Adama: hello and question

[Adama]

 

Hello everybody. 

I'm new here as u can see. I feel it's so important that this forum is existed. I'm here because I'm thinking about withdrawal (again). I'm consulting with whoever I can about it. I'm afraid because last time in 2018 was so hard... and then I was back after 4 months to AD. I wish I had all the information I have now. I didn't know what to expect back then and I was very surprised... and I struggled... god knows... now on Duloxetine 30 mg. I saw in the taper strip website that I need to switch to Venlafaxine 37.5 to start the taper... does anyone did it?

 

I started to take AD when I was at the age of 22. after few years of depression episodes that had come and go from time to time. I was lonely and I had so many things to achieve. now at the age of 33, I have all I ever needed and dream of- I have myself developing, I have a partner and dog which I love, I have very good friends, a profession that I proud of myself doing, and I feel quite good. this is why I wanted to withdrawal... and this is why I want it again. am I ready? am I strong enough? why I want to withdrawal? it feels like a tunnel I will get in and never know what it's going to be like when I'll came out this tunnel? am I ready to survive the withdrawal symptoms? do my relationships will get hurt by it? my work? my health? all I've achieved? is it worth it?

 

my main reason to go off AD it's because I feel numb sometimes, far from my feelings, and I'm having to deal with sexual issues that comes with AD. also appetite not that good since I'm on Duloxetine. but I have myself not with anxiety, not depressed, doing all that I want. but... with this "far away from myself" sense. I need to make sure for myself that I know why I want to go off AD. Otherwise, it's not going to work. any comments will be appreciated. 

 

I'm interested by doing a support group in Tel Aviv, Israel. I'm a psychotherapist. social worker and group facilitator. so I really want to know from your experience what work for you in groups and do they have kind of structure? I read Alto's post regard to this- very interesting. and if someone know a group via zoom anywhere in the world, I can participate in, that would be wonderful.

 

it's so important for me being here.

thank u all.

[Altostrata]

Welcome, @Adama

 

We do not yet have a check-in topic for our Israeli members. If you wish, you may start one in our Relationships and Social Life forum, where we have some virtual support groups listed as well. Or, you may wish to start your own and invite our members.

 

First, you should know that emotional blunting is a common adverse effect of antidepressants. Here are only a few of the many references:

 

 

Christensen, M. C., Ren, H., & Fagiolini, A. (2022). Emotional blunting in patients with depression. Part I: Clinical characteristics. Annals of General Psychiatry, 21(1), 10. https://doi.org/10.1186/s12991-022-00387-1

 

Rütgen, M., Pletti, C., Tik, M., Kraus, C., Pfabigan, D. M., Sladky, R., Klöbl, M., Woletz, M., Vanicek, T., Windischberger, C., Lanzenberger, R., & Lamm, C. (2019). Antidepressant treatment, not depression, leads to reductions in behavioral and neural responses to pain empathy. Translational Psychiatry, 9(1), 164. online. https://doi.org/10.1038/s41398-019-0496-4

 

Fornaro, M., Anastasia, A., Fusco, A., Pariano, R., De Berardis, D., Solmi, M., Veronese, N., Stubbs, B., Vieta, E., Berk, M., de Bartolomeis, A., & Carvalho, A. F. (2019). The emergence of loss of efficacy during antidepressant drug treatment for major depressive disorder: An integrative review of evidence, mechanisms, and clinical implications. Pharmacological Research, 139, 494–502. https://doi.org/10.1016/j.phrs.2018.10.025

 

Second, you should know that the statistics of relapse from going off antidepressants are almost universally confounded by failure to recognize withdrawal symptoms. We really do not know how often relapse occurs after long-term antidepressants.

 

Leeuwen, E. van, van Driel, M., De Sutter, A., Robertson, L., Kendrick, T., Horowitz, M., Donald, M., & Christiaens, T. (2021). Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013495.pub2

 

Third, incidence of antidepressant withdrawal symptoms is >45%. 

 

Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, S0306460318308347. https://doi.org/10.1016/j.addbeh.2018.08.027

 

Jauhar, S., & Hayes, J. (2019). The war on antidepressants: What we can, and can’t conclude, from the systematic review of antidepressant withdrawal effects by Davies and Read. Addictive Behaviors, 97, 122–125. https://doi.org/10.1016/j.addbeh.2019.01.025

 

Lastly, we advocate very gradual tapering to avoid those withdrawal symptoms, which may be mistaken for relapse. About your drugs:

 

 

Tips for tapering off mirtazapine (Remeron)

Tips for tapering off duloxetine (Cymbalta)
 

If you are taking mirtazapine for sleep, you may wish to taper off duloxetine first.

 

Please let us know if you'd like to proceed with tapering your drugs.

 

PS Antidepressant-induced sexual dysfunction runs from about 50%-85% incidence.

[Adama]

Hello Altostrata,

Thank you very much for your informative and caring response.

 

1- I would like to do a check in topic for Israeli members. I'll do that.

2- the articles look very interesting, stared reading few.

3- I read the link about tapering duloxetine, I need to think (with my psychiatrist also) whether I'm switching to Prozac (which can be bit problem because I already took it and sometimes it doesn't work again) or do withdraw with duloxetine or another drug. I think I may use the beads counting.

4- I now off Mirtazapine- I took small amount for 2 months for sleeping as "a bridge" till the duloxetine will work and then off it gradually. 

5- I want to start my withdrawal within 1 month, just to see I'm ok the duloxetine and then start. 

 

Thanks

Golan

[Altostrata]

Why are you tapering mirtazapine?

 

Quote

August 18'- taper Cipralex - 5 mg, for a few months, then a quarter of a pill for two weeks then stop Cipralex in the end of Aug 18'- end of September 18'- appearance of withdrawal symptoms, back on AD after four months of emotional rollercoaster
January 19'- starting sertraline (Seranda) 100 mg March 19'- back to Cipralex 10 mg (Serenada didn't work for me)

 

It appears to me your withdrawal problems might have started when you went off Cipralex. The successive drugs didn't "work" because you had protracted withdrawal syndrome from going off escitalopram. How did you feel when you took 15mg Cipralex again in April 2019? 

 

We do not use Prozac as a bridge because it "works" for depression, we use it because it may keep you from having withdrawal symptoms. However, when prescribers start the drug at too high a dosage, it can make people feel terrible, especially if they are already destabilized from withdrawal syndrome.

 

You're feeling less withdrawal since you started duloxetine?
 

If you only started duloxetine, you could probably reduce the dosage right away, this may reduce the adverse effects.

 

If your intention is to stay on duloxetine for therapeutic reasons, please take your questions to your prescriber, that's their job. Please let us know when you want to go off a psychiatric drug.

[Adama]

8 hours ago, Altostrata said:

Why are you tapering mirtazapine?

 

 

Hey

i went off mirtazapine according to my psychiatrist advice- he suggest I'll take the mirtazapine for more 6 weeks since starting duloxetine. it  made me very sleepy- i don't want that.

8 hours ago, Altostrata said:

It appears to me your withdrawal problems might have started when you went off Cipralex. The successive drugs didn't "work" because you had protracted withdrawal syndrome from going off escitalopram. How did you feel when you took 15mg Cipralex again in April 2019? 

 

I agree with you. I didn't feel any difference with the 15 mg.

8 hours ago, Altostrata said:

You're feeling less withdrawal since you started duloxetine?

yes- actually I started to fill less withdrawal since the minute I started mirtazapine. when I added the duloxetine i felt even much better- no withdrawal symptoms.

 

8 hours ago, Altostrata said:

If you only started duloxetine, you could probably reduce the dosage right away, this may reduce the adverse effects.

 

the only reason I want to wait a bit - (2-3 weeks) its because i just went off mirtazapine, and to be careful and go off "one at a time"- i want to wait and see I'm stabilize. I do feel some withdrawal symptoms from mirtazapine- a lot of "chilies" over the body. I guess it will pass and then I'll start tapering duloxetine.

 

Anyways, I'll be glad to participate in one of the zoom support groups, and I'll be happy to learn if there is any structure for guiding such groups so I can open one in Tel Aviv.

 

Thanks

Adama

 

[Altostrata]

So you've gone off mirtazapine but intend to continue duloxetine? Would you like any tapering advice?

[Adama]

20 hours ago, Altostrata said:

So you've gone off mirtazapine but intend to continue duloxetine? Would you like any tapering advice?

Hey, yes of course, I'd be happy to get some advice. thank you

[Altostrata]

When did you quit mirtazapine? Has your symptom pattern changed since then?

[Adama]

i quit mirtzapine a week ago. i feel changes mainly in my sleep (and its also due to the duloxtine- adrenaline)- its hard go sleeping and my sleep is shaky. and a bit more anxious then before.

[Adama]

15 hours ago, Adama said:

i quit mirtzapine a week ago. i feel changes mainly in my sleep (and its also due to the duloxtine- adrenaline)- its hard go sleeping and my sleep is shaky. and a bit more anxious then before.

 

update: 

 

today i felt awful. cried suddenly for few times and was very anxious, nervous, sad. It was very hard. It passed after few hours. Didn't sleep well. I'm afraid it will continue. I think it's a withdrawal symptoms from mirtzapine. I wasn't that careful with tapering. I thought that because it was a low dose of 7.5 and the fact that I took it for just 2 months,  I can do it quickly.  Guess I was wrong.  it was a hard day for me. i'll go back fore 3.5 mirtzapine, sadly.

 

 

Edited August 31, 2022 by ChessieCat
Resized font

[Altostrata]

3 hours ago, Adama said:

i'll go back fore 3.5 mirtzapine, sadly.

 

Good idea. Let us know how you're doing.

 

Some people can quit abruptly, but it looks like you got withdrawal symptoms from going off too fast.

[Adama]

Hello there,

 

today i went to work but after 2 hours i understood i can't do this, crying and agitated and anxious. i went back home frustrated. tomorrow going to have a talk with my psychiatrist. i think i'm going to consult with him maybe going back on Prozac instead of duloxetine. Prozac was the last drug i was o.k with (still sex issues side effects) hope it will work again... i was on for 2 years.

 

with duloxetine- i feel like i don't have appetite- frustrating. with venlelfexin- it was o.k, sex issues side effects.

 

one more consideration for me, its the tapering- as i read and did a dome research i understand that tapering with duloxetine and venelefexin can be much more difficult then prozac. what do u guys think? and of course there is this Mirzapine 7.5/3.5 i don't know what to do with now. i feel its a too big thing to do- the tapering... at least with prozac i can use liquid. (should i post this in antother subject?)

 

thanks a lot

Adama

 

[Altostrata]

You will need to give your reinstatement of 3.5mg mirtazapine a chance. It will take a week or so for it to take full effect.

 

In general, we recommend people not make a lot of drug changes within a short amount of time. You won't know what's causing what. If you start taking Prozac now and you get an adverse effect, you won't know if it's the Prozac or a continuation of withdrawal symptoms from your quitting mirtazapine 8 days ago.

 

Have you ever taken Prozac before?

[Adama]

9 hours ago, Altostrata said:

You will need to give your reinstatement of 3.5mg mirtazapine a chance. It will take a week or so for it to take full effect.

 

In general, we recommend people not make a lot of drug changes within a short amount of time. You won't know what's causing what. If you start taking Prozac now and you get an adverse effect, you won't know if it's the Prozac or a continuation of withdrawal symptoms from your quitting mirtazapine 8 days ago.

 

Have you ever taken Prozac before?

Hey. 

I do. I took prozac before. From 10/2019-09/2021. 

Anyways, Update: I do feel better today today, after taking again the mirtzapin 3.75.  Had a short conversation with my psychiatrist. He said that the 30 MG of Cymbalta I'm taking it is not therapeutic dose, thus I need do take 60 MG. He said it's like I went off mirtzapin without nothing to cover in the back. So he advice to take 60 MG duloxetine and continue with mirtzapin for 6 weeks, then talk to him again. My plan it's do do what he said and If I'll be stable, to start withdrawal,  I don't know which is first. Hope I'm doing the right thing. What do u guys think?

[Altostrata]

10 hours ago, Adama said:

He said that the 30 MG of Cymbalta I'm taking it is not therapeutic dose, thus I need do take 60 MG. He said it's like I went off mirtzapin without nothing to cover in the back.

 

Your psychiatrist knows nothing about withdrawal or tapering. This is not unusual. You got withdrawal from going off mirtazapine too fast, not because of inadequate Cymbalta. Withdrawal is not a "relapse" of depression, which is what your psychiatrist is trying to treat.

 

As for "therapeutic" dose, that is the dosage purported to cancel "depression". It is an arbitrary amount; different dosages will "work" for different people. We do not diagnose or treat "depression" here, so we don't recognize therapeutic doses, only the small amounts that are needed to reverse withdrawal symptoms.

 

As this is a site for going off drugs, if you want to increase your drug burden beyond what's necessary to reverse withdrawal, you will have to work with your prescriber and take any problems about your drug combination to them, that's what they get paid for.

 

Please let us know when you want to unpatient yourself and taper your drugs.

[Adama]

21 minutes ago, Altostrata said:

 

Your psychiatrist knows nothing about withdrawal or tapering. This is not unusual. You got withdrawal from going off mirtazapine too fast, not because of inadequate Cymbalta. Withdrawal is not a "relapse" of depression, which is what your psychiatrist is trying to treat.

 

As for "therapeutic" dose, that is the dosage purported to cancel "depression". It is an arbitrary amount; different dosages will "work" for different people. We do not diagnose or treat "depression" here, so we don't recognize therapeutic doses, only the small amounts that are needed to reverse withdrawal symptoms.

 

As this is a site for going off drugs, if you want to increase your drug burden beyond what's necessary to reverse withdrawal, you will have to work with your prescriber and take any problems about your drug combination to them, that's what they get paid for.

 

Please let us know when you want to unpatient yourself and taper your drugs.

I think you are right and sharp. Thank you. I think he doesn't understand me or my concerns. And he doesn't understand that I want to come off, not to be medicated more. I'm doing well with 30 mg Cymbalta.  Therefore, I'm not going to increase. I want to start taper. On Sunday I'll buy the empty capsules so I can start taper Cymbalta 10%, and stays on mirtazapine 3.75. Is this sounds logic? That ill start the taper with Cymbalta first and keep mirtazapine 3.75? Or should i do the opposite?

 

I'm understanding in the few weeks that I didn't find yet a psychiatrist in Israel who understand about withdrawal and willing to help me with that. I understand it's a rare find.

[Altostrata]

Since you just had a bout of withdrawal from mirtazapine, if I were you, I would not reduce duloxetine right away, let your nervous system rest for a month or more. Then, I would taper duloxetine rather than mirtazapine, to maintain sleep while going off duloxetine.

[Adama]

On 9/3/2022 at 1:30 AM, Altostrata said:

Since you just had a bout of withdrawal from mirtazapine, if I were you, I would not reduce duloxetine right away, let your nervous system rest for a month or more. Then, I would taper duloxetine rather than mirtazapine, to maintain sleep while going off duloxetine.

o.k, thanks, I'll do that. i'll write again when i'll start taper.

[Adama]

Hey

i consulted with Mark Horowitz. he adviced start tapring mirtzapine, so i did. now on 3 mg- liquid version i did by myself. my plan is to taper once at 3 weeks, if it all going well. had several days of feeling depressed, emptiness, lack of meaning, dizzeness. it passed. now feeling o.k overall. my next taper will be to 2.5 at 11/10/22. still taking duluxtine 30 mg.

[Adama]

Hey everyone.

I'm now 2 weeks off mirtazapine. still taking 30 mg duloxetine. having a lot of headaches lately, feeling I need time to rest. although I'm feeling these headaches and some heat in my body, a bit anxious, I'm feeling better in general, much more alive. 

Adama

[Altostrata]

Good to hear. Please let us know when you want to taper duloxetine.