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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Elanor Roosevelt on May 21, 2010, at 6:29:43
In reply to Re: Cymbalta Withdrawal, posted by 49er on January 17, 2010, at 7:49:00
Thanks for this post
I ahve been having these pitiful teary moments, nausea, blurred vision, headaches, and aches just about everywhere else.
I'm in week 2.5 of no Cymbalta
When my pdoc suggested going back on I told him he was crazy.
How much longer must I endure this?
Posted by mellow on May 21, 2010, at 6:41:03
In reply to Re: Cymbalta Withdrawal, posted by Elanor Roosevelt on May 21, 2010, at 6:29:43
> Thanks for this post
> I ahve been having these pitiful teary moments, nausea, blurred vision, headaches, and aches just about everywhere else.
> I'm in week 2.5 of no Cymbalta
> When my pdoc suggested going back on I told him he was crazy.
> How much longer must I endure this?I'm sorry you are feeling so bad. I can certainly relate to the crying spells, pain and feelings of dread during medication changes/tapers.
I'm not familiar with your situation. Are you taking any other drugs right now? What was your pdoc's logic stopping your cymbalta? Do you think this is the worst of it? Can you muster through a few more days and maybe do a little exercise to get some endorphins going?
I can't be of too much help with that particular drug b/c i have never taken cymbalta, but i have felt excatly how you describe when my doc took me off celexa last year when i was manic. I came crashing down and spent a few weeks in the pits.
I hope you feel better. Keep talking to us today and let us know how you are doing!
mellow
Posted by 49er on May 21, 2010, at 7:51:58
In reply to Re: Cymbalta Withdrawal, posted by Elanor Roosevelt on May 21, 2010, at 6:29:43
> Thanks for this post
> I ahve been having these pitiful teary moments, nausea, blurred vision, headaches, and aches just about everywhere else.
> I'm in week 2.5 of no Cymbalta
> When my pdoc suggested going back on I told him he was crazy.
> How much longer must I endure this?Hi Eleanor,
How much were you taking previously?
If you didn't taper slowly, your pdoc isn't as crazy as you might think. It might be prudent to go back to the dose that you were stable at, stabalize at that dose, and taper from there.
I really feel for you and hope things get better.
49er
Posted by manic666 on May 21, 2010, at 7:58:26
In reply to Re: Cymbalta Withdrawal, posted by mellow on May 21, 2010, at 6:41:03
cymbalta an you have ache,s an pain,s//that new it is usually great for ache,s a pains
Posted by Phillipa on May 21, 2010, at 10:52:42
In reply to Re: Cymbalta Withdrawal, posted by manic666 on May 21, 2010, at 7:58:26
Elanor 49er makes a lot of sense. I'm so sorry your're feeling this way. Do you still have to travel? Phillipa
Posted by SLS on May 21, 2010, at 16:13:07
In reply to Re: Cymbalta Withdrawal, posted by Elanor Roosevelt on May 21, 2010, at 6:29:43
> I'm in week 2.5 of no Cymbalta
> How much longer must I endure this?
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? Unfortunately, discontinuation syndromes are variable and difficult to predict. In the past, I have tapered SRIs and BZDs as slowly as was necessary to prevent withdrawal symptoms from becoming too intense. How did you go about tapering the dosage of Cymbalta?
I get the impression that once withdrawal symptoms are allowed to fully emerge due to tapering too rapidly, they are more likely to persist and grow in intensity. Are these symptoms decreasing in magnitude, or are they about the same or even getting worse?
You might restart Cymbalta and find the lowest dosage that will prevent the withdrawal symptoms. From there, you can taper more gradually. You will need to use fractions of pills. I find that you don't have to be so exacting in dividing the contents of pills. I usually just estimate the amount. I will then wait until withdrawal symptoms begin to reappear before taking my next dose. In doing so, I believe that I am tapering as quickly as my system will allow. An alternative approach is to use Prozac as a substitute for Cymbalta and then taper the Prozac. Prozac is usually easier to discontinue, in part because it has such a long half-life. Some people use Benadryl to reduce the intensity of symptoms. I never bothered to research why it works, but it does. It might be due to its ability to inhibit the reuptake of serotonin. I have an interest in knowing if anticonvulsants can reduce the intensity of withdrawal symptoms. I have not found any research indicating that they can. They seem to help with alcohol and benzodiazepine withdrawal. Perhaps glutamatergic pathways are overactive during withdrawal. Anticonvulsants would be relatively easy to discontinue..
Perhaps 49er can offer some suggestions. I will probably disagree with him, but the methods he advocates will probably work. They just take a long time.
- Scott
Posted by Phillipa on May 21, 2010, at 20:58:57
In reply to Re: Cymbalta Withdrawal » Elanor Roosevelt, posted by SLS on May 21, 2010, at 16:13:07
Anticonvulsants for benzos which ones? Phillipa
Posted by Elanor Roosevelt on May 22, 2010, at 5:56:36
In reply to Re: Cymbalta Withdrawal » Elanor Roosevelt, posted by SLS on May 21, 2010, at 16:13:07
Thanks Scott
I do think the discomfort peaked a few days ago. I am taking 800mg of ibuprophen twice a day and that works wonders for the joint pain.I a not willing to touch the cymbalta again and i am bringing down the abilify to 2mg. I have gained 10 pounds in just this month. I weigh 182 pounds and I'm 5'4". I think I shall soon just explode.
In a week the pdoc is going to start me on Parnate(which I know I am at least able to lose weight with)or another weith loss friendly med--damn i can't find where i wrote it downI think I will go with the parnate. i see this doctor weekly and i feel more comfortable this way. Hope to combine a stimulant or adhd med with the parnate
Posted by Elanor Roosevelt on May 22, 2010, at 5:58:01
In reply to Re: Cymbalta Withdrawal, posted by manic666 on May 21, 2010, at 7:58:26
yes, cymbalta is great for aches
then when you withdraw the aches and pain get their vengence
Posted by 49er on May 22, 2010, at 6:27:32
In reply to Re: Cymbalta Withdrawal » Elanor Roosevelt, posted by SLS on May 21, 2010, at 16:13:07
Hi Scott,
I just read Elanor's response about not wanting to reinstate so I will just respond in general terms because I think this is an important issue.
> 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.
Also Cymbalta has one of the shortest half lives of all antidepressants so when you cold turkey this me, you feel it even more than you would with a med that has a longer half life.
Of course, there are exceptions to every rule but that is generally how it works.
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. 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.
If it works, obviously tapering Prozac is alot easier than tapering Cymbalta but it just seems like there are alot of ifs.
Using an anticonvulsant to taper is a bad idea in my opinion. People on other boards have a had a horrendous time getting of drugs like Lamictal.
Be careful with Benadryl as it is an ototoxic medication. If you have developed tinnitus or hearing problems from any med, you will be susceptible to the ototoxic effects.
There is no denying that my method for tapering takes a long time. So what?
This is isn't a race as the goal is to stay off meds.
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.
And people have talked about having no problem tapering quickly the first go around only to do the same thing and then have problem the 2nd time. Is that a risk worth taking?
Personally, I don't think it is but that's me.
49er
Posted by SLS on May 22, 2010, at 6:38:36
In reply to Re: Cymbalta Withdrawal » SLS, posted by Phillipa on May 21, 2010, at 20:58:57
> Anticonvulsants for benzos which ones? Phillipa
Trileptal (oxcarbazepine) has been used.
http://www.ncbi.nlm.nih.gov/pubmed/18821451
- Scott
Posted by 49er on May 22, 2010, at 7:16:17
In reply to Re: Cymbalta Withdrawal, posted by SLS on May 22, 2010, at 6:38:36
> > Anticonvulsants for benzos which ones? Phillipa
>
> Trileptal (oxcarbazepine) has been used.
>
> http://www.ncbi.nlm.nih.gov/pubmed/18821451
>
>
> - ScottThe problem is without seeing the full text, we don't know what happened down the road.
Sure, you can do that and have no withdrawal symptoms but can that be sustained over time? The answer is no from everything I have read.
49er
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?
- Scott
Posted by SLS on May 22, 2010, at 8:30:53
In reply to Re: Cymbalta Withdrawal, posted by 49er on May 22, 2010, at 7:16:17
> > > Anticonvulsants for benzos which ones? Phillipa
> >
> > Trileptal (oxcarbazepine) has been used.
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/18821451
> >
> >
> > - Scott
>
> The problem is without seeing the full text, we don't know what happened down the road.
>
> Sure, you can do that and have no withdrawal symptoms but can that be sustained over time?That is the obvious question.
> The answer is no from everything I have read.
What things?
- Scott
This is the end of the thread.
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