vitamin B12? I am deeply concerned that this is related to your chronic depression.

[Rainbow]

I'm confused about the B12. My blood tests from LabCorp and Quest have shown B12 as pg/mL. I understand the conversion to ng/mL, however the standard ranges for both labs are 232-1,245 pg/mL and 200-1100 pg/mL. My doctors didn’t flag my level of 1,157 pg/mL because that’s within range with LabCorp.

I can tell you that 1 year prior, my B12 level was extremely low based on both these ranges, at 351 pg/mL, and that’s when I began taking the B Complex.

What are your thoughts given I’m currently “within range” for pg/mL?

Separately, given how little 3 beads are of 60mg, why should the body be reacting so strongly to the reduction of a very tiny dose?

[fishinghat]

https://www.mayoclin...terpretive/9154
Normal 180-914 ng/L which is obviously much different than the values for Labcorp.

 

I can tell you that there are different methods to analyze for different chemicals and each method has its own 'normal' range but these values differ by a 1000 fold. That is very unusual. I have looked at several other sources and some agree with Mayo (above) and some agree with Labcorp. If your test was done by LabCorp and that is their normal range than I would go with that.

Sorry about the paranoia but just had to be sure all was OK.

You are taking a B-complex? How much vitamin B6 does it contain?

As far as the withdrawal effects it relates back to the sensitized nerves. It takes time for the body to adjust to not having Cymbalta to lean on and the lower you go the more sensitive these nerves become. Even a slight reduction at your stage can really aggravate things. The idea is to pause from time to time to let your nerves recover some before proceeding. People who have quit cold turkey have suffered from seizures, suicide, and considerable other issues as the nervous system just can not adapt that quick.

[fishinghat]

I am one of those people who want to know why...?

https://iioab.org/Vo...2011-23-32p.pdf
This article discusses the various methods (12+/-) to analyze for Vitamin B12. Apparently there is a lot of variability in these methods. Each method also has different factors that can interfere with the analysis such as protein levels in the blood, mineral concentrations, medications and supplements, etc. Over the years I have done a lot of screening for heavy metals (lead, copper, iron, etc). and during those times have used at least 3 different methods to do the analysis. Variations in the 'normal' range would only be 5 to 10%. Nothing like what we are seeing here. Very surprised.

[fishinghat]

Notes -
https://www.mayoclin...12/art-20363663
Taking vitamin B-12 with vitamin C might reduce the available amount of vitamin B-12 in your body. To avoid this interaction, take vitamin C two or more hours after taking a vitamin B-12 supplement.

 

https://www.labcorp....in-b-sub-12-sub
This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

[invalidusername]

Hi Rainbow,

 

Apologies for my delayed response to your message - and a very warm welcome ot the forum. I am very glad that you found so much useful information from the site during your withdrawal. Your story is quite a strong one and unfortunately, like your ex partner, not everyone understand withdrawals. My sympathies for the turmoil you have gone through. For what it is worth, I think you did the right thing in moving to sunshine and support.

 

Hat's first reply got your on the straight and narrow and my first point would have been the SAMe - you really need to be careful with that. There is a time and a place for it, and often people do not realise that despite it being OTC, it can be just as viscous as prescription meds. Proceed with caution.

 

Regarding minerals in general, supplements are not treated and absorbed in the same way as when they are sourced from food, which is why Hat has made the points he has. Magnesium can also be a source of anxiety in the wrong levels, but at the right levels can be a benefit. It isnt as simple as just taking xxmg and it makes it all better - if only!! So for sure, heed Hata's pionts there again.

 

To answer the norepinephrine question, you need to let your brain find its homeostasis in its own time. If you supplement, it will confuse the situation further. The metaphor I like to tell a lot of our users when they stop taking a drug that took control over certain neurochemicals (such a norepinephrine) is that it is like you have lost the recipe for a cake and you are trying to make it again by experimenting. Sometimes you will put too much on one ingredient, another time too little, but you learn from each of these mistakes and eventually, you will have the recipe correct. This is EXACTLY what you brain needs to do with your norepinephrine. It will find what is right for your brain (cake!). Unfortunately it does take time, but it will resolve in time.

 

I will leave the Vit B connundrum with Hat as that is his speciality, but you sure need to follow this up...

 

Again, welcome to the forum and feel free to ask anything - we will do all we can,

 

IUN

[fishinghat]

Hey, IUN. Who is Hata?  Oh I just love getting even.  

[invalidusername]

Hey, IUN. Who is Hata?  Oh I just love getting even.  

 

..and what are Hata's "pionts" as well!!

 

That was a bad day

[Rainbow]

Thanks to both of you for your help here!

As for the B-complex I take, it contains 25mg of B6. I also appreciate the info about taking Vitamin C separately.

I actually wasn’t aware that the SAM-e withdrawal is nearly as bad as an antidepressant, so thank you for calling that out. The psychiatrist advises that I take 400mg in the morning, 400mg at night, which my mom actually feels is a lot of serotonin along with the Trintellix 20mg. I started taking it when things began going downhill emotionally during the Cymbalta wean and I didn’t think it could hurt. I’ve read more about it in the ebook but would love your perspectives.

[invalidusername]

Trintellix is a relatively new kid on the block for AD's, and p-docs are all over it like some sort of new candy. I was recommended it a couple of years ago being told it was "far superior" until I asked for their basis for that statement. New does NOT mean superior. New is not such a good idea when it hasn't been used for any length of time by many patients.

 

Your Mom is also right that this combined with 800mg of the SAMe is quite a large dose of combined serotonin antagonist. A big jump can be just as problematic and harmful as a big decrease. It is the respective alteration to the balance that causes the problems, not the loss. The gain if too great can be just as harmful. Things like this should always be in moderation, be it updose or downdose...

[fishinghat]

Vitamin B6 Toxicity

My wife had Vitamin B6 toxicity. My wife's supplement, without consideration of her dietary intake, was 5 mg/d.

https://www.ncbi.nlm...ooks/NBK114313/
Half-Life is 15 to 24 days.

RDA is 1.5 mg/d for women over 50.

A spreadsheet based on bioaccumulation showed that her levels after 2 years and 1/2 could have been equal to around the same as a single dose of 550 mg buildup in her body based on a 80% absorption rate.

A spread sheet that considered bioelimination calculated that her blood levels should return to near normal levels within 6 months. This does not give consideration to her diet which has a substantial number of B6 containing vegetables.

Many of the supplements on Amazon have from 20 to 100 mg/day of Vitamin B6 and with a half life of 15 to 24 days would allow toxic levels to be obtained with continuous use.

The dr she saw for treatment said that Vitamin B6 toxicity was one of the most common poisonings seen in the ER.

FYI
https://www.ncbi.nlm.../pubmed/6308447
We describe seven adults who had ataxia and severe sensory-nervous-system dysfunction after daily high-level pyridoxine (vitamin B6) consumption. Four were severely disabled; all improved after withdrawal. Weakness was not a feature of this condition, and the central nervous system was clinically spared. Although consumption of large doses of pyridoxine has gained wide public acceptance, this report indicates that it can cause sensory neuropathy or neuronopathy syndromes and that safe guidelines should be established for the use of this widely abused vitamin.

https://www.ncbi.nlm.../pubmed/3041185
Pyridoxine neuropathy.
A case of sensory neuropathy in a young woman due to long-term ingestion of pyridoxine, with subsequent recovery, is described. Because of its widespread use in the community, both the general public and the medical community need to be aware of this recently described complication of megavitamin therapy.

https://www.ncbi.nlm.../pubmed/3630649
A newly recognized neurotoxic syndrome due to pyridoxine (B6) overdose is described. It is the largest series of B6 intoxication hitherto reported. A raised serum B6 level was present in 172 women of whom 60% had neurological symptoms, which disappeared when B6 was withdrawn and reappeared in 4 cases when B6 was restarted. The mean dose of B6 in the 103 women with neurological symptoms was 117 +/- 92 mgs, compared with 116.2 +/- 66 mgs in the control group. There was a significant difference (P less than 0.01) in the average duration of ingestion of B6 in the neurotoxic group of 2.9 +/- 1.9 years compared with 1.6 +/- 2.1 years in controls. The symptoms were paraesthesia, hyperaesthesia, bone pains, muscle weakness, numbness and fasciculation, most marked on the extremities and predominantly bilateral unless there was a history of previous trauma to the limb. These women were taking a lower dose of B6 than previously described (1,2), which may account for the complete recovery within 6 months of stopping B6.

https://www.livestro...icity-symptoms/
Vitamin B-6 toxicity cannot occur from eating natural foods, but it can occur from supplementing with its synthetic form, pyridoxine. The recommended dietary allowance of vitamin B-6 for adults is no more than 2 mg daily, but toxicity is not thought to occur until ingesting at least 100 mg daily, if not 500 mg daily, for many weeks consecutively. Some people do mega-dose pyridoxine for long enough to cause toxicity, which leads to symptoms ranging from temporarily irritating to permanent and disabling.

https://www.ncbi.nlm...pubmed/25137514
Supplementation with pyridoxine at doses greater than 50 mg/d for extended duration may be harmful and should be discouraged.
https://www.ncbi.nlm...pubmed/25056196

https://www.ncbi.nlm.../pubmed/3630649
Because of supplements and certain medical therapies including some chemotherapies, vitamin B6 toxicity is becoming much more common.

https://www.ncbi.nlm...pubmed/30040985
Thus, the present study confirmed the involvement of GABAergic and NO-sGC-cGMP pathway in the 'anxiolytic-like' effect of pyridoxine (vitamin B6) in mice.

https://www.ncbi.nlm...pubmed/31796339
[Peripheral neuropathy with hypervitaminosis B6 caused by self-medication].
Hypervitaminosis B6 remains a possible cause of peripheral neuropathy and it may be caused by self-administration of over-the-counter vitamin-containing drugs.

Member comments -

Cin - a good mult-vitamin, but don't overdo it on the B vitamins (even though they are water soluble, I actually got vit. B6 toxicity and that caused some nerve issues that I'm not sure will ever completely reverse).

FH - My wife developed Vitamin B6 toxicity by taking a stress tab with 5 mg dose once a day for several years. The dr said it would take her 6 months to recover and that recovery may not be complete.

Three members have reported Vitamin B6 toxicity.

Note - A search of vitamin B6 supplements on Amazon shows that many supplements currently on the market are well above the recommended dietary allowances. The long half life allows for toxic levels to build rapidly.
 

[fishinghat]

As IUN mentioned, that high a SAM-e dose combined with Trintellix can cause a condition called serotonin syndrome that can make one very sick and can even cause death. The easiest way to monitor if you may be getting into an issue is to frequently check your temperature as serotonin syndrome will cause a fever to develop.

[Rainbow]

Really appreciate all the help. I will discuss with my doctor!

[invalidusername]

More than welcome dear Rainbow - please keep us posted.

[Rainbow]

Hi again,

 

I just had a very frustrating conversation with my psychiatrist - I have been struggling emotionally, and I question whether the Trintellix is actually helping me/would like to try something else. The first thing he asked me was how I felt about going back on Cymbalta given it treated my depression well. I DO NOT want to do that. I have weaned myself to 3 beads. I also told him it's not a drug that's safe to be on if I become pregnant one day, and having almost finished a withdrawal and knowing how bad it was for me, I don't want to have to do it all over again. He suggested I speak with a reproductive psychiatrist about the validity of the statement that it's not safe to take while pregnant. I can't tell you how angry I am.

 

My question is, are there other antidepressants you know of which are not particuarly difficult to wean off of? One of the reasons he put me on Trintellix is because it has a long half life and he understands how hard the Cymbalta withdrawl has been for me.

 

I am talking to the psychiatrist again in 8 hours (appointment ran over so he will call me again at 8PM EST), and I would be so grateful if you could provide any insight that might be helpful for that conversation.

[fishinghat]

If nothing else there is a growing body of evidence that ANY antidepressant use during prenancy greatly increases the risk of autism. Quite simply none are truely safe. 

 

The ones that our members seem to have the least problem weaning off of are Prozac, Lexapro and Zoloft. Their withdrawal is not a walk in the park either. 

[invalidusername]

It is also commonly known that the more you switch between AD's the less effective they become, which is why it is not a good idea to play medication roulette with them.

[Rainbow]

Thanks to both of you for your replies yesterday. The psychiatrist was weighing Lexapro vs Zoloft (I liked that they happened to be 2 of 3 that Fishinghat mentioned) and opted to start me on Lexapro while I wean off the Trintellix. Starting with Lexapro 5mg this week and then moving to 10mg. 

 

I had read a lot of IUN's Withdrawl thread and saw Lexapro 15mg at one point. I was wondering, IUN, if you are still taking it? Or, what is your protocol now to manage depression?  

 

Many thanks!

[invalidusername]

Hi Rainbow...

 

Yes, been there and done that with Lexapro. I went to Lexparo after issues with Cymbalta, so at first it was difficult to say what was causing what, but after 6 months, I was still having severe stomach issues. Knowing Cymbalta, it could have been that, but I was getting no support, so I decided to cross-taper back to Citalopram, which is where I have been for the last year. 

 

Once I settled back on the Citalopram, got some supplements from a homeopath and a good therapist, I was back on the straight and narrow... for the most part. 

 

I still suffer from depression every now and again, but it isn't nearly as bad as it was. Anxiety isn't really a problem any more - that which I am left with (blood tests, airports etc) are things that have always been there. 

 

As it happens, you have caught me on a bad day as I woke with a bit of depression today, but this was due to 11 days of non-stop work. But treated like a wave, you come out the other side.

 

Regarding your own switch, it is anyones guess. I was put on Lexapro (or Escitalopram in the UK) as it is supposed to be Citalopram v2, and thus much better, safer, efficient etc. But was it bollocks. It caused overproduction of acid and aggravated my hiatus hernia. Not to say that would be the same for anyone else, but it just shows you that new is not always better. ADs are completely and 100% subjective. Some might argue for gene therapy, but that has a looooong way to go.

 

I wish you all the best.

 

Any questions regarding Lexapro just post and I will do my best to help.

[Rainbow]

IUN, thank you so much for your response. I am sorry to have caught you on a bad day. Reading threads and posts on here, you just seem like such a lovely person and I really feel for how much you’ve gone through and am in awe of how dedicated you are to helping others (as is Fishinghat of course, and others). Fingers crossed with the Lexapro. I will be staying on my daily 3 beads of Cymbalta for a long while as I have no intention of throwing a variable in while adjusting to this new medicine!

[invalidusername]

Thank you for such lovely words Rainbow. That really made my day - as it was again not such a good one. I usually have 2 or 3 days in a row when I have properly overdone it. My biggest issue is looking after a wife who is badly suffering from depression, OCD and agoraphobia. There is a lot of responsibility on my shoulders. Even one of my neighbours thought we had split up because she hadn't seen her in a year! That is a neighbour in the same building! 

 

Much like Hat, I just hate to see people suffer as we have. If there is a way in which this suffering can be abated, and I can be a part of that, then great. Bring it on. Yes, I have my ongoing issues, but  there are a lot of people that need help that aren't getting any. 

 

I think you are wise to remain as you are Rainbow - too many variables can cause their own confusion...