4eversick: Tapering Duloxetine/Cymbalta

[4eversick]

Hi all,

 

I just recently found this site while looking into SSNRI withdrawals. I'm glad it's here. 

I have been taking duloxetine for fibromyalgia pain for about 2 years (30mg/day). I haven't noticed a marked difference in pain levels since taking the drug, but it did help with my anxiety. When I started taking duloxetine, I had some pretty significant bruising from minimal activity. This was concerning but it eventually went away. I have a lot of other health issues to worry about, so I kind of forgot about it. 
 

However, a couple months ago the bruising started again. Around the same time, I was dealing with mood changes. My mood would be uncontrollably low, and I couldn't manage it with the coping skills and exercises I've built up over the years. I asked my doctor to help me wean off of Cymbalta. The options she gave were taking my 30mg dose every other day, or switching to 20mg/day for two week and then taking 20 mg every other day. I did the latter.

Switching from 30mg/day to 20mg/day was easy. I had some minor brain zaps and dizziness but it was manageable for me. Once I started taking 20mg every other day I felt like I was in hell. I suffer from different neurological conditions and types of chronic pain, which I've learned to manage the best I can. These withdrawal symptoms, however, were unmanageable. My cognition was so impaired I could barely hold a conversation, I couldn't swivel my head to talk to someone without extreme dizziness and brain zaps. I couldn't even walk. Every time I tried I'd get dizzy and nauseated. I could barely eat and I was constantly dry heaving. Certain types of pain I deal with also got worse. 

I messaged my clinic, but it took days for them to get back to me. I had already found this website and mentions of tapering in academic journals, so I was already tapering my doses. The doctor at my clinic told me the only thing I could do is take a 20mg dose every 36 hours instead of 48 hours. I told the clinic I was already tapering my medication- with positive results- and they warned me against it. They told me that what I was doing was dangerous because I was going to receive an entire dose at once (even though I'm still using the time-release capsules the original medication comes in). They told me that I'm not getting close to approximate doses by counting beads. My primary care provider (PCP) then messaged me telling me that my only options were to completely stop the medication or stay on the 20 mg dose. I am so angry. 

I really fear that I'm going to be labeled a non-compliant patient (which is a very loaded term, especially for marginalized people) and "fired" by my primary care provider. As someone who relies on an entire care team, losing my PCP would absolutely destroy the years of work it took to find people who didn't tell me it was all in my head; people who have been willing to order tests which have shown again and again that I have very real, complex health issues. At the same time, I don't want a PCP who would rather keep me dependent on a drug than allow me to taper because the clinic doesn't want the legal liability. 

Anyway, what will happen with my PCP will happen- I can't control it. On the bright side, tapering is working well so far. I am tapering faster than 10% steps because I am not sure my PCP will continue my prescription. In two weeks I plan to move down to 5mg. Take 5mg/day for another week and then stop. I would like to have the option to taper slower, but I don't know if my doctor will refill my prescription knowing that I am not taking the medication as directed. 

I will keep you all updated. Thanks for reading. I wish you all good health. 

[Gridley]

Welcome to SA, 4eversick.

 

I sympathize with your situation with your PCP and the problem of possibly not having enough of the drug to do a safe taper.   

 

I know you're caught between the devil and the deep blue sea on this, but (as you know) we recommend a slow taper of no more than 10% of your current dose every 4 weeks. 

 

Why taper by 10% of my dosage?

 

Tips for tapering off duloxetine (Cymbalta)

 

You've already experienced severe withdrawal from alternate day tapering, which we never advise because it causes the amount of the drug in your bloodstream to go up and down, battering the nervous system and making  withdrawal worse.  It is a 50% reduction in dose.  Your proposed taper is equally problematical.  It's one thing to drop from 30mg to 20mg, very much another from 10 to 5 and then from 5 to zero.  The lower you go, the slower you should go.  The graphs in this topic might help to explain the reason for this:

 

Why taper paper: dose-occupancy curves

 

So you have withdrawal information all in one place--

 

What is withdrawal syndrome.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

I'm not telling you anything you don't already know when I say that the vast majority of doctors know nothing about safe tapering.  If more did, this site could close up shop.  

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

I wish I could be of more help.  Please keep us updated how it goes.

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

 

 

 

 

 

 

 

 

[bluebottle]

Hi 4eversick, welcome to SA, I'm new here too and also tapering duloxetine.  Sorry to hear about your struggles with your PCP and withdrawal from this evil drug.  This is my second attempt at tapering, it all went pear shaped the last time as I went far too fast as I wasn't sure how long my doctor would prescribe my drugs.  I'm taking it real slow this time!

 

I haven't yet told my GP (PCP) that I'm tapering and am only going to request 100mg from her on Monday so I can get some 40mg tablets (I'm actually on 57 mg).  If I were you I'd just agree to take the 20mg but take the advice of the mods here for your taper.  

 

Good luck with your taper, I hope you get lots of windows

 

B x

[4eversick]

Hi all- 

 

Thanks Gridley for putting all of the info in one spot for me, and for your advice. 

 

 

bluebottle, I appreciate your advice. I am going to continue to be honest with my PCP. I'm not judging anyone for concealing info from their doctor to get the care they need. I have been studying medical epistemology for almost 9 years now. First in college, then in a few jobs, now as a patient/disabled person myself. I want my doctor to know that there is research and tons of patient experience info that suggests what she was taught or has assumed is contrary to what is best for patients. Again, I'm not judging anyone for making a different decision, but I need to be honest with my doctor for my own sanity. 

 

I'm sorry that you're having a difficult time tapering, bluebottle. I hope this time it goes smoother for you and you can get off Duloxetine. 

 

[bluebottle]

Hi 4eversick, I think we all need to follow our own instincts. I really hope it works out for you. 

 

I'm doing well, albeit only a week or so into my taper.  My GP has agreed to drop my dose to 100 mg so I have no worries about having the right tablets.  I plan to reduce to 40mg over the next few months and see how I feel.  I would love to be drug free but that seems so far away (I'm also on olanzapine).

 

Hope you enjoy the site, there's so much information and reading other people's stories is really helpful too.

 

B x