Finch: Medication Journey

[Finch]

Been at this a while and lurked here on and off over the years, but after my most recent failure to get off Cymbalta I decided to become active here. 

 

Medication and mental health have been part of my journey for the entirety of my life. My mothers side of the family has instances of schizophrenia, depression and anxiety while my fathers side has ADHD and anxiety. I was diagnosed at age six with ADD and placed on Ritalin. I experienced aggressive bouts of anxiety and panic attacks from early on, with most of my issues coming from healthy anxiety and intrusive/ruminating thoughts. I didn't have the vocabulary at the time to tell anyone what was happening specifically, I just came to think of myself as inherently broken. Combined with the mental illness struggles my extended family had gone through with a loved one with respect to schizophrenia, I sort of accepted this as fact for me.

 

Mine was not a kind childhood, as I was bullied extensively by my peers. Home wasn't much better, as my father traveled a lot and my mother was emotional, physically and verbally abusive. I was pulled off of Ritalin at age eleven after my Dad said he didn't recognize me anymore. My grades plummeted and I began to flounder even more aggressively socially. After a number of years, I was diagnosed with Type II Bipolar at age sixteen and was briefly placed on Prozac as a result. I didn't observe much difference and was CT'ed off a year later with growing anxiety issues in tow. From the age of seventeen to nineteen, I had multiple anxiety spirals that prevented me from making a lot of progress in my life. I eventually got my bearings for a six month period before turning nineteen and decided to move away from home.

 

After the move, I began to notice a steady uptick in stress and anxiety that I now recognize as an emotional spiral. Everything came to a head in the winter of 2014, when I went to sleep one person and woke up as someone completely different. My obsessions fully controlled my every thought and led me to be barely functioning. At this time, I was put on Lithium and Lexapro. From this, I was able to even out and continued therapy. I didn't know at the time, but I began to have a number of side effect issues including libido, weight and emotional blunting. 

 

I didn't attend college until 2006, as I had barely graduated high school and had to work multiple jobs while putting myself through community college. This was an incredibly stressful time in my life, and it was hard to keep up with the demands of everyday life. My meds helped, but they were an incomplete solution without effective therapy. Over the years, I ended up on Zoloft and Luvox after eventually bottoming out months/years after a previous CT. Finally in 2015 I decided to stop all medications and CT'ed off Luvox with moderate difficulty. I was able to stay off meds until 2018.

 

My mental health condition started to deteriorate again in early 2018 as a result of stress and anxiety from a number of large life events. It all culminated in summer of '18 when I had some dental work that kicked off a TMJD issue resulting in pain. The first few weeks after the procedure, I was completely fixated on my jaw and eventually worked myself up so much that I began to experience excruciating pain in my left year. After months of going to dentists, I found a specialist who told me that I had arthritic changes in both joints and would have to more effectively deal with my stress and anxiety going forward to diminish its progression. By the time I had begun to see this specialist, I was already back on Lexapro after completely and utterly coming apart with health anxiety and subsequent pain. I was also diagnosed with somatoform disorder in which my anxiety and stress became so extreme that I entered into a pain cycle where anxiety would increase, then pain would increase and so on.

 

I was quickly moved from Lexapro to Effexor by my psychiatrist as she felt it was better suited for my symptom presentation. I continued to struggle with pain and was eventually trialed on Cymbalta some months later as a result. I was told that I likely suffered from some sort of conversion/pain disorder where my mind had been sensitized to feeling and searching for pain. I became obsessed with the possibility of having Trigeminal Neuralgia, as my anxiety and muscle tension would misfire and pinch nerves resulting in numbness, tingling and so on in the left side of my face where I had the dental work done. I went to specialist after specialist searching for an answer to this until my family intervened due to my obsession. Shortly after starting Effexor, I saw a significant decline in symptoms from my TMJD and eventually got treatment that helped get me into remission.

 

At the end of '20, I believed myself to be ready to move off meds again. I had been somewhat familiar with the reputation that SNRIs had and requested the be crosstapered to Prozac. I did not inform my doctor of my intention to stabilize on Prozac for six weeks and then CT. That attempt failed with flying colors. I trialed Amitriptyline during this time, but found the drug to be heavy and sedating. A brief try with Trintellix was attempted as well, with poor results. I opted to return to Cymbalta and by the early Spring of '21, I was back to baseline. Stress from work, the pandemic and financial situation with my fiance led to a brief mental breakdown in the winter of '21 where I entered outpatient DBT. I went from struggling to function and advocate for myself to being the closest to a solid, reliable human being I had ever been. I kept up with therapy weekly, I stayed on my meds and was able to navigate some very stressful life experiences far better than I had been able to at any other point.

 

In October of '22, I decided to change doctors and began to work toward tapering off Cymbalta. What followed was a two month taper from 60mg to 0mg. I was highly irritable, tired and sore but it was very moderate overall. Brain zaps, for example, only lasted the first couple weeks and didn't return. Unfortunately, by early January I began to spiral again after experiencing some ear pain likely from a combination of stress tightening muscles along with allergies. My health anxiety took this as a sign that I again had Trigeminal Neuralgia or that my TMJD condition was in active flare. Instead of being able to distract, I spiraled completely with each passing week becoming more painful than the last. I had been worried about my pain returning, but after 4 weeks of zero pain post-discontinuation I felt that maybe I was in the clear. My anxiety had other ideas and fixated me entirely on the issue and in turn caused my pain to ramp up exponentially as a result. Additionally, the sensations on my face returned as it did during my previous experience with extreme stress which fed the spiral even further.

 

As of yesterday (2/7/2023) I was reinstated at 20mg by my doctor to restabilize. Within hours of taking my first does, my anxiety was cut in half and my pain was similarly dulled. I'm jittery, I'm tired and looking at weeks of side effects while I even back out after nearly 8 weeks off. I'm frankly unsure of what to do and multiple people in my life, both personal and medical, have told me that my being off medication isn't an option for me due to the length and severity of my symptoms over the course of my life in addition to a strong genetic component to my mental health struggles on both sides of the family. 

 

So I'm stuck. I want off, I feel like I want to take control of my life and I had an AMAZING '22 where I built myself up more than I ever had prior. I'm sad at the thought of being stuck on a medication with such a strong side effect profile (poor libido, emotional blunting and weight gain), but I can't ignore the fact that I function better on than off. I'm going to stabilize for the next 6-8 months and will discuss a crosstaper to Prozac with my doctor after I fully stabilize and recover from this most recent attempt. I'm unsure of what the future holds, but wanted to share my story all the same as this has been a hard and conflicted road where the outcome and success are far from certain.

[Altostrata]

Welcome, @Finch

 

It seems your withdrawal syndrome has been somewhat relieved right away by reinstating 20mg Cymbalta. Over the next week or 2, this effect should be getting stronger. Could be 20mg will be sufficient to reverse withdrawal symptoms.

 

On 2/8/2023 at 9:07 AM, Finch said:

I'm frankly unsure of what to do and multiple people in my life, both personal and medical, have told me that my being off medication isn't an option for me due to the length and severity of my symptoms over the course of my life in addition to a strong genetic component to my mental health struggles on both sides of the family. 

 

Most of the members here have been told the same thing. It's not true. You've been on and off many drugs and probably suffered many adverse reactions and periods of withdrawal, which your doctors cluelessly mistook for "relapse".

 

You can decide you've served your time on psychiatric drugs.

 

On 2/8/2023 at 9:07 AM, Finch said:

I'm going to stabilize for the next 6-8 months and will discuss a crosstaper to Prozac

 

Good idea to stabilize for a while. If your intention is to go off antidepressants, you don't need to cross-taper to Prozac, you should be able to taper directly from Cymbalta. See Tips for tapering off duloxetine (Cymbalta)

 

Please let us know when you'd like to taper.

[Finch]

Appreciate the information on the Cymbalta taper! I’ve reflected a lot in the last week since reinstatement and I’m honestly disappointed that I didn’t continue to push through. That comes from my own non-acceptance of my situation, which is something I’ve decided to work on more generally this year as it’s a thing across the board. I’m scared of ‘breaking’ my mind after this experience and it’s causing me to recenter myself to dig in for the long haul taper wise. 
 

I’m going to spend the coming months stabilizing and building healthy with exercise, diet and mental health habits to prepare for a much, much slower taper using that Cymbalta guide. I’ve definitely destabilized myself and dealing with some derealization issues as a result, but every day is a tiny bit better in some way than the last. I’m mentally preparing myself for this being a marathon and not the sprint I thought it could be. I’m also thinking it might be best to leave the Cymbalta alone for the foreseeable future and work on tapering off my Wellbutrin first since that’s the more activating of the two and my primary issue has always been anxiety. I imagine I’ll take another run at tapering towards the end of the year at this point. 

Either way, progress is going to be measured in months/years, not days/weeks like I had planned. Nothing worthwhile is easy and I’m going to see this through!

 

[Altostrata]

You are taking Wellbutrin with Cymbalta?

 

What times o'clock do you take your drugs, with their dosages? Do you feel better or worse at any particular times of day?

[Finch]

I am taking Wellbutrin (150mg XL) with Cymbalta (20mg), yes. I take both around 8am every morning. 
 

Mornings aren’t a lot of fun with a fair amount of anxiety. I tend to be pretty solid in the afternoon and then symptoms ramp up a bit in the evening. I’m getting some days where I feel okay-ish but others where I feel pretty rough. I anticipate this will continue for some weeks as my system adjusts again. 

[Altostrata]

Why do you take the 2 drugs together in the morning? What are the symptoms that ramp up in the evening?

[Finch]

Honestly, that’s just always the way I’ve done it. No reason other than that. 
 

Evening is almost entirely anxiety and racing thoughts, but I also have days where I struggle with feeling flat/disconnected. 

[Altostrata]

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can help identify symptoms that are adverse effects from your drugs.

[Finch]

Will do, I’ll start making notes on that tomorrow. 

 

I’m also starting to suspect that 20mg might not fully stabilize me, as I had been at 60mg for two years prior to the two month taper. Going to talk to my doctor later this week, might need to up the dosage to fully stabilize and come down from there. 20mg pulled me out of a tailspin, but it’s not getting the job done fully. Tracks that my system might be needing more than I’m giving it. 

[Altostrata]

Could be that the drug combination is what's causing what you think is a lack of stabilization.