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I’ve been here before but I don’t think I posted an introduction when I first joined the site. That opening sentence is a good analogy for my story - I started something a number of years ago, I didn’t get far, couldn’t fully engage or complete the steps and now looking back, it’s hard to recall the detail (I had to go to my profile page to see the date I signed up - shocked that it was almost 5 years ago). Many ambitions in work, life, health, friendships but minimal progress and much frustration, sadness and increasing ill health. 

SSRI use began in my early 20s after many years of depression and anxiety. I think I was prescribed Citalopram. 
Towards the end of my 20s my husband and I decided to start a family. I came off meds twice because I didn't want to be on them during pregnancy or breadstfeeding. I don’t even recall how I stopped. 
Tried Zoloft after my 2nd child and had a terrible experience. Went on to Lexapro for approx 6 years.


Switched to SNRI Effexor. I found the addition of norepinephrine really helpful to begin with as a prominent feature of my depression is lack of motivation and I was positive about the benefits I experienced. 

After some years I started experiencing debilitating daytime sleepiness. I had very heavy menstrual blood loss after my 2nd baby and often had low iron. Being a tired parent, the sleepiness didn’t seem that unusual, especially with my symptoms of low mood, anhedonia, etc. I tried to research the effect of antidepressants on sleep quality as I suspected that long term use could be affecting my sleep stages. 


Approx 2012 - 2015

Attempted to withdraw from Effexor twice. First attempt was way too fast and withdrawal was awful and so unsettling. Reinstated  

Second attempt was much slower after researching and finding anecdotal accounts of slow tapering; I think it was over 10-12 months. I coped until the end of the taper and then was once again really unwell. Once I reached small numbers of the little white beads I was swallowing them without a capsule It’s possible the drug didn’t make it past my stomach acids - essentially at the most precarious stage of tapering the decreases were way too large and fast. Couldn’t cope - back to GP and started on Cymbalta 30 and then 60mg.

 

I saw a psychologist over many months and she encouraged me to investigate my sleepiness with a specialist and also to have an assessment for ADHD. In 2018 I did a number of sleep studies and was diagnosed with Idiopathic Hypersomnia; excessive daytime sleepiness despite fairly normal night time sleep.Sleep specialist prescribed Armodafinil 250mg daily - thankfully this keeps me awake.

 

Psychiatrist diagnosed me with ADHD late 2018, age 46, and prescribed Vyvanse - This gave me mental clarity and optimism for better functioning in life. I couldn’t tolerate side effects and stopped after a few months. Also unable to tolerate Ritalin and Dexamfetamine. Devastated- after a brief glimpse at being able to organise and function well I had to stop the ADHD meds. 

Sleep Specialist doesn’t believe I have ADHD & that my executive function deficits stem from my sleep disorder. When I have raised the issue of long term antidepressant use as being the cause of my disorder, I get a blank stare and a recommendation to stay on the AD. 

Vyvanse gave me a very dry mouth, jaw clenching, mouth ulcers and a feeling of having burnt my tongue in a hot drink. The symptoms with my tongue in particular remained even after stopping Vyvanse. Oral specialist ruled out any issues. Nearly 5 years later I still have ‘burning mouth syndrome’. Some literature connects it to anxiety and also menopause. 

 

Oh yeah, menopause. ALL of my mental health struggles and symptoms have worsened with the hormonal upheaval. Pretty constant anxiety and very poor executive function.

I discuss my depression and anxiety with my GP and they are very sympathetic. Suggested antipsychotics to get my anxiety under control. No thank you. I expressed concern that the long term AD use and daily anxiety is affecting my gastrointestinal health. She referred me for Gastroscopy & Colonoscopy, 2023. Colonoscopy all clear. Gastroscopy showed Telangiectasias in my upper stomach - like spider veins - with a ‘slow ooze’ of blood. No explanation of the cause  Second gastroscopy was scheduled at a different clinic so they could treat the blood vessels - they use argon gas to seal off the bleeding - but this time the telangiectasias were not found. No explanation. 

My own theory is that the long term use of antidepressants is degrading my stomach (affecting so many systems in my body and brain) and that this mild bleeding happens sporadically and then resolves. I sometimes experience a bad taste in my mouth and wonder if it is from the blood. Blood test reveal low iron at times despite no dietary changes and no menstrual bleeding. 

Woah, this is turning into a long piece. I’m sure I could edit but I may never get it done and posted. 

I saw a different psychiatrist mid 2023. I was and am desperate to function better. The Psychiatrist didn’t recommend any of the non-stimulant ADHD meds, believing they could lead to adverse effects. Suggested I ask my Sleep specialist about increasing the Armodafinil to see if that helped. I increased by a half but it doesn’t help my executive functioning. 

Feb 2024 reduced Armodafinil from 375mg back to 250mg bc I was experiencing heart racing. That symptom has gone but I’m struggling with sleepiness during the day again. I guess my brain adapted to the higher dose.

 

I’ve no way of proving my theories about the list of medical and psychological problems I have being linked to nearly 30 years of AD use. I want to get off Cymbalta. I have bought the Maudsley Deprescribing Guidelines. It’s going to be a very long road & I’m grateful for the SA resources and community.  

≈ 1997 SSRI  Citalopram/Cipramil

2003 & 2005 tapered off during pregnancy and breastfeeding 

2006 - Zoloft

2006 - Lexapro

≈ 2010 changed to SNRI, Effexor

2013 - 2016 Two failed attempts at tapering off Effexor

≈ 2016 - Change to Duloxetine/Cymbalta 60mg

April 2018 Armodafinil 250mg

Dec 2018 - Jan 2019 - Vyvanse 15mg

May 2023 Armodafinil 375mg

Feb 2024 Armodafinil 250mg

April 2024 TAPERING Duloxetine 5% reduction

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  • Moderator

Hello, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal.

 

This topic is for anything relating to you, and any questions you have. Please do not start another topic.

 

Many of our members find they have accumulated numerous unusual health problems and conditions over many years of antidepressant use. The good news is, most of them find these symptoms improve as they gradually taper off their drugs in a safe manner. The bad news is, this takes a long time and a lot of perseverance.

 

Please read the page on Tips for tapering off duloxetine (Cymbalta). The method for tapering it involves bead counting and removing, like you did with the effexor. Slow and steady is the aim of the game.

 

We recommend tapering by no more than 10% of your CURRENT dose each month, to limit withdrawal symptoms. E.g. 10mg --> 9mg --> 8.1mg --> 7.29mg

 

All the answers you are looking for regarding tapering and antidepressant withdrawal are on this site. Please search around and continue to read as much as you can manage. Use the site search function to search for specific words or phrases, such as drugs or symptoms.

 

Here are a few of the most useful links:

 

Important topics in the Tapering forum and FAQ

 

Micro tapering

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

We only recommend two supplements. Omega 3 Fish Oil and Magnesium. Both should be introduced separately and increased slowly.

 

Regards

Erimus

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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Thank you for your reply and the links. I’m really having trouble getting started despite my urgent desire to begin tapering. My brain function is so poor and I’m putting off the bead counting, have looked up micro scales countless times - get confused and overwhelmed about which one to buy. I need to ask my partner for help to get me started. It’s awful feeling so incapacitated and not being able to do what I need to start the process of tapering and healing. 
 

I am really struggling with my hypersomnia. I dropped from 375 to 250mg of Armodafinil in one go, Feb 2024. Even though I’m not experiencing the kind of withdrawal symptoms of AD I guess I should have done it more gradually to avoid this sleepiness. I wonder if I should reinstate to some level above 250mg and then taper more gradually. Does anyone here have experience with Armodafinil tapering, dose changes?
 

I have an appointment with my sleep specialist in a few weeks so I could ask about this. I’m undecided about telling them my plans to taper off duloxetine. I only have a Telehealth check-in every 6 months and sometimes see different doctors. I don’t mind them knowing my intentions but not sure I have the energy for the conversation. I could wait until further down the track in the taper and let them know how I’m feeling. 🤷‍♀️ 

 

≈ 1997 SSRI  Citalopram/Cipramil

2003 & 2005 tapered off during pregnancy and breastfeeding 

2006 - Zoloft

2006 - Lexapro

≈ 2010 changed to SNRI, Effexor

2013 - 2016 Two failed attempts at tapering off Effexor

≈ 2016 - Change to Duloxetine/Cymbalta 60mg

April 2018 Armodafinil 250mg

Dec 2018 - Jan 2019 - Vyvanse 15mg

May 2023 Armodafinil 375mg

Feb 2024 Armodafinil 250mg

April 2024 TAPERING Duloxetine 5% reduction

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  • Moderator
14 hours ago, Nic72 said:

Thank you for your reply and the links. I’m really having trouble getting started despite my urgent desire to begin tapering. My brain function is so poor and I’m putting off the bead counting, have looked up micro scales countless times - get confused and overwhelmed about which one to buy. I need to ask my partner for help to get me started. It’s awful feeling so incapacitated and not being able to do what I need to start the process of tapering and healing. 

You don't need scales when you're dealing with duloxetine. It's one of the easiest in the sense of dose preparation. If you are taking one 60mg capsule daily, here is what you need to do to begin the taper:

 

1. Open a capsule and empty the contents onto a plate or similar. Count the number of beads and write this down.

2. Repeat this for another four capsules, so you have the number of beads counted in five different capsules.

3. Add the five figures together, then divide by 5 to get your average number of beads per capsule.

 

Write this down as: 60mg duloxetine/cymbalta = <average from calculator>

 

4. Calculate your first reduction, I would recommend starting with 5% rather than the 10%. It's easier to test the waters this way.

 

First reduction of 5% = <average from calculator> * 0.95 = <x>

 

Then prepare your doses for 1-2 weeks:

 

5. Open a capsule and empty all the beads.

6. Count up until you reach <x> beads.

7. Add this amount back to the capsule and push the lid back on.

8. Store the remaining beads in a container for use further down the line.

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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  • 2 weeks later...

Tapering down 5% of 60mg Duloxetine has begun. Today is day 5 and I don’t think I’m experiencing any symptoms of the dose change. I have been teary but this is not unusual for me and I think it’s also related to all the thoughts and preparations that got me here. Contemplating the long process, probably years, of tapering and letting my brain and body recover is daunting. I do feel some hope that this is the way to recover and to discover a healthier life. 

≈ 1997 SSRI  Citalopram/Cipramil

2003 & 2005 tapered off during pregnancy and breastfeeding 

2006 - Zoloft

2006 - Lexapro

≈ 2010 changed to SNRI, Effexor

2013 - 2016 Two failed attempts at tapering off Effexor

≈ 2016 - Change to Duloxetine/Cymbalta 60mg

April 2018 Armodafinil 250mg

Dec 2018 - Jan 2019 - Vyvanse 15mg

May 2023 Armodafinil 375mg

Feb 2024 Armodafinil 250mg

April 2024 TAPERING Duloxetine 5% reduction

Link to comment
  • 3 weeks later...

I posted this as a reply in the Duloxetine tapering discussion a week or so ago. I hadn’t had any reply and I haven’t got my head around where I should post. I know that moderators and admin are volunteering and in all different time zones. I don’t expect instant responses, just not sure where I should post questions so that others can respond with their experience and a sense of the ‘best available’ pharmaceutical knowledge. 

 

I’ve done a few searches looking for advice or any experiences of taking Duloxetine made by different manufacturers. 
I’ve been using a generic brand for years. There’s a supply problem at the moment and only the Cymbalta brand, made by Lily is available. 
Getting my first box of this coincided with the start of my taper and I just got my next script dispensed and it’s also Cymbalta brand. Who knows when the generic will be available again.

 

Is there any concern about switching between brand name and generic Duloxetine during tapering? 
 

If I get the generic again I know I will have to start over counting the beads to get an average (which will likely be different to the Cymbalta brand) to calculate my dosage. I don’t mind doing this - have to be willing to put in the work as it’s going to be a years long process - just want to know if changing brands is ok. 

I have the recently published Maudsley Deprescribing Guidelines book. Anyone know if there’s anything in there on this topic? 
 

Thanks 

≈ 1997 SSRI  Citalopram/Cipramil

2003 & 2005 tapered off during pregnancy and breastfeeding 

2006 - Zoloft

2006 - Lexapro

≈ 2010 changed to SNRI, Effexor

2013 - 2016 Two failed attempts at tapering off Effexor

≈ 2016 - Change to Duloxetine/Cymbalta 60mg

April 2018 Armodafinil 250mg

Dec 2018 - Jan 2019 - Vyvanse 15mg

May 2023 Armodafinil 375mg

Feb 2024 Armodafinil 250mg

April 2024 TAPERING Duloxetine 5% reduction

Link to comment
  • Moderator
7 hours ago, OnTheMend said:

 

I posted this as a reply in the Duloxetine tapering discussion a week or so ago. I hadn’t had any reply and I haven’t got my head around where I should post. I know that moderators and admin are volunteering and in all different time zones. I don’t expect instant responses, just not sure where I should post questions so that others can respond with their experience and a sense of the ‘best available’ pharmaceutical knowledge. 

 

I’ve done a few searches looking for advice or any experiences of taking Duloxetine made by different manufacturers. 
I’ve been using a generic brand for years. There’s a supply problem at the moment and only the Cymbalta brand, made by Lily is available. 
Getting my first box of this coincided with the start of my taper and I just got my next script dispensed and it’s also Cymbalta brand. Who knows when the generic will be available again.

 

Is there any concern about switching between brand name and generic Duloxetine during tapering? 
 

If I get the generic again I know I will have to start over counting the beads to get an average (which will likely be different to the Cymbalta brand) to calculate my dosage. I don’t mind doing this - have to be willing to put in the work as it’s going to be a years long process - just want to know if changing brands is ok. 

I have the recently published Maudsley Deprescribing Guidelines book. Anyone know if there’s anything in there on this topic? 
 

Thanks 

Some people have issues switching between different brands, some people don't. When you switch brand I would advise not making a reduction at the same time, wait 2 weeks or so. I've found that once I've adapted to a brand I can switch between them without concern in the future, but of course everyone is different.

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment
On 4/23/2024 at 7:34 PM, Erimus said:

Some people have issues switching between different brands, some people don't. When you switch brand I would advise not making a reduction at the same time, wait 2 weeks or so. I've found that once I've adapted to a brand I can switch between them without concern in the future, but of course everyone is different.

Thanks. Good advice re, the timing. 
 

Prepare for more trial and error 😉 

≈ 1997 SSRI  Citalopram/Cipramil

2003 & 2005 tapered off during pregnancy and breastfeeding 

2006 - Zoloft

2006 - Lexapro

≈ 2010 changed to SNRI, Effexor

2013 - 2016 Two failed attempts at tapering off Effexor

≈ 2016 - Change to Duloxetine/Cymbalta 60mg

April 2018 Armodafinil 250mg

Dec 2018 - Jan 2019 - Vyvanse 15mg

May 2023 Armodafinil 375mg

Feb 2024 Armodafinil 250mg

April 2024 TAPERING Duloxetine 5% reduction

Link to comment

Hi @OnTheMend- I have no advice for you but wanted to reach out to say hi, and express my sympathies that you've had to deal with this revolving door of drugs.  I went through the same thing in the early 2000s, and like you, I have plenty of theories about the damage it has probably done- very poor sleep, labile emotions, hot flashes when hormones were normal, infertility, idiopathic miscarriages, muscle and joint pain with no observable cause... the list goes on.  I can't prove it either, but the more I learn, the more I believe that these drugs have seriously altered the course of my life.  I try to look forward rather than back though... looking forward to finding out who I am after a proper taper of my escitalopram, and never, ever returning to these drugs again!

 

I feel you on the menopause- I'm perimenopausal now as well, and it really a challenge.  I also have long covid to complicate things lol.  I'm so glad we've found this place- we really need an accepting community to get through all these challenges.  I'm so glad to see that your 5% taper has gone smoothly so far.  Fingers crossed that you have a smooth path to discontinuation! 

 

Wishing you well, and I look forward to following your journey! :)

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell.

2009- Daughter born 🥰

2016- Back on escitalopram

2022- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN

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  • getofflex changed the title to OnTheMend: Finally here - preparing to taper

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