JenniferRing: Taper Cymbalta or Wellbutrin XL

[JenniferRing]

I have been tapering off of 60mg cymbalta since January 2023. Am now down to 20mg and having severe withdrawal symptoms such as: insomnia, anxiety, panic attacks, crying, etc. I plan to hold at 20mg cymbalta for awhile. I am also on 300mg Wellbutrin XL. Since I am having insomnia, should I start to taper off of Wellbutrin XL at this point or is it best not to make any further medication dose adjustments at this time?

Edited September 9 by Emonda
Name to title

[Catwoman73]

Hi @JenniferRing, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes.  

 

If you could kindly complete your drug signature, we would greatly appreciate it.  A drug signature is a summary of your drug history that appears at the bottom of each of your posts.  This helps those visiting your intro thread to know your drug history at a glance, without having to read through many pages of posts.  Drug signatures should be updated as you make changes.  To create a drug signature, click the following link, fill in the box to the best of your ability, and click save.  That's it!  You can have a look at mine at the bottom of this post to see the general format. 

 

Your drug signature

 

I'm not sure how you have been approaching your tapering of the Cymbalta, but here at SA, we recommend tapering by no more than 10% of your CURRENT dose, no more often than every four weeks.  So as an example- 10mg, 9mg, 8.1mg, 7.3mg, 6.6mg and so on.  This is known as hyperbolic tapering, and is designed to release the receptors in the brain from the drug in a slow and controlled manner, in order to minimize withdrawal symptoms.  If you have been dropping in a linear fashion (for example, 5mg at a time), you would be releasing the receptors in your brain faster and faster as your dose gets lower.  This could explain why you are struggling with severe withdrawal at the moment.  Read more here on hyperbolic tapering, and why it is so important:

 

Why taper by 10% of my dosage?

 

In your situation, what you need right now is a very long hold in order to stabilize from the severe withdrawal you are experiencing.  I would certainly not recommend starting to taper from your Wellbutrin right now.  What your brain and body needs is stability.  We recommend tapering one drug at a time, starting with the drug that is more activating.  Unfortunately, both of your drugs are 'accelerators' as we call them, so it didn't really matter which one you started with.  But when you resume tapering, you will have to choose one or the other.  Here's our thread on choosing which drug to taper first:

 

Taking multiple psych drugs? Which drug to taper first?

 

While holding, you will experience periods where you feel better, and periods where you feel worse.  This is a normal part of the stabilization process, and we refer to this as the windows and waves pattern of stabilization.  It's a good idea to start a symptom journal now, tracking your symptoms and rating them on a scale of 1-10 each day.  This will help you identify your windows and waves, and over time, will allow you to look back and see how far you've come.  Here's some more info on windows and waves, and a checklist of withdrawal symptoms that you could use as a template for a symptom journal, if you wish:

 

The Windows and Waves Pattern of Stabilization

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

There are a few things you can do to help your body reach a state of stability a bit more easily.  Most of them are rather intuitive.  Eat a balanced, whole foods diet, stay hydrated, get adequate rest (more on sleep shortly), and gentle exercise.  Avoid neurologically active substances like caffeine, nicotine, alcohol and recreational drugs, as these will only destabilize your nervous system further.  And do not add any further psychiatric drugs to the mix to treat the withdrawal symptoms from psychiatric drugs- the results are not predictable with a destabilized nervous system, and adding more medications could make you worse rather than better.  Not to mention, adding more drugs creates a situation where you would have to taper off of something else in the future, thereby  prolonging your withdrawal journey.  We only recommend two supplements here at SA- magnesium, and omega-3 fatty acids.  Do be mindful though, it is common for those in withdrawal to become hypersensitive to all sorts of things, including medications, supplements, and even foods!  So if you start any supplement, including those we recommend, start at a very low dose, and increase slowly over time if you are able to tolerate it.  If you track your foods, activities and supplements in your symptom journal in addition to your symptoms, it helps to identify any potential triggers you might have.  For me, intense exercise, coffee (even decaf) chamomile and magnesium are all triggers.  Magnesium actually causes a totally paradoxical reaction for me, giving me brain zaps and insomnia!

 

The real question is, how do we deal with our symptoms while holding to stabilize, right?  We have many, many threads on non-drug coping mechanisms here at SA.  I will link some of them below for you.  You may find some of your own ways of coping as well!  Personally, I have made living with mindfulness the cornerstone of my coping these days.  I also use guided meditations/yoga Nidra at night for sleep.  I spend lots of time in nature.  I use CBT techniques, like box breathing, and challenging negative thoughts.  I swim, because I feel great when I'm in the water.  And I engage in many relaxing distractions- my latest obsession is art projects.  

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

Symptoms and Self Care

 

So many of us here have issues with insomnia!  You are absolutely not alone there!  In addition to the above (yoga Nidra is WONDERFUL for sleep- there's lots of them on YouTube), here are a few more threads that might help you:

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 Path to Better Sleep FREE online for everyone from the US Veterans Administration

Melatonin for sleep

 

In summary, your best bet right now is taking a good long hold on your tapering in order to give your brain a chance to catch up to the changes you've made.  When you do resume tapering, you can choose either drug, but should only taper one at a time.  In the meantime, it would be a great idea to start a journal, so you can track your progress, your windows and waves, and identify anything that might be triggering symptoms for you.  Holding will give you the opportunity to start practicing some non-drug coping mechanisms without putting further stress on your nervous system.  This is a great time to create those new, healthy habits.

 

Whatever you do, don't lose hope.  You WILL heal.  We are all healing, all the time, whether it feels like it or not.  This journey requires patience and time, and we're here to support you, 100% of the way! 

 

This is your introduction topic- each member gets one intro topic.  Please post updates, questions, or concerns here, on this thread.  But please explore the rest of the forum- there's lots of good information here!  And don't hesitate to read the intro topics of other members, and drop a comment/ word of support.  Withdrawal can be a lonely journey, but I have definitely found it is made easier by creating a community of people who completely understand what you are experiencing.  

 

Hang in there!!!❤️‍🩹 I look forward to follwoing your journey, and helping out in any way I can!