HealingJourney: tapering Cymbalta while bridged to fluoxetine and mirtazapine

[HealingJourney]

Hi all,

 

Thank you for this forum.

 

I was originally put on Effexor (venlafaxine) for pain and depression in 2003 but stopped CT in 2004 and then had withdrawal symptoms until I was put on Cymbalta (duloxetine) in 2005.

 

I felt ready to stop in 2013 and successfully dropped from 90 mg to 60. I then tried to get from 60 mg to 30 mg in 2016-2017 which was harder, and it was suggested to me to take the doses on alternate days which I did for about a year with no success. I now know this was bad advice but that is what I did at the time.

 

Eventually I found an online forum that described opening capsules and creating your own, so in 2018 I started making my own 45 mg capsules, and eventually divided them into morning and night capsules to minimize morning anxiety.

 

In February 2022 I was down to approximately 25 mg but started to experience anxiety. By this time I was counting beads. I tried to increase to the previous dose where I had felt ok but that didn't work, if anything it made symptoms worse with severe anxiety, brain fog and insomnia.

 

I waited for a couple of months to see if symptoms would settle but eventually I went to a psychiatrist for help who bridged me to Prozac (fluoxetine) and Mirtazepine in July 2022. She gradually increased the dose of Fluoxetine and suggested I taper by reducing Cymbalta by 10 beads every week which worked for two weeks when I felt great at the end of July 2022. Then the withdrawal hit me again.

 

I have been waiting for symptoms to settle but that has not happened. Just over two weeks ago my psychiatrist introduced Mirtazepine 15 mg at night to help alleviate withdrawal symptoms, and Olanzapine when needed. 

 

She suggested I taper the remainder of the Cymbalta at 5 beads every 5 days, which I've been doing for two weeks now.

 

I feel strange and slow, find it hard to focus, can't see positives or experience pleasure, wake up in night sweats with anxiety, and only just about manage my affairs. I haven't been able to work since May.

 

I go out for walks and eat healthy, take supplements such as fish oil, vitamin D and B12. 

 

Grateful for advice as to how I should manage tapering off the last of the Cymbalta given the new drugs that have been introduced. Would it help to reinstate Cymbalta at this stage? According to my psychiatrist, it's easier to taper off fluoxetine, which is why she bridged me to it.  

 

Thank you so much for reading this and for your support.

 

 

  

[Altostrata]

Welcome, @HealingJourney

 

It sounds like you are currently under the care of a psychiatrist. Have you discussed your issues with withdrawal symptoms with her? What did she advise?

 

Please stop changing any drug dosage until we unravel this.

[HealingJourney]

Thank you for your reply and the time and care you dedicate to this forum.
 

Yes, I contacted a psychiatrist when withdrawal symptoms became intolerable in June and she bridged me to Fluoxetine to alleviate withdrawal symptoms. She was aware of the withdrawal problems with antidepressants and said she had successfully got several other patients off Cymbalta with the help of Fluoxetine.

 

She started me on a low dose of Fluoxetine, 5 mg and gradually got me up to 20 mg. I stabilised there (felt good again) and then she suggested I reduce Cymbalta by 10 beads per week. That worked fine for three weeks but then full withdrawals symptoms returned.

 

She then suggested I increase Fluoxetine to 40 mg, which didn’t help, and then to 60 mg, which also didn’t help.

 

I was waking up multiple times in the night so she then also added Mirtazepine 15 mg at night.

 

She suggested I continued the taper despite SSRIs not alleviating withdrawal symptoms as I wanted to get off Cymbalta. She suggested to taper by 5 beads every 5 days which is where I am at present.
 

At this rate I should be off Cymbalta by early November and then hopefully be able to stabilise on new meds and then taper off them. The psychiatrist told me it’s easier to come off Fluoxetine.

 

As I’m still waking up at night I also take olanzapine 2.5 mg at bedtime.

 

What are your thoughts?

 

Thank you so much for your help.

[Altostrata]

22 hours ago, HealingJourney said:

That worked fine for three weeks but then full withdrawals symptoms returned.

 

What were the symptoms? How long had you been taking 20mg Prozac when the symptoms started?

[HealingJourney]

I had been taking Prozac 20 mg for a total of about 6 weeks when the withdrawal symptoms returned.
 

I had got relief after about 3 weeks on Prozac as she gradually increased the dose. I then started the taper the psychiatrist suggested, by 10 beads morning and night. I continued to feel fine for 3 weeks of doing this, but then the symptoms returned.

 

The symptoms that returned were anhedonia, brain fog, severe anxiety, difficulty sleeping, tinnitus, sensitive to smell, sound and light.

[HealingJourney]

Sorry, I had been on Prozac for a total of about 6 weeks, gradually increasing the dose, when symptoms returned. I had probably only been on 20 mg for a total of 3 weeks. It’s hard to remember exactly.

[Altostrata]

4 minutes ago, HealingJourney said:

I had probably only been on 20 mg for a total of 3 weeks.

 

This is about the span of time in which a dosage increase would take full effect. What were the symptoms that appeared at this time, the onew you call withdrawal symptoms?

[HealingJourney]

Hi,

 

The adverse symptoms have been the same throughout, and started while tapering down very slowly off Duloxetine. 
 

They are low mood, anhedonia, brain fog, anxiety, tinnitus, difficulty sleeping, sensitivity to sounds, light and smell and an increase in pain from original pain condition.

 

So the Fluoxetine which was instated to relieve these symptoms worked for about 2 weeks at 20 mg, but then the above symptoms returned.

 

The psychiatrist then increased dose of Fluoxetine further.

[Altostrata]

13 hours ago, HealingJourney said:

Sorry, I had been on Prozac for a total of about 6 weeks, gradually increasing the dose, when symptoms returned.

 

This is what you reported. This event occurred in July 2022. What were the symptoms that returned?

 

How did taking mirtazapine and olanzapine in September affect your symptom pattern? Please stop tapering duloxetine for now.

[HealingJourney]

The symptoms that returned are low mood, anhedonia, brain fog, anxiety, tinnitus, difficulty sleeping, sensitivity to sounds, light and smell and an increase in pain from original pain condition.

 

Mirtazepine was instated to help alleviate above symptoms when fluoxetine 60 mg didn't do it. Mirtazepine initially helped me sleep better, but after about four nights I started waking up again. Olanzapine was instated to alleviate severe anxiety (I refused benzos). Olanzapine 2.5 mg at night is helping me sleep better. 

 

 

[Altostrata]

1 hour ago, HealingJourney said:

Olanzapine was instated to alleviate severe anxiety

 

When did this anxiety start? How much Prozac were you taking then? Was it better or worse at any particular times of day?

 

What times o'clock do you take each of your drugs, with their dosages?

[HealingJourney]

The anxiety started in March when I had tapered down Cymbalta to 99 beads at 2.5% increments. This was before Fluoxetine or Olanzapine had been instated. Anxiety was worst in the mornings.

 

I then tried to go back up to the latest dose of Cymbalta where I’d felt stable, which was 107 beads. This didn’t work and made anxiety worse. I tried to hold this dose (107 beads) for 2 months but didn’t stabilise. That’s when I reached out for help.

 

Morning: 60 mg Fluoxetine and 35 beads Cymbalta at 8 am.

Night: 15 mg Mirtazepine, 35 beads Cymbalta and 2.5 mg Olanzapine at 9 pm.

[Altostrata]

13 hours ago, HealingJourney said:

I then tried to go back up to the latest dose of Cymbalta where I’d felt stable, which was 107 beads.

 

Was this after you started fluoxetine? How much fluoxetine were you taking with 107 beads Cymbalta?