ac612: Introduction/side effects from Cymbalta & Effexor?

[ac612]

Hi from Minneapolis!

I just joined this group and hope some of you can help me. I'm currently on Day 6 of tapering off Effexor (venlafaxine) ER back to citalopram (which I was recently on for 7 years with no major problems).

 

Here's my story: I was put on citalopram in 2009 for situational depression (now I question if I even should've been put on it by that primary care doctor I no longer see). I didn't have any weird side effects or problems the entire time I was on citalopram, except for the couple of times I tried to taper down and off it. Like clockwork, about a week after I had decreased the dose I'd start having anxiety. So then I'd go back up to my usual dose.

 

Anyway, a year ago I started having very bizarre and excessive sweating (only from my head) and what I thought might feel like hot flashes (I'm in my mid 30s, and not in menopause). I was living in NYC at this time and wound up not being covered by my insurance there (another long horrible story), so I couldn't get the sweating/hot flash thing sorted out. I also have rheumatoid arthritis, which I've had since I was 18. I wound up moving back to Minnesota September 1st mostly due to my RA flaring up really bad.

 

Once I got home I started making doctor appointments and had MANY tests done for the sweating problem which all came back just fine (I saw my primary care internist/rheumatologist/endocrinologist/gynecologist). The last person I saw was a pharmacist who works at my primary care clinic (at the University of Minnesota). The pharmacist thought that I had developed a sensitivity to serotonin (NOT serotonin syndrome).

 

The pharmacist had me taper off citalopram and switch to Cymbalta (duloxetine), starting at 30 mg and then tapering up to 60 mg. I started doing that around the end of November. Sometime in December I was at the full 60 mg and off the citalopram. Well, I started noticing I was having a lot more anxiety than normal in Dec/Jan/Feb/March. I had to go on short doses of Ativan and Xanax which I don't usually take.

Finally around March 23, I think, I saw a different primary care internist (only have seen him a few times in my life) because he was closer to where I live. He told me that I shouldn't be on Cymbalta and that Effexor would work better, so he gave me an rx for 75mg capsules of Effexor ER with instructions to taper from the Cymbalta. It was about a 2-3 week taper/transition, I think.

 

**Note: Turns out the sweating/hot flashes was from me taking hydrocodone (vicodin) for my RA pain, and not from the citalopram**

 

Around the 26th of April I started having really BAD, abnormal anxiety: racing heart, extreme jitters, irrational scary thoughts racing through my head, feeling like my head wasn't attached to my body (depersonalization?). Then I began also having extreme depression, with nearly constant crying. I felt like I was losing my mind or something. It was terrifying. I tried taking Xanax but it did NOTHING. That Friday I wound up going to the behavioral ER, which I've never done before. The psychiatrist I saw thought I was having vicodin withdrawal (I had recently quit it cold turkey), but deep down I didn't think that was it (I have gone off it before with little problems).

 

Luckily I got in to see a psychiatrist (for the first time) a week after my ER visit. I like her and I feel like she really cares and wants me to get better. I also felt like she believed me when I said I thought the Cymbalta and/or Effexor was causing my extreme anxiety. So, she's now helping me get off the Effexor and back on citalopram as the first step.

I do feel better today, although I don't feel "normal." I still feel anxious and I still have the irrational thoughts/fears going through my head, but I'm no longer walking around the house sobbing. I had also lost like 10-12 lbs in two weeks when the anxiety was at its worst--my appetite was totally gone. That's never happened to me before. Also scary. My appetite has come back somewhat, which I hope is a good sign.

 

So, I guess I'm posting my story here (I'm sorry it's so long!) in the hope that others can relate to what I've been experiencing. I do have some anxiety anyway, but before this "THING" hit me in April, earlier in the month I was busy working, I traveled to Chicago for a conference I was excited for, and I was riding my bike about 5 miles every day. Since the severe anxiety/depression hit, I haven't been able to work or barely leave the house. I haven't been able to drive. I've mostly been curled up on the couch waiting until it's night so I can go to sleep and get relief.

 

Luckily my parents and my sister have been helping me out during all of this. I REALLY hope it's the Cymbala and/or Effexor that's causing this and it's not just ME. I feel like it must be, due to the severity. I also suspect that I'm sensitive to these types of drugs and anything that can increase anxiety (I had a very bad experience 5 years ago with thyroid medication, I'm sensitive to sudafed, coffee, marijuana).

 

Thoughts?? Hope? I can't wait to get off Effexor, but I'm also really scared of withdrawal and scared that I won't feel normal again.

 

-angela

 

 

[AliG]

Hi Angela.     Welcome to S.A.   You will receive plenty of support and encouragement here. It's not surprising that you are having withdrawal symptoms as you have had quite a lot of drug changes over a fairly short period of time. Your nervous system is most likely struggling to adapt to all the ups and downs .We recommend the 10 % taper method . This enables you to slowly taper in a safe way that doesn't destabilize your CNS.

Why taper by 10% of my dosage?

 

Back In March , when you came off the Cymbalta,  over 2-3 weeks, how did you taper?  Was it alternate dosing ? As in - alternate days or doses ?

Do you intend to eventually taper off the Citalopram  as well ?

Once we have a little more information, we can make some suggestions.

 

If you have a read of these links , it will help you to understand a little more of the process. This is your thread to journal your progress and ask questions. Please come back with any other questions .

Ali

 

What is withdrawal syndrome?

Neuro emotions

Brain Remodelling

 

Tips for tapering off Effexor and Effexor XR (venlafaxine)

[KarenB]

Hi ac and welcome from me too.

 

I'm also tapering effexor, and you are right that it is hard.  BUT - it is doable!  AliG gave you some good reading to start with because having the right info really makes a difference.  Slow tapering and carefully thought out decisions will help you get through this. 

 

Something I'd like to tell you (cause I really wish my doctor had told me) is that once your system gets destabilised then it is very unlikely that a different drug will work for you.  From that point onward, further drug changes lead to more instability and a more complicated situation to taper from.  So citalopram may not end up being answer.  I switched drugs a few times before realising my only real option was to get off everything - and by then I was in a worse position than ever before. 

 

So to deal with my depression, anxiety, exhaustion etc I started to build up a nest of self-care tools and supportive elements in my life.  There's heaps of ideas here:  http://survivingantidepressants.org/index.php?/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/page-2

 

Welcome to s/a

Karen

[nz11]

Hi Angela, I also welcome you to sa

I am so sorry you have had to go through this.

 

I find it odd that a pharmacist can just step in and take over control of your drug intake and even tapering.

 

My guess is the one month or less taper off citalopram in dec 15 was very misinformed and has triggered serious ssri wdl and the cymbalta didnt cover the symptoms.

 

[psychiatrist] told me that I shouldn't be on Cymbalta and that Effexor would work better, so he gave me an rx for 75mg capsules of Effexor ER with instructions to taper from the Cymbalta. It was about a 2-3 week taper/transition, I think.

Wow thats a big call 'effexor  would work better than cymbalta' i wonder were they are getting that info from or how do they reason that? Personally i think they are just guessing.

 

The pharmacist thought that I had developed a sensitivity to serotonin (NOT serotonin syndrome)

If that is the case then why double down on the serotonergic chemicals because taking citalopram and ven together opens one up to the definite possibilty of serot.syndrome.

 

 So, she's [pdoc] now helping me get off the Effexor and back on citalopram as the first step.

 

I think that is probably a good plan to get back to stability on the citalopram alone and then taper off it safely (you may have to put aside several years to do it) as per sa advice.

In the meantime whats the taper plan to remove the venlafaxine?

 

A really cool tool is the drugs interaction checker its a good idea to run everything you are taking through it and copy and paste  the result in your thread.

http://www.drugs.com/interactions-check.php?drug_list=679-0,2874-0,2296-0

 

As well as the great links AliG gave you another  very good one is the checklist for wdl symptoms,

Dr. Joseph Glenmullen's withdrawal symptom checklist

Note crying spells is number one on the list.

 

so glad you found sa.

 

Edit: oops karen posted while i typed...hey im not getting the little notification that appears when someone posts while one types...has it gone or maybe its my computer.

[KarenB]

NZ - that notification function seems quite intermittent of late.  Trips me up sometimes too.