Woof: Cymbalta re-stabilization, after cold turkey withdrawal

[woof]

Woof,

 

If you are set on trying to find a level where you see comfort, I would probably increase by 3-5 beads and wait 5 days to see if you improve.  If not, I'd add another 3-5 beads.  Wash, rinse, repeat until you find a level where you feel improvement. If you get through a month going like that and don't see improvement, it probably makes sense to revisit the issue.

 

Best,

 

Andy

I now this was in no way the consensus, but I was in Crisis situation.  So I updosed by 5 beads this Saturday. 

 

Day one and two were no fun at all.  Increased anxiety and Tinnitius and more insomnia.

 

But now after 4 days, Tinnitus is less than it has been in months since July 4th cut.

 

Slept 7.5 hours last night.

 

Most importantly to me is that the Crisis of greatest concern is gone.

 

Anhedonia and loss of appetite are only slightly improved from 10/10 to 7/10.

 

So we will, wash rinse and repeat.

 

Thanks so much for everything,

Woof

[apace41]

As always, Woof, it is your call.  However, if you are feeling something of a "linear" improvement after the increase, i.e., each day seems slightly better than the one before, I would suggest continuing where you are and not doing another increase (assuming that was the import of the last sentence).  I would give it through the weekend and see if you are fully back to where you were before.  Remember that nothing is guaranteed any time you increase the meds.

 

Best,

 

Andy

[woof]

Hi Andy,

 

Yes, you are correct I had been planning to updose tomorrow. 

 

As always, thank you for the sagacious advice.  I will see how how the dysphoria, anhedonia and anorexia progress prior to further change.

 

I forgot to mention that my core body temperature has also come back to about 90% of my normal and my anxiety is down from 6/10 to 3/10.

 

Also, I have stopped having this weird thing happen, where my skin temperature would get icy cold with paraesthesias over my back and arms immediately after I would force myself to eat anything. 

 

Like all of you have always said, one med at a time.  No more Vicodin or anything else as it really makes it that much harder to advise and to take any action; it's confusing enough as it is.

 

Andy, thanks again for being there for me.

 

 

Most Sincerely,

Woof

[woof]

Since Sept 4th updose of 5 beads; depression, dysphoria/anhedonia, and loss of appetite have not improved.  

 

I am also extremely fatigued (not enough Norepiniphrine?) even trying to go on walks and working out as I had been are very, very difficult.  No drive or energy to do anything. 

 

 

On the good side. Tinnitus and Insomnia are back to normal wd.  Still have some anxiety 3-5/10.

 

Core body temperature 90% improved.

 

Crisis mode gone.

 

I plan to updose another 5 beads, from 148 to 153 tomorrow AM, and hold there for 5 days and I will see how things are.  If this updose follows the same pattern as the first one, I know it's not going to be fun at all for at least the first 2 days.

 

All the Best

Woof

[KarenB]

I'd be in favour of waiting a little longer to give further stabilisation a chance, but you are the one who knows all the subtleties about your taper that we cannot know.  I hope it goes better for you.

[woof]

Waited until Oct 6th to updose another 5 beads.   First two days not as bad as first updose - as you know it can be quite activating.

 

Crisis mode, Anhedonia, loss of Appetite and body temperature issues have all returned to normal and sleep has improved.

 

Anxiety still remains a problem 3-4/10, although not increased from pre-updose level.

 

My understanding is that the AD's anxiolytic affects are generally not felt for 3-4 weeks, so I am hopefull that the anxiety will decrease with time.

 

I had planned to updose again in two weeks and slowly continue with the updosing to a full 20mg, (194 bead pill), as I had no ill affects prior to my CT,  and then just stay there and try to stabilize for 2-3 years.  Prior to any further tapers.

 

Any thoughts would be appreciated.

[woof]

I had planned to updose again in two weeks and slowly continue with the updosing to a full 20mg, (194 bead pill), as I had no ill affects prior to my CT,  and then just stay there and try to stabilize for 2-3 years.  Prior to any further tapers.

 

Any thoughts would be appreciated.

Is updosing like tapering in reverse in other words should I wait for at least 4-8 weeks to see how the updose has affected my CNS and also to promote stabilization. 

 

As I said above now the only thing that I have is Anxiety, which I think was primarily from the second updose. 

 

So, should I cut back on the 5 beads of the second updose, to say 2 or 3 beads or just stay here for two months?

 

thanks Woof

[apace41]

Woof,

 

Not sure I understand why you feel the need to go back up to 20mg.  While it is possible you will return to "how you felt" then, it is also possible that you won't feel like that.  I think you are holding onto this idea that you can simply "turn the clock back" and treat it as if this never happened.  The biggest mistake people make in this process is creating false illusions for themselves.  When it comes to the CNS -- there are no guarantees. 

 

It doesn't sound like you are doing all that badly at 15.5mg.  While I'm sure the thought of a "full pill" with no need to count beads seems alluring, if you can stabilize at 15.5 you are putting less drug into your system which, on some level, has to be better for you.  I would vote in favor of your 2 month hold right here to see if you can get that anxiety down from a 3/4 to a 1.  Perhaps adding in some additional "coping tools" would work for you. 

 

Preordaining that you are going back up to 20mg just doesn't seem like the best option for me.

 

As always, my two cents.

 

Best,

 

Andy

[woof]

HI Andy,

 

Your "two cents" are very valuable to me.

 

You are totally correct about the allure of not having to count beads. 

 

I just did not know how good I had it before as, many of you had told me. Again and Again.

 

Thanks so much,

Woof

[woof]

 

Do I need to come off of Cymbalta completely to have a chance at having my current symptoms, hopefully resolve?

 

On the contrary, if I were to hold here indefinitely, could the healing process begin from here and  my current symptoms, hopefully resolve?

 

Woof,

 

One of the great debates that persists in all areas of withdrawal from psychotropic medication is whether or not someone needs to be completely off the medicine in order to heal.  This is a difficult and complicated question.  In my view, the key question is whether your symptoms are coming from withdrawal or from an adverse reaction to the medicine.  Assuming it is the former, there is no reason you should not be able to stabilize prior to getting off the medicine and, given a long enough hold, find a place where your symptoms resolve.  The issue becomes complicated, however, when you are reacting in some adverse manner to the medicine.  If that is the case, you can't expect to feel completely well until the offending agent is no longer being introduced into your system.  This is, however, an area where I'd love to hear what others have to say because I think it is a very interested and complicated area.

 

 

 

If I were to hold here indefinitely, could the healing process begin from here and my current symptoms, hopefully resolve?

 

Does anyone else have any thoughts or experience on holding at a given level (15.5mg for me) and attempting to, in my case, get back to my pre CT status.   I had no issues with the Cymbalta prior to my CT?  I just heard Cymbalta was not good for you. 

 

I did no research myself, doctor said to skip every other day for a week and continue on that pace so after 4 weeks I was done, or so I thought... and I got what I deserved.

 

Thanks Woof

[woof]

If I were to hold here indefinitely, could the healing process begin from here and my current symptoms, hopefully resolve?  vs Tapering all the way off?

[woof]

Second updose was over stimulating no sleep and increased anxiety.  So I had to reduce back down to 148 beads.  I will just have to wait it out as the updosing became intolerable.

[Altostrata]

Sounds like you found your maximum dose, woof.

 

Yes, your CNS can stabilize even though you are taking a drug. It needs stability to adapt to its environment. It will adapt to the lower level of drug. Then you will be ready for another cautious reduction, rocking the boat as little as possible.

[woof]

Thanks Alto,

 

That's what I have been wondering about all along and both you and Andy have now confirmed this, so this will be my new dose.

 

Thanks Again,

Woof

[woof]

Alto,

 

Once my CNS stabilizes to the new dose, is there a problem with me just remaining at that dose indefinitely?

 

I just don't think I am strong enough to take another event like this, I actually reached the Crisis state prior to my update for the first time during this entire proces.

 

Also I have been on 10mg of Lisinopril antihypertensive, as of 2012, it did a great job of lowering my BP. 

 

Is there any interaction with Cymbalta, as far as my wd sx's are concerned?

 

Thanks Woof

[KarenB]

Hey Woof,

 

I'd like to add my experience to Alto and Apace above, and say that a good long hold can work wonders.  I just held 8 months and stabilised beautifully.  I'm so glad I was encouraged to do it. 

 

The problem with staying at that level indefinitely is that eventually you'll start to get side-effects from the drug.  So it's a balance of holding long enough to stabilise, and then working out a very gentle rate of reduction.

 

Karen

[apace41]

Woof,

 

Karen's point is a fair one and I would translate it slightly differently.  You can think of holding and stabilizing at any particular level as being where you were before you ever found SA and ever thought about tapering.  Clearly, there are reasons you and all of us decided we wanted to get off the drug.  That could be that it stopped working (to the extent it ever was), that there were side effects you didn't care for, concerns about long term implications of psych med use, etc.

 

Nothing has changed when you find a level that works and stabilize. Whatever of those reasons existed still exist.  Over time, as Karen suggests, most people find there are side effects (recognized or not) that make them feel "less than they are". 

 

At the end of the day, however, the decision whether to taper or not is an individual one that can only be made by the person in question.

 

Best,

 

Andy

[woof]

Hey Woof,

 

I'd like to add my experience to Alto and Apace above, and say that a good long hold can work wonders.  I just held 8 months and stabilised beautifully.  I'm so glad I was encouraged to do it. 

 

The problem with staying at that level indefinitely is that eventually you'll start to get side-effects from the drug.  So it's a balance of holding long enough to stabilise, and then working out a very gentle rate of reduction.

 

Karen

Karen

 

Thank you for sharing your experience.  It gives me confidence that a good long hold at this level is what I need.

 

Thank you so much for caring about me, Woof

 

At the end of the day, however, the decision whether to taper or not is an individual one that can only be made by the person in question.

 

Best,

 

Andy

Andy,

 

As always thank you so very much for your concern and wisdom.

 

Woof

[KarenB]

Thanks for rounding that out Andy - a helpful perspective. 

 

Woof - you're gonna be fine .

[woof]

Great thanks to you all!   The encouraging words mean so much to me!!!!

 

The following is an interesting (at least to me) article on Anti-hypertensive medications and depression.  I don't know where to put it or if this is already common knowledge.

 

http://www.patientcareonline.com/mental-health/antihypertensives-affect-risk-hospitalization-depression

 

Thanks so much again,

Woof

[woof]

I saw my primary care Internal Medicine Dr. and he gave me a presciption for Trazadone to help with sleep.

 

Then I spoke with a local psychiatrist and he recommended Amytriptiline (Elavil?), he said it would help with my sleep.  I have yet to make an appt to obtain a script.

 

I have not taken any of the Trazadone.  

 

From what I have learned on this site, I think I know what the suggestions will be.

 

Any thoughts?

[apace41]

Woof,

 

You know the answers.  Nobody here is going to recommend you take either med.  Elavil is an absolute and unconditional nonstarter.  The tricyclics carry with them their own set of problems so you would be looking at a second med to taper.  Using Trazadone for sleep is all too common and too many docs treat it as a sleep aid rather than an antidepressant which it is. It is an SARI as opposed to an SSRI (serotonin antagonist and reuptake inhibitor) so its mechanism of action is somewhat different but it hits your serotonin receptors when they are already damaged and sensitized.

 

I would not get involved with either. 

 

How bad has your sleep been and what are you doing for it?

 

Best,

 

Andy
 

[woof]

Hi Andy,

 

Yes, I was a bit disappointed in there recommendations and I totally agree with you.

 

I sleep from 9 PM to 2:30 AM.

 

Andy, could you tell me when and how much do you take of the L-theanine? 

 

I used it once and it helped me to relax and fall asleep, do you happen to know its mechanism of action?

 

Thanks,

Woof

[apace41]

Woof,

 

I take 200mg of Suntheanine brand L-theanine in the morning.  I started when our moderator Petunia had great success with it a while back.  I know it did not turn out to be a miracle for her after a while, and it never was a miracle for me, but I think it provides some additional CNS stabilization for me.

 

It is a mild agonist of serotonin, dopamine and GABA as I understand it, giving you a slight increase of those neurotransmitters without giving you a jolt.

 

Hope that helps.

 

Best,

 

Andy

[woof]

Andy,

 

Thanks for the all the information.  I think I'll give it a try.

 

Woof

[woof]

I just wanted to add this for my ease of finding it's from:

 

 

cymbaltawithdrawal5600, on 18 Jun 2016 - 06:33 AM, said:

If this is already here it bears repeating anyway (courtesy of Brassmonkey) on "Stopping the Anger Spiral":

There are pretty much four steps: 1) identify that it's happening, 2) defuse the situation, 3) change the channel, 4) go on with life.

 

Identifying the situation can be hard at first because it's very natural to fall into the spiral.  A person needs to go through the entire cycle several times to identify the pattern and understand the progression.  I find that I am several minutes into the pattern before I realize that it's happening again. Learning what ones triggers are is a good place to start and previsualizing situations where those triggers might occur.  That way a person can "keep on guard" when those situations arise. It's frequently the little things that set it off.  Getting cut off in traffic, a coworkers off comment, someones tone of voice.  When a spiral has ended I try to go back and coldly analyze it to see what the trigger was for future reference.

 

Defusing the situation is very important especially in "confrontations".  This is a matter of self preservation because things have a bad habit of escalating to violence, and that has a lot of ramifications.  The person who is angry is often deemed the "bad guy".  The one who hits first is always in the wrong, and the like. Because we're in the anger spiral that put us in the center of things and according to society we have to "control our selves".  So finding ourselves in a bad situation caused by our anger spiral we have to take control and make things right.  Trying to talk out way out of it won't work, the spiral is in control making it so we can't think clearly.  The best bet is to just walk away. It is much better to be seen as rude than violent.  Turn, walk away, relax, regroup and if necessary reapproach the subject from a different angle (work related things you just can't get out of) otherwise drop it and move on.

I just wanted to add this to my thread for ease of finding it.

 

 

The key aspect of the anger spiral is ruminating thoughts.  Once the trigger happens it sets off of series of mental events that build out of control. There is the initial trigger which is frequently followed with a small flash of anger and then dropped.  A few minutes later the ruminating kicks in with an "I should have..." followed closely by "that's like when....." "those b******s" "I always get treated like this..."  all these thoughts swirling around and compounding each other.  This builds until there is an explosion.  Changing the channel at "I should have..." is the best way out, but it can be done effectively at any point in the spiral.  As soon as one realizes that the spiral is happening changing the channel is called for. I frequently use a stern "don't go there" close my eyes, deep breath and concentrate on what I'm doing.  While distracted I do deep breathing and progressive relaxation to regain control of my body.  I can take several tries to get control back and I need to keep an eye on things so the spiral doesn't try to sneak in several hours later.  This is the part that takes a lot of practice but with time becomes second nature and very effective.

 

Once the spiral has been broken it is best to just go on with life.  The event happened, it was controlled, it's in the past, move on.  Later, after things have had a while to calm down, the situation can be reviewed in a rational manner to understand how it progressed and what worked to defuse it.  It now becomes a learning situation.  During this analysis it is important to use a cold eye so as to avoid retriggering the spiral.

 

I added emphasis to show the habit of rumination (which can be a CAUSE of depression in the first place) carries on into recovery and controlling it may be a great step in allowing us recoverees to live life without resorting to drugs again."

 

Thanks so much to Brass and cymbaltawithdrawal5600

[woof]

Thanks to all,

 

First two days of Updose of 5 beads on Sept 24th was tough.  Increased anxiety, but since then things have improved greatly. 

 

3.5 weeks after updose: appetite, anxiety, temperature issues and anhedonia have all resolved. 

 

Crisis state state and temperature issues were almost completely resolved 5 days after updose.   

 

Antidepressants certainly are accelerators, but it is my understanding that after 3-4 weeks they also have an anxiolytic affect.

 

Woof doing better

[apace41]

Good to hear, Woof. 

 

Glad you are stabilizing.

 

Best,

 

Andy

[woof]

Thanks Andy!

[woof]

Altostrata, on 03 May 2013 - 2:34 PM, said:

You need to let your nervous system stabilize after reinstating.  Do not attempt to taper again until you feel symptom-free.

I did not see this post on the reinstatement Forum...My fault.

 

Does this mean I should try to get back to my full reinstated dose?

 

Thanks Woof

[scallywag]

No. Hold at your current dose to stabilize.

[woof]

Thanks Scally and to all,

 

I also wanted to say that this is all so very confusing and not, because of SA.

 

When I first came to SA, after a 4 month hold, I was still having morning anxiety and MammaP advised me to cut by 10%, on April 21st,  and my morning anxiety has been completely gone since that day and stayed away for 3 months, until my third 10% cut on July 14th, that is when things got really bad...Crisis state.

 

Thanks Again,

Woof

[woof]

As you all know I had a very bad time after my July 04, cut from 16 mg to 14.5mg: 10/10 Crisis State, Anxiety, Anhedonia, Anorexia, Extreme fear of everything, dysphoria, thermal dysregulation.  The fear and or anxiety made it such that I could not even watch TV. 

 

I fully realize that everyone is unique and there is so much that is unknown in this field of medicine and that Big Pharma does not help the matter.

 

However, I felt I needed to updose as I was in a Crisis state.

 

Sept 24th added 5 beads (143 to 148) beads after 5 days I felt much better: 1/10 thermal dysregulation & Crisis State gone.  After 3 weeks all of the wd sx's from the July 4th cut were gone.

 

Oct 29th added 5 beads (148-153) and that night my insomnia went away and has stayed away for the past 5 days.  This is the first time in a year in which I have not had Insomnia except for one night after my initial cut on April 21st when I first came to SA.

 

Also since the Oct 29th updose my Tinnitus has also gone.

 

And most amazingly I am emotionally, back to normal for me, socializing, laughing, telling stories, joking around and socializing.

 

These drugs are bizzare to say the least and we know so very little about them their affects.  This of course is compounded by the fact that everyone can react differently.

 

I believe the ADs' are initially antidepressants (accelerators) and then after 3-4 weeks act as anxiolytics (brakes).  At least that has been my experience.

 

I don't know if all of this is possibly, because: I did not have a problem with the Cymbalta prior to the CT, that I reinstated at my full dose, that it has been about 10 months since my reinstatement or something else.

 

I don't know what's going on, but I do know that I feel normal...at least for me.

 

Any thoughts or comments would be much appreciated.

 

Thank you all for all of your support, caring and help throughout this most difficult time in my life.

 

Most Sincerely,

Woof

[woof]

I have learned a lot of vital things from SA and I don't know what would have happened without all the love, wisdom and support which I received here. 

 

When I first found SA I was advised to make a 10% cut of my Cymbalta.

 

So, on April 21 2016, I made a cut from 20-18mg (194-19 = 175 beads) and the AM anxiety which I had for some 4 months, resolved the next day and remained gone until my July 4th cut. Also, slept through the night for the first night.

 

At this point in time I believe this process is incredibly individualized, unpredictable and difficult to understand; in large part due to the Med professions lack of knowledge of the meds they are prescribing. 

 

This directly contradicts the most important rule of the medical profession - DO NO HARM.

 

Thanks again,

Woof

[woof]

Oh boy,

 

I now suddenly have bright red blood in my stools for the past two days. 

 

Both times I have updosed I have had a 4/10 headache (HA) for the first two days and have taken one dose of 800mg Ibuprofen and it has handled the HA's.

 

This past Sunday I also ate some spicey Mexican food at 2 PM and had acid reflux all day and night.

 

Can my updosing, the Ibuprofen and the spicy food be the cause of my bloody stools?  I've never had this happen before. 

 

Sorry about TMI, but I am concerned.

 

Thanks Woof

[ChessieCat]

Are you sure it's blood?  It may be ingredients from the food.  You could keep an eye on it over a couple of days to see if it continues.