Nivsch: what do you think about reducing 1mg every week

[Altostrata]

As we've said maybe 50,000 times, you have to see how you feel after a drug change before deciding on the next step. THIS IS THE LAW OF DRUG CHANGES.

 

See The Prozac switch or "bridging" with Prozac

[Nivsch]

Ok I am new here I didn't know...

[Altostrata]

You'll have to read the links.

[Nivsch]

1 hour ago, Altostrata said:

You'll have to read the links.

I just finished read it now and ill read it again before i decide. My gut feeling tends strongly to the favor of switching but I will give cymbalta at least more few months of chance and at least till I get to ~30-35mgs.

 

What I am worried about is the withdrawl from noradrenaline which will be (almost) cold turkey if i do that switch, what makes me think about switching to venlafaxine firstly (but this time to 75mg and not 150 cause it from only 30 cymbalta) stay couple of weeks, and only after that start bridging with prozac to make noradrenaline reduction more gentle. Also on venlafaxine i were for 5 years long and on cymbalta i will be in the winter only 10 months so my system maybe will tolerate well switching to venlafaxine first because it probably remember it well. What do you think?

 

Of course i will do it with a psychiatrist that will support my plan. I have my current psychiatrist that have accompanied me last 10 years but she doesn't support tapering for me, so i will have to find a new one. 

[ChessieCat]

I've moved all the posts discussing your questions discussing changing from Cymbalta to Prozac from the Tips for Tapering Cymbalta topic.

 

This keeps your history in one place. 

 

Please ask questions specific to your own situation here in your Introduction topic.  Thank you.

[Nivsch]

On 8/3/2020 at 2:02 AM, ChessieCat said:

I've moved all the posts discussing your questions discussing changing from Cymbalta to Prozac from the Tips for Tapering Cymbalta topic.

 

This keeps your history in one place. 

 

Please ask questions specific to your own situation here in your Introduction topic.  Thank you.

Ok no problem

[Nivsch]

If I have restlessness in my body and urge to walk all the time, maybe akathisia, and It happened 4 days after I reduced the dose by 1% to 51.3 -

1. Is it probably a withdrawl symptom?

2. Can I try magnesium citrate or that its a sign to taper even slower (0.5%)?

Note #1: I had those kind of akathisia evenings even BEFORE I started tapring (then i took the drug in the evening), but this week i think its a little stronger. 

Note #2: This week I started to take the drug in the morning and the restlessness appears more in the middle of the day so i think its probably (or at least partially...) an effect of the drug itself.

[Altostrata]

2 hours ago, Nivsch said:

This week I started to take the drug in the morning

 

Yes, changing your drug schedule dramatically can cause worse symptoms. Some people get withdrawal symptoms if they're late by only an hour. And you did this at the same time you made a reduction, which complicates your situation considerably. As you may recall, we recommend making only one change at a time.

 

Perhaps you missed this

 

Symptoms from your change in drug schedule may settle down in a week.

 

2 hours ago, Nivsch said:

Note #1: I had those kind of akathisia evenings even BEFORE I started tapring (then i took the drug in the evening), but this week i think its a little stronger. 

 

When did these feelings start?

[Nivsch]

@Altostrata

OK this explains some things. I read this guide but it helped to read it again. Also this week I made some change in nutrition (back to heavy meals to couple of days) and I suspect maybe it caused the akathisia because its not the first time when my symptoms appears just after this kind of meal. So this week I will remove this food completely, see whats happens, and update next week.

 

58 minutes ago, Altostrata said:

When did these feelings start?

 

In April when I was like a month after I started cymbalta. I think this drug is maybe too stimulating to me.

It will sounds a bit unrational but I am a little afraid to switch to another drug because AFTER I moved to cymbalta, I learned that this is almost the only drug which doesn't make QT prolongation. I know that only Celexa does something significant to the QT and all the rest drugs do an unsignificant prolongation, but for me because of my OCD and anxiety it still make me stressed. Thats why If I will decide to move back to SSRI and switch to proczac, it will be only after cymbalta will be reduced to 30 or below, so the prozac will be only on 10mg, and then it will be ok to me to switch because of the low dose i will not be stressed from the QT issue.

 

thanks!

[Altostrata]

More likely the drug changes caused an increase in your symptoms rather than food.

 

If you've had these symptoms of activation since you started Cymbalta, they're from Cymbalta.

[Nivsch]

1 hour ago, Altostrata said:

More likely the drug changes caused an increase in your symptoms rather than food.

 

If you've had these symptoms of activation since you started Cymbalta, they're from Cymbalta.

is there a difference in how much stimulating is the drug between if I take it with food or if i take it on empty stomach? Because this week because of the transition to the morning, it also made me take the drug (capsule with enteric coating) on empty stomach. The transition to the morning was aimed to make me less stimulated in the evening.

[Altostrata]

Ask your pharmacist if the drug should be taken with food.

[ChessieCat]

 

8 hours ago, Nivsch said:

I start to think there is no future to keep tapering this absurd pill.

 

I will give it one more try next week, if it keep be the same i will try 0.5% (~one bead) every 3 days and if IT also won't be good i will do a switch. 0.5% every 4-5 days will be too slow and I dont want to be in 30mg only in october 2021... there is also a limit to how SLOW I can tolerate (not only to how fast)

 

"there is also a limit to how SLOW I can tolerate"

 

Most of the members of SA can easily say:  'we hear you and we understand'.

 

I'm currently taking 0.75mg Pristiq.  Original dose 100mg.  It seems really stupid to be taking such a tiny dose.  And it's going to take me at least another year before I'm off.  But I'd rather go slowly and get off eventually with as little discomfort as possible.

 

If you need to go slower, go slower.  Even reducing by a small amount is reducing your drug load.

 

Some members find that there are doses that they have difficulty getting past.  Once they get past it they are able to go faster.

 

And I find it better to look at how much I've reduced my drug than to look at how much I still have to go.

 

Do you take your dose at about the same time every day?  Because of the short half life of Cymbalta you might want to split your dose (move part of the dose by 1 hour each day - if your sleep starts being affects move the last dose back 1 hour).  Remember to only make one change at a time.

 

QUESTIONS:  There may be something else which is causing/contributing to your symptoms.

 

Are you taking anything else?  Do you drink caffeine, eg coffee, cola drinks, energy drinks?  Do you consume alcohol?  Do you eat foods containing MSG, eg Chinese food, savoury snacks etc?  Do you drink diet beverages containing artificial flavouring?  Do you smoke?  Are you getting some gentle exercise every day?  Do you overdo exercise?  Are you eating a healthy diet?  Do you eat regularly throughout the day (drops in blood sugar can affect how you feel)?

 

 

[ChessieCat]

Q:  Do you take any vitamin B?

[Nivsch]

10 hours ago, ChessieCat said:

Do you take your dose at about the same time every day?  Because of the short half life of Cymbalta you might want to split your dose (move part of the dose by 1 hour each day - if your sleep starts being affects move the last dose back 1 hour).  Remember to only make one change at a time

 

Yes until I started to feel evening is not good and I turned it to the morning (at the beginning of august) but then it got worse and the restlesness spreaded to the whole day so this week I turned it back to the evening ~18:30 and I will stay in it and not change it anynore.

 

10 hours ago, ChessieCat said:

If you need to go slower, go slower.  Even reducing by a small amount is reducing your drug load.

 

Doesnt it better to let a long half-life pill to tell me the phase I can go, and not a crazy pill?

 

10 hours ago, ChessieCat said:

 

Are you taking anything else?  Do you drink caffeine, eg coffee, cola drinks, energy drinks?  Do you consume alcohol?  Do you eat foods containing MSG, eg Chinese food, savoury snacks etc?  Do you drink diet beverages containing artificial flavouring?  Do you smoke?  Are you getting some gentle exercise every day?  Do you overdo exercise?  Are you eating a healthy diet?  Do you eat regularly throughout the day (drops in blood sugar can affect how you feel)?

 

No take something else. I reduce to almost zero the caffeine (just a little dark chocolate). No alcohol. No MSG. No artificials. No smoking. Yes from this week the excercise is regular because of the restlessness from the pill. No overdo I discovered that walking for 1.5 hours but in just moderate phase do better to me than fast walking.

 

Yes mainly 801010 Raw vegan these days and a little cooked because I suspect heavier foods also trigger my symptoms. Next 2 weeks i will know if the symptoms are from the reduction or not. If the reduction will be felt good I will know that the food is the problem. If the reductions even of 0.5% under 801010 diet wont be good I think i will make a switch to another drug.

[ChessieCat]

5 minutes ago, Nivsch said:

If the reductions under 801010 diet wont be good I think i will make a switch to another drug.

 

2010-2015 Cipramil 20-40mg. half-year break in the middle which was tough.

2015-2020 Effexor 150-200 mg. 225 for a period than stabilized in ~187.5 (1.25 pills) for 2 years than reduced to ~168.5 (1.125 pills).

3.2020 - Cymbalta 60mg.

 

Q:  Why did you change from Cipramil to Effexor and then to Cymbalta?

[ChessieCat]

1 minute ago, ChessieCat said:

2015-2020 Effexor 150-200 mg

 

Q:  When in 2020 did you stop taking Effexor?

 

Q:  How did you make the change from Effexor to Cymbalta?  Please write dates and doses of each drug.

[Nivsch]

41 minutes ago, ChessieCat said:

 

2010-2015 Cipramil 20-40mg. half-year break in the middle which was tough.

2015-2020 Effexor 150-200 mg. 225 for a period than stabilized in ~187.5 (1.25 pills) for 2 years than reduced to ~168.5 (1.125 pills).

3.2020 - Cymbalta 60mg.

 

Q:  Why did you change from Cipramil to Effexor and then to Cymbalta?

 

First 2 years (2010,2011) with cipramil were good to very good. After this the effect reduced and reduced with anxiety crawling slowely back I updosed to 2 pills. and in mid 2013 I started to be obssesed (i have ocd after all) about stopping the medications and i tapered very fast so to tapring from 1 pill to zero was only in one month.The half-year without drugs was very tough so i returned to cipramil in 2014.

 

Cipramil to effexor in 2015 because of the anxiety got worse. The effexor reduced the anxiety well but only for the first couple of months. But then 2016 on the effexor was even worse than in the cipramil.

 

Then I started mindfulness every day as the psychiatrists asked me to do, and 2017,8,9 were better but still with couple of tough months every year. And then 2020 came in and all the anxiety-ocd-mood swings was back in the full strengh so I went to the psychiatrist and she gave me cymbalta in March 2020 in cross tapring of a week. Half cymbalta 60 + vanlafaine 150 for a week then only cymbalta 60.

 

After 2 months I asked her to support a very-very-super slow tapering. She refused because "as i know you and the OCD syndrom I will not support this" so i do it without her. What can i do that I today feel worse than before the drugs in 2009? In 2009 at least it was very episodic, but last 4 years and especially 2020 it feels to me much more chronic. In 2009, at least as i was more normal with less ocd. Sure I had ocd. But much less intense. Thats what I FEEL. The doctor will sure say i am not objective but thats what i strongly feels.

 

There is always a phobia in the background (health anxiety / fear of flying) that get me obssesed and feared daily. But also it changed itself often to more forms. But in the last 4 years the sense of phobia in the background got very chronic! And the moods swings are MUCH more fast.

 

Its clear to me that the content of the fears it just a mask and not the real thing which is the anxiety and ocd.

 

So now i AM obssesed with the tapering but do it very slow and listening to my body, do mindfulness and makes my diet better and want to recover from that 10 years on meds that were enough for me.

[Nivsch]

Also I feel I live my life 50% and even less of what i want, have social relationships as like 25%-50% of what i want and generally i feel 25%-50% fulfilled in my life right now. Like there is an invisible cloud between me and my life that doesnt let me really live and "touch" my life and enjoy them. Like a berrier. It must be changed.

Im 32 years old.

 

Last month i feel an improvement in the thoughts, even tough the restlessness is worse still the thoughts are better and overall it feels like a net improvement.

[Altostrata]

@Nivsch, you switched from Effexor to Cymbalta in March, is that correct? How did you feel after you made this change. Why did you decide to go off Cymbalta in May?

[Nivsch]

4 hours ago, Altostrata said:

@Nivsch, you switched from Effexor to Cymbalta in March, is that correct? How did you feel after you made this change. Why did you decide to go off Cymbalta in May?

Yes. I felt bad again since January and because of that I went in mid March to the psychiatrist and she recommended me to switch to cymbalta. 

After the change to cymbalta I think I felt a little better at least part of the time and only in the first couple of weeks, but during all that time, and even from February before the meeting, I started to think that maybe staying on drugs for 10 years IS part of the problem, and in May I decided i want to start tapering, not specifically because of cymbalta but because the drugs in general and the thought that maybe 10 years of drugs made my mental health worse.

[Altostrata]

19 minutes ago, Nivsch said:

Yes. I felt bad again since January and because of that I went in mid March to the psychiatrist and she recommended me to switch to cymbalta. 

 

In January, you were taking Effexor, correct? Did you accidentally skip any doses? Did you try to stop Effexor?

 

Did you feel better or worse after you started taking Cymbalta?

[Nivsch]

1 hour ago, Altostrata said:

 

In January, you were taking Effexor, correct? Did you accidentally skip any doses? Did you try to stop Effexor?

 

Did you feel better or worse after you started taking Cymbalta?

 

No I didnt try to stop. During the years of the effexor there were doses I skipped here and there, but only here and there. Not as a routine. Maybe one dose every couple of weeks or every month+. I dont remember something different in January 2020. In january i still took effexor.

 

I had some sort of hypomanic period in october-december 2019 that as it naturally tend to happen with me - made the next period the opposite - anxiety, some crying spells, bad emotions etc at the beginning of 2020.

 

After I started taking cymbalta I think I felt a little better part of the time and only in the first few weeks. After that - similar to vanlafaxine i think. The desire to taper started in february when i still took effexor but i didnt stop at all and didnt do any tapering before May. and in the meeting with the psychiatrist I said i want to be less and less dependent on the drugs as time goes. She accepted to replace part of the cymbalta with 5htp if i want in the future and I just started cymbalta 60mg.

 

The cymbalta for me was aimed only to short term relief. I wanted to taper off my addiction built from 10 years on drugs anyway.

 

During the last few years also I had worse digestion difficulties that Im sure caused but the drugs that slowed the gut movement and made "traffic jams" in my stomach that made the problem worse during the years and i mention that because i think its also caused my mental issues to get worse. 

[Altostrata]

Is it possible your hypomanic periods were related to skipping doses here and there while you were taking Effexor?

 

It's important you not skip doses of Cymbalta. Please take it at the same time each day.

[Nivsch]

10 hours ago, Altostrata said:

Is it possible your hypomanic periods were related to skipping doses here and there while you were taking Effexor?

Maybe. I dont know.

 

10 hours ago, Altostrata said:

 

It's important you not skip doses of Cymbalta. Please take it at the same time each day

 

Actually when on cymbalta I never skipped any dose at all.

Just the changes in the schedule last 2 weeks that are over.

There was a change between evening and night in april for 1-2 weeks.

May-June were 100% consistent - every day at 20:00.

July the same just in 18:30 most of the time.

Still had ups and downs in my mood which lasted (each cycle) days/1-2 weeks in every one of this months. Before the tapering and during it.

[Altostrata]

On 8/15/2020 at 3:39 PM, Nivsch said:

After I started taking cymbalta I think I felt a little better part of the time and only in the first few weeks. After that - similar to vanlafaxine i think.

 

Please explain what this means. What do you mean by "similar to venlafaxine"?

[Nivsch]

8 hours ago, Altostrata said:

 

Please explain what this means. What do you mean by "similar to venlafaxine"?

 

When I started cymbalta it improved a bit mainly in the 2nd week and also in 3rd week i think but the essense remain the same. During all that first months on cymbalta the "toughts pressure" was high and I was obssessed only about one thing - the change in diet i will do and the waiting until 4-6 weeks will pass and ill know cymbalta didnt help and then i will do the diet (because i felt i must know the diet helped and not the pill) and etc... the content is less important just the fact that the ocd was still remaining on the same intensity. There were also couple of evenings with crying during these months on cymbalta. I mean that the instability in emotions + the ocd - all that things were on venlafaxine (2016 - mid march 2020) and continued to be also during the months on cymbalta (mid march 2020 - today).

 

First half-year (2015) on venlafaxine was ok to good. After that - not good and even worse then the cipramil. I wrote a detailed message as a response to ChessiCat's question about all the years. Here:

 

 

[Nivsch]

During 2015-2020 - sometimes i bought "viepax" (the name of effexor here in Israel) and sometimes its generic - "venlafaxine".

 

During march 2020 - today - I buy always the generic of cymbalta "duloxetine".

[Nivsch]

I know I gave a long answer relative to your question haha but I didnt know exactly what you didn't understand so I told the whole story.

[Nivsch]

May I switch back to viepax and stay for a while before swtiching to prozac?

 

I afraid the switching from cymbalta to prozac will cause noradrenaline strong withdrawal.

 

I suspect i cant tolerate cymbalta reductions I feel worse this week even after two 0.5% reductions. Emotionally less stable and worse thoughts.

 

I need 1-2 more weeks to be sure.

[ChessieCat]

Because your brand name drugs are different from the names used in many other countries, when posting about your drugs please ALWAYS use the drug names, ie venlafaxine instead of Viepax, .

 

This will be less confusing for us.  It will also save time and cause less frustration for the mods because we have to keep looking to see what the drug the brand name is that you are talking about.

 

Thank you.

[Nivsch]

26 minutes ago, ChessieCat said:

Because your brand name drugs are different from the names used in many other countries, when posting about your drugs please ALWAYS use the drug names, ie venlafaxine instead of Viepax, .

 

This will be less confusing for us.  It will also save time and cause less frustration for the mods because we have to keep looking to see what the drug the brand name is that you are talking about.

 

Thank you.

Ok i didnt know this caused confusion No prob👍

[Altostrata]

We've given you our best guess about what you might do. A switch from duloxetine to venlafaxine might cause you problems. Venlafaxine is also difficult to taper.

 

It looks like you change your dosage every week. We advise against frequent drug changes. You might hold at one level for a month, let your nervous system settle down.

[Nivsch]

1 hour ago, Altostrata said:

We've given you our best guess about what you might do. A switch from duloxetine to venlafaxine might cause you problems. Venlafaxine is also difficult to taper.

 

It looks like you change your dosage every week. We advise against frequent drug changes. You might hold at one level for a month, let your nervous system settle down.

 

1. Do you mean that for example, 1% per 8 days is better than 0.5% per 4 days because it gives more time to rest even if its the same phase in both cases?

 

2.  A question about absorption:

Can the amount of the duloxetine i take, be absorbed in my body a little different everytime, especially if I have gut issues and difficulties to empty the gut (because maybe mocous or other stuff that started within the years on the drugs)?

 

There are ~235 beads in my current dose, and it seems to me, intuitively, that changes between the days of about 1 to couple of beads in average in the absorption ability are likely to happen. Maybe im wrong but thats what i think.

 

3. Can the fact that i am tapering the generic  duloxetine (and not the original - cymbalta) might make problems and inconsistency in the active ingredient in my body?

 

 

 

[Nivsch]

2 hours ago, Altostrata said:

We've given you our best guess about what you might do. A switch from duloxetine to venlafaxine might cause you problems. Venlafaxine is also difficult to taper.

Even if in march I moved from venlafaxine to duloxetine wothout problems? There were no problems.

 

The thing is: I am SCARED to stay on duloxetine because my brain will adapt too much to the noradrenaline that switching to prozac in the future will be maybe problematic if i will decide to.

 

Thats why i want to go back to venlafaxine to cause a GENTLE reduction of noradrenaline (because venlafaxine is still noradregenic but obviousely less) and from there switch to prozac (maybe) in the future if i wont be able to taper slowely. I have been on venlafaxine for 5 years very long time so my system probably remember it well and will adjust well because of this, i think.

 

And now im only 5 months on duloxetine so maybe its time to act NOW to stop the noradrenaline addiction before it will be more difficult in the future.

 

And as i see duloxetine is really activating me physically (as i wrote in our discussion above) so maybe its by itself part of the anxiety and difficulty to taper and what i see is not only the withdrawal but withdrawal mixed with anxiety from noradrenaline.

[Altostrata]

Changing your dosage every few days will definitely cause the amount of duloxetine in your bloodstream to fluctuate.

 

Not sure why you're here and asking us questions. I've given you my best guess. I'm not going to argue with you about switching back and forth from venlafaxine. 

 

Please make your own decisions.