Posted by SLS on May 22, 2010, at 8:24:31
In reply to Re: Cymbalta Withdrawal, posted by 49er on May 22, 2010, at 6:27:32
Hi 49er.
Thanks for all of the valuable information.
> > I imagine you feel that you have already invested 2.5 weeks of time and endured much pain towards discontinuing Cymbalta such that you would not want to restart it. Who would want to reintroduce this drug if the discontinuation syndrome will end in a few more days? >>
> I am not sure why you would think the discontinuation syndrome would end in a few days because even drug companies don't advise you to cold turkey a med.I'm sorry 49er. You are right. I was speaking rhetorically, but I guess that was not apparent. I would not venture a guess as to how long a discontinuation syndrome would last for any one individual. I am horrified to read reports of withdrawal symptoms lasting for weeks and weeks. I don't discount them.
> Regarding using Prozac, that is a good idea with these caveats. Unfortunately, it doesn't prevent a person from having withdrawal symptoms from the Cymbalta if they taper too quickly.
That is interesting. That could represent evidence of a kindling phenomenon occurring. This is why I am looking into using certain anticonvulsants to aid in discontinuing SRI medications. Lamictal is not a drug that I would consider. I don't think it makes for a good global dampener of glutamate activity. I was thinking of Trileptal and Depakote.
What are the difficulties that one would encounter when discontinuing Lamictal?
> You could also have start up symptoms from the Prozac.
>
> Not that this is proof but it seems people on the Paxil Progress Boards who are doing this are not having success. One person in particular has reinstated the Paxil and will eventually taper it after stabilization.I can see how this would be possible. Compared to Prozac, Paxil is much more potent as a reuptake inhibitor and it has other properties such as muscarinic anticholinergia and NE reuptake inhibition. Paxil is sort of like a tricyclic in some regards. This mixture of properties makes Paxil substantially different from Prozac, so Prozac might not always act as an effective substitute. However, that is all just theoretical garbage. I would be interested to know, empirically, how often Prozac fails as a surrogate, and with which other drugs. Perhaps the website you refer to is representative of a majority. It could also be that it is skewed towards a minority who are already Prozac substitution failures. Why else would they be there? I have never tried Prozac substitution myself. I have seen it work for others, though.
> There is no denying that my method for tapering takes a long time. So what?Time can be critical when someone is very ill and must change antidepressant drugs. This is epecially true when one is switching to or from a MAO inhibitor.
> Yes, there are folks who can go more quickly but again, you're not going to know if you're one of the lucky ones until it is too late.
I don't understand what the risk is. One can always adjust their taper rate when withdrawal symptoms first emerge. This does depend on compliance to a plan, but so does a gradual taper schedule. I doubt there is any evidence that withdrawal effects are irreversible from the moment they appear.
The issue of managing drug discontinuation is not so simple. There are too many variables. A universal plan of employing a single protracted taper schedule that lasts for months and years is not practicable in cases where an individual must change drugs to continue treatment.
Intuitively, it would seem prudent to discontinue antidepressants gradually so as to minimize the risk of relapse. Unfortunately, there isn't much evidence to support this idea. The two studies that I came across investigating this issue were contradictory. If it were me, I would not stop taking an antidepressant abruptly. Without further evidence, I would err on the side of caution and taper gradually so as to prevent relapse.
I guess the question becomes: How gradual is gradual?
- ScottThe measure of achievement lies not in how high the mountain,
but in how hard the climb.The measure of success lies only in how high one feels he must
climb to get there.
poster:SLS
thread:948148
URL: http://www.dr-bob.org/babble/20100514/msgs/948295.html