Johann: My introduction - Duloxetine

[Johann]

Good day everyone

 

My back story:

- Mid 2019 (age 19) I went to my doctor a few weeks after a bad breakup of 3 years. I just was not feeling like myself. He insisted on me taking 5mg of an antidepressant for 4-6 months (I cannot remember the name and have since moved to different doctors, but I will try and find out). I took it for about 2/3 months but had to switch to Duloxetine Hydrochloride 30mg due to the other AD giving me ear infections. In hindsight, I probably could have gotten through it without AD, but what's done is done.

 

- In Oct 2020 (age 20) I had severe COVID-19 and had to start taking asthma medication - Symbicord and Omnair. My asthma is well controlled now.

 

- In 2021 I saw a new doctor, and she upped my dosage to 60mg because she considered it the normal dosage. Within 2-3 months I tapered back to 30mg as there was no reason to be on a higher dose. I switched to my current doctor after that. I experience no withdrawal symptoms from the up and down dosage.

 

- In June 2022 I had 2 small surgeries. That doctor advised me to take Tramadol. I told her about my medication and asked if there arent any clashes. She told me no. I read up about the possible clashes and wasn't sure whether to take it. My parents told me to trust the doctor and take it. I took it for 3 days and then started to get panic attacks. This lasted for 2 - 3 months. Panic attacks every day the whole day, even in my sleep. (Before then I only had panic attacks in 2014 (age 14) when my brother left for university - due to my separation anxiety.) At month 2, I contacted my Homeopathic Doctor, and she prescribed me Stram 200. This helped a lot and got me on track quickly. (I trust my homeopathic doctor, as it cured my torrets when I was a child and cured my brother's lung problems as a child.)

 

- On 27 Nov 2023 I started to taper off my medication with the help of my GP (since then found out it's not a taper but rather a cold turkey). I wanted to come off my medication before I moved to a new country (now I know it's not the best move). Details about the move - starting my articles at a new firm, moving from South Africa to London, and leaving all my friends and family and my loving dogs behind. My brother lives in Brighton, England, which is a benefit.

The taper method was one day on, one day off, and by 7 December 2023, I took my last dose. This taper was extremely difficult and I felt horrible. By 10 December I had a full-blown panic attack and could not function as a human. This panic session lasted about 2-3 hours. I also had most of the withdrawal symptoms except not feeling emotions and suicidal thoughts. The following week I had panic attacks throughout every day, and by week 2 it turned into crying spells. Accompanying this anxiety and panic was an abnormal dizziness and loss of appetite. At the end of week 2, I contacted my homeopathic doctor and proceeded to take stram 200 for 3 days, afterward stram m for 2 days, and afterward stram lm for a few days. This helped a lot and after a week I was back to normal.

 

- Then on 7 January, all the withdrawal symptoms returned. My stress levels suddenly were a lot higher, due to my board exam I had to write in 2 weeks, and my signing the lease of my apartment in the new country. Everything became real. The worst symptom is the constant dizziness that interfered with my life. This caused me to lose power over my thoughts and I spiraled back into a hole. Since then I worked with my homeopathic doctor. She tried Stram 200, Nat Mur 200, Ignatia 200, and Phos 200. These have significantly improved my anxiety and thoughts but had zero effect on my dizziness. I also woke up after every nap and night with an anxiety attack. After my board exam, my dizziness improved but is not gone. This leads me to believe that stress and anxiety amplify my dizziness. The anxiety attacks when waking up and in my sleep have not gone away either but the rest of my life is on track. I even started listening to music and watching series again. AKA doing things I love. Since then I have seen 3 doctors, a psychologist, and my Christian counselor. All of them believe that I should go back to my Duloxetine 30mg. I have until Monday the 5th to decide whether I am going back on the medication or not because my Doctor wants at least 4 weeks to monitor how the reinstatement goes before I move to London. My big fear is that of kindling because I have become very sensitive to the things I consume. I can't drink coffee anymore, and the antihistamine makes me super drowsy and I have since stopped taking them. Sugar also affects me way more. 30mg is the smallest dose of Duloxetine we get here. I am not sure what to do, but I believe everyone has my best interest at heart when they say I need to go back on the antidepressants.

 

TLDR - went off duloxetine CT in Nov/Dec 2023, doctor wants to reinstate back at 30mg now before I move overseas. I think I agree, but I am afraid of kindling. 

 

[LotusRising]

Hi @Johann

 

We are a peer-run volunteer site dedicated to a harm reduction tapering approach in an effort to minimize withdrawal symptoms. As you may have already read, we suggest tapering by no more than 10% of your most recent dose each month. See  Why taper by 10%.

 

Thank you for creating a signature. It sounds like you tapered off duloxetine over about 10 days, is that correct? And your last dose was Dec 7?

 

Reinstatement of a small dose of the original drug can sometimes help to alleviate withdrawal syndrome. The only other alternative is to wait out the symptoms and manage the best you can while your CNS returns to homeostasis. Unfortunately, no one can give you an exact timeline as to when you'll start to feel better, or if you even will. While some will notice immediate improvement, for others it can take many months or longer.

 

Reinstatement isn't a guarantee for everyone, but it's the best tactic available, aside from waiting it out. Since you are within the the 3 month timeframe where reinstatement reliably works, it might work and it might not. If you decide that reinstatement is an option for you, we would recommend a much smaller reinstatement dose than your last dose. These drugs are strong and your system has become sensitized and if you take too high a dosage, it may be too much for your brain, since it will have already begun making adaptations without the drug. 

 

Please reach out if you feel this is what you'd like to do and we can make a recommendation on what dose to start at. I would anticipate that 30mg may be too high a dose to return to, but it would be helpful if you could answer the above bolded questions.

 

Please post any updates or questions related to your specific situation right here in your thread. It's helpful to keep everything related to your tapering journey in one spot. 

 

Again, welcome to SA  

 

 

[Johann]

@LotusRising

 

Yes 10 days, and I my last dose was 7 December. 

I unfortunately need to reinstate to best this new anxiety.  

I am moving in 5 weeks to the UK and I need to be able to cope. 

 

The lowest dose we have here in South Africa is 30mg, and I'm not sure how to decrease this. 

[LotusRising]

The link below has information about how to taper duloxetine.

 

Since you basically CT'd your medication, you might try reinstating only a partial dose, maybe 25% of your dose.

[Johann]

Thank you for the information

And will I stay at this dose long term or how would it work? 

And since my time-line of 5 weeks is so short before I move countries, how will this affect this?

[Johann]

I have to tell my doctor tomorrow about my intention to reinstate.

But I am beyond terrified to use the medicine again. What I went through with the Tramadol, and now with the extreme withdrawal makes me so scared that I'd have to go through it again someday.

I'm filled with this fear of drinking the meds again.. 

[Johann]

I reinstated at 30mg on Tuesday - I know it is not what you recommended, but between my doctors and parents, I was basically forced to take the medicine. I also have no way of creating a smaller dose as My capsules don't want to open. I've taken a dose Tuesday and Wednesday and the side effects are horrible - my brain is squeezing as if it's gonna pop, my nose feels like it's going to bleed the whole time, I'm nauseous, my chest burns intensely when anxious and I have insomnia. I've only taken it 2 days (possibly 3 days depending on when I get an answer). Should I stop taking the drug? Should I perhaps ask my doctor to phase me into sertraline? or should I just stay on this course?

 

Help will really be appreciated. (I'm sorry about not taking a smaller dose, there was a lot of pressure and I gave in to the pressure)

[Stephanie389]

Hi Johann!  Just checking in to see how you are?  I too have struggled with tapering off of duloxetine.   I am at 120 mg per day.  My neurologist had me tapering down over 6 weeks.  He also had me taking 60 mg every other day during the 5 th week of the taper.  The 6th week was supposed to be 60 mg  every third day.  I didn’t make it to week 6 .  He also reinstated me to 120 mg after one week of 60 mg every day.   

[Johann]

@Stephanie389

Hey

I am so sorry to hear

 

There is a Facebook group, Cymbalta Hurts Worse, which is very supportive and informative. 

 

They have helped me a lot.

I'd suggest to join the group and explain your situation.