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  1. Guilietta

    Guilietta

    Hello all, I am new to the forum after reviewing some of the posts intermittently since December 2018. I have posted my intro as a PDF (note: pasted below). When I tried to post it - the fonts and spacing were inconsistent and I couldn't edit it. This is my first online forum on any subject so please bear with me on the technical goofs I will make. 😉 Fortunately I did find the emoji and finally get the introduction written. Thank you! PDF information pasted below (CC manually reformatted as best as possible): Hello all, I am a new member and trying to liberate myself from duloxetine/Cymbalta 20 mg (compounded in a LIQUID). My goal is mood management without medication – and being able to cope positively with unwelcome (or sometimes welcome) events. I have been viewing information on the web site off and on since last December. My thanks and empathy to all of you on this site who are ridding themselves of Cymbalta and other ADs, benzos, etc. I remain optimistic that the light at the end of the tunnel is not that of an oncoming locomotive. J I am grateful for having found SurvivingAD and to the subject matter experts and people who administer it. I have been tapering duloxetine 20 mg (compounded) since December 15, 2018 under the care of an MD. I am at 10 mg (3.3 ml) as of July 20, 2019. I am decreasing by about 10% a month. I am also taking clonazepam 2 mg (my next taper goal) as well as meds for a childhood neurological illness (lamotrigine XR 600 mg and gabapentin 1000 mg). I have taken many medications since age 9 due to the latter. Because of my medical history and the many meds tried or used over the years to manage it, their efficacy, safety and side effects – I am anxious about medications. Anxiety exacerbates the neurological health issue. I was prescribed ADs about 15 years ago (and the clonazepam) to manage moods amid traumatic life events. I took Duloxetine for about the last 4 or 5 years; the highest dose was 60 mg. About my taper: The taper started in December 2018. However – before I knew better – I stopped cold turkey (per prescriber’s advice) in August 2018. I endured subsequent bouts of panic, elevated anxiety, auras and some agoraphobia - so I restarted the duloxetine and the symptoms went away. I figured out that cutting the medication maybe caused the symptoms. I found a new MD who reluctantly agreed to the taper. After learning I lack the fine motor skills to count beads, I found a compounding pharmacy and get the duloxetine in an oil-suspension. I decreased by 2 MG (10%) per his direction and I experienced 3 weeks of bad symptoms. Thereafter I tried a ‘micro-taper’ approach – a series of mini-cuts - per this website. This approach seems to have moderated many of the side effects– but the symptoms are still a problem a good proportion of the time. My process for the micro-taper is to reduce by about .5 mg a week (about 2 mg a month total) – with mini decrements across the week (in ml). I have symptoms for a few days, then a few days where I am feeling mostly OK, and then I make another mini-cut. This is fatiguing and difficult to manage. Some side effects I experience(d) on this medication at 20 mg– and they continue: • Hot flushing over head and torso and perspiration (in 70 F) and not attributable to endocrine function. • Blurry vision • Short-term memory impact • Focus and concentration and recall • Insomnia – awakening 2-3x night many nights…. • SSRI/SNRI sexual side –effects • And many more… Withdrawal effects Generally - the most consistent and prevalent withdrawal effects (thus far) have been: • Anxiety - which may often be markedly worse in mid to late afternoon and into the evening (about 7-8 hours after my dose). • Jitteriness/tremors/shakiness • Auras and other sensations (related to the neurological illness) which may be extremely uncomfortable • Tinnitus (hearing loss was ruled out as a cause) • Insomnia • Lower GI (one extreme or the other) • Appetite issues (one extreme or the other) • Maybe more sensitive to cloudy days – particulary when they cluster Less consistent: • Dizziness when quickly turning my head • Postural hypotension • Sinus headaches • Lightheadedness • Panic • Dysphoria • Short-term memory impact – worse at times during this taper than on the full dose • Focus and concentration and recall– worse at times during this taper than on the full dose June – July Withdrawal Symptoms Out of the blue in June I experienced additional and horrendous symptoms for 2-3 weeks (see ‘less consistent’ above). They were so acute I asked myself if this is worth it, whether I will ever get off this drug and so on with the nefarious what if’s. I have no idea what caused it but I made it through and I am now doing much better. Looking for another MD or NP The psych MD (started in December 2018) does not have my full confidence to taper me successfully off Duloxetine. I am looking for an MD or NP who sincerely wants to taper me off and take a holistic approach to mood management moving forward. Spending much time online and looking things up (like about ADs, tapering, etc.) elevates my anxiety to unhealthy levels. It’s therefore important to have an MD or NP on whom I may depend for this information. If it had not been for information I found on Surviving AD and other web sites – he would have tapered me to Viibryd or off duloxetine in 4 weeks. What I am doing to help myself • Joining Surviving AD and searching for an in person support group • Helping others through this and letting everyone I know about Cymbalta and AD withdrawal • (Re-) learning Cognitive Behavioral Therapy • Meditate (10 – 15 minutes a day I practice this – but 5 minutes are better than no minutes) – this may take me a while to learn…. • Exercise daily ( 45 minutes on the treadmill in the morning (and it would be good to do some walking in the afternoon). • Physical therapy and hand weight exercises most nights. • Eating plenty of protein, healthy (whole grain) carbohydrates, salad a day, nuts, and could do better with vegetables • Searching for a faith that aligns (mostly) with mine • Looking for a group to volunteer with • Write down (most days) what I am grateful for – even if I need to repeat things from one day to another J A few things I have learned – and wish I had known earlier – about exercise and diet and spending too much time online Maybe this may help someone out… 1. You may not want to start a ketogenic (or low carb) diet (depending on your medical circumstances). My personal experience with this: I was advised/told to restrict carbs (40%) to lower my a1c. I did 50% - and I suffered more anxiety, panic, etc. Ended up in ER with panic. No one told me about this and my MD wasn’t aware. Learn more about keto diets and psych meds: https://www.psychologytoday.com/us/blog/diagnosis-diet/201803/ketogenic-diets-andpsychiatric- medications. 2. Activate dopamine receptors and generate serotonin by EXERCISE (aerobic and/or weight lifting) and PROTEIN. Exercise releases endorphins and helps with dopamine receptor activation. Activating dopamine receptors is ‘critical’ to this process. A diet rich in protein helps with this. (this from the neuro RN) 3. A good snack in the mid to late afternoon – whole grains and protein - may help me with anxiety. It helps with blood glucose management –and a low BG will cause anxiety and a number of the symptoms that are also caused by AD withdrawal 4. To help cope with anxiety – I have found that doing something anything physical or with your hand (and focusing on it) can help (for example, clean the bathroom, knit, weed, etc.). I have a few questions, which I will post separately – and I would really appreciate your comments. Thank you Surviving AD Intro.pdf
  2. Cymbalta comes in 20 mg, 30 mg, and 60 mg capsules. Full prescribing information: http://pi.lilly.com/us/cymbalta-pi.pdf Cymbalta is tricky to taper. It does not come in liquid form and cannot be compounded into a liquid. To protect the drug, each bead inside the gelatin capsule has an enteric coating to protect the drug from stomach acid, which would destroy the drug. (It is absorbed further down in the digestive tract.) The pellets cannot be dissolved in any liquid without destroying the active ingredient. You cannot crush the pellets (see http://survivingantidepressants.org/index.php?/topic/275-do-not-crush-list/page__view__findpost__p__3021 ) or dissolve them in a solution -- the drug would never get into your system, it would be destroyed in your stomach and you would have immediate cold-turkey withdrawal. Of course, the range of dosages from the manufacturer is inadequate for very gradual tapering. Like all psychiatric drugs, do not skip doses or alternate doses to taper Cymbalta. Its half-life is very short, about 12 hours. It is metabolized via the liver enzymes P450 1A2 (substrate, inhibitor) and 2D6 (inhibitor). This post has a chart that shows what happens with the level of Cymbalta in your bloodstream when skipping doses. See Doctor is shocked at severe Cymbalta withdrawal symptoms and testimony by Dr. Joseph Glenmullen regarding Cymbalta withdrawal syndrome: http://www.baumhedlundlaw.com/pdf/DrGlenmullenDeclarationSupportofCymbaltaClassCert.pdf (PDF) Reduce by 10% per month to start As with any neurologically active drug, a conservative taper is the safest way to go off Cymbalta. Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time. A conservative taper for Cymbalta, like other psychiatric drugs is: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.) See Why taper by 10% of my dosage? Cymbalta CANNOT be crushed, compounded into a liquid, or dissolved in a liquid The pellets in the capsule cannot be dissolved in a liquid; this would destroy the active ingredient. High-dosage Cymbalta: Using different dosages to decrease to 40mg If you are taking as much as 120mg Cymbalta, see this topic for an example of how to taper to 40mg using existing capsule dosages and a few compounded prescriptions: http://survivingantidepressants.org/index.php?/topic/7060-razzlesf-off-abilify-tapering-cymbalta/?p=129252 To taper from a dosage of 40mg, you're going to have to either open up 20mg capsules and count beads, or get custom compounded dosages. The bead-counting method Like Effexor XR, some people have tapered by opening the Cymbalta capsule and taking out the beads to gradually reduce the dosage. (See http://survivingantidepressants.org/index.php?/topic/272-tapering-off-effexor-venlafaxine/page__view__findpost__p__2985 for the technique.) You can do this if you have brand-name Cymbalta or generic capsules containing hundreds of tiny beads rather than 4-12 "mini-tablets" (see below). The number of tiny beads in each Cymbalta capsule will vary within a given dosage, across dosages, and from different manufacturers. The capsules are filled by weight. To find an average number of beads per capsule, you will have to carefully count the beads in several capsules. Then you can estimate how many beads amount to 10% of the dosage and manage your taper accordingly by keeping notes on paper showing the number of beads removed and equivalent Cymbalta dosage. Take out 10% of the beads at each step of the taper. Put unused beads into a clean, dry, capped prescription bottle marked with the dosage of the original capsule and expiration date. You might want to use them later. Do NOT mix beads from capsules of different dosages, such as 30mg and 60mg. NOTE When you are taking loose beads, put them in an empty capsule to swallow them. Gelatin capsules and vegetarian capsules are available at health food store. The FDA reports here http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm103473.pdf there have been some instances of the beads causing throat irritation when swallowed without a capsule. Dividing Cymbalta beads into empty gelatin capsules To make counting of the beads easier, this technique may work with Cymbalta, see details at http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__3033 Opening capsules and weighing beads Eventually, as you remove more and more beads, it may become too confusing and time-consuming to count out them. You may wish to weigh them instead, see Using a digital scale to measure doses and Counting beads in a capsule versus weighing. Have a compounding pharmacy make up capsules of smaller dosages For precise dosing, a compounding pharmacy will accurately weigh the doses and put the right number of beads into capsules for you. See http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__3001 Dividing Cymbalta beads into apple juice or applesauce Follow the instructions above for dividing the beads in a capsule and put your reduced dose apple juice or applesauce. --------- It has been scientifically demonstrated that the Cymbalta pellets survive being put into apple juice or applesauce but NOT chocolate pudding: http://www.ncbi.nlm.nih.gov/pubmed/18691989 Clin Ther. 2008 Jul;30(7):1300-8. In vitro stability, potency, and dissolution of duloxetine enteric-coated pellets after exposure to applesauce, apple juice, and chocolate pudding. CONCLUSIONS: Results from this study found that the enteric coating of duloxetine pellets mixed with applesauce or apple juice was not negatively affected. The pellets were stable at room temperature for < or = 2 hours and should quantitatively allow delivery of the full capsule dose, provided that the pellet integrity is maintained (ie, not crushed, chewed, or otherwise broken). Therefore, mixing duloxetine pellets with applesauce or apple juice appears to be an acceptable vehicle for administration. However, exposing the pellets to chocolate pudding damaged the pellets' enteric coating, suggesting that pudding may be an unacceptable vehicle for administration. --------- Tapering generic Cymbalta (duloxetine) capsules containing "mini-tablets" The generic forms of Cymbalta may contain beads, like brand-name Cymbalta, or 4 to 12 "mini-tablets" rather than beads. From Lupin Pharmaceuticals http://medlibrary.org/lib/rx/meds/duloxetine-3/ The "mini-tablets" cannot be split or dissolved to make a liquid. Suggestions for gradual tapering: If you are taking 20mg, 30mg, or 40mg (two 20mg capsules) per day, switch to brand-name Cymbalta or a generic containing tiny beads rather than mini-tablets. Use the bead-counting method. If you are taking 50mg (20mg plus 30mg) per day, reduce by one mini-tablet from the 30mg capsule (5mg, or 10%) initially for a month, then switch to brand-name Cymbalta or a generic containing beads rather than mini-tablets. Use the bead-counting method. If you are taking one 60mg capsule per day, reduce by one mini-tablet (5mg) per month for 2 months until you are taking 50mg per day, then switch to brand-name Cymbalta or a generic containing beads rather than mini-tablets. Use the bead-counting method. If you are taking one 60mg capsule plus any of the other dosages per day (at least 80mg), reduce by one mini-tablet (5mg) from the 60mg capsule per month until you get to 45mg total daily dosage, then switch to brand-name Cymbalta or a generic containing beads rather than mini-tablets. Use the bead-counting method. You can combine brand-name Cymbalta or generic beads with generic duloxetine mini-tablets to taper. (This would cost less than using brand-name Cymbalta for your entire taper. A prescription for 60mg brand-name Cymbalta capsules will go further.) You could take part of your dosage in brand-name Cymbalta beads and the rest of your daily dosage in generic mini-tablets. For example: If your 30mg generic duloxetine capsules contain 6 mini-tablets, each mini-tablet contains about 5mg duloxetine. Let's say you want to reduce 10% from 30mg to 27mg. You can take 5 mini-tablets (25mg) and add 2mg in beads to it. If a 60mg capsule of brand-name Cymbalta contains 200 beads, each bead contains about 0.3mg duloxetine; you would take 7 beads (2.1mg) to total a daily dose of 27.1mg. (BE SURE TO COUNT THE TOTAL NUMBER OF BEADS IN YOUR CAPSULES -- THEY CAN VARY FROM THIS EXAMPLE.) When you are down to 5 mini-tablets (25mg) per day, take 4 mini-tablets and the rest in beads to reduce another 10%, and so forth. Reduce by micro-taper The very smallest dose of brand-name Cymbalta is one bead. Some people find they can better tolerate a reduction of one bead at a time rather than a 10% decrease. You may be able to make reductions of one bead more frequently; try reducing by one bead a week for a while to see what your tolerance is. See http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/ Do not reduce by one additional bead per day. This is too fast, you may develop withdrawal symptoms before you know what's happening. Here is an example of a micro-taper from cymbaltawithdrawal.com http://www.cymbaltawithdrawal.com/topic/8325-dose-down-bead-counting-chart-anywhere/?p=50499 Switch to Prozac Like its fellow SNRI Effexor, withdrawal from Cymbalta can be very difficult. Recently, I asked a knowledgeable doctor about how he switches patients to Prozac. He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta. Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Cymbalta. And, at least Prozac comes in a liquid. He confirmed that Cymbalta cannot be compounded because the pellets are enteric-coated to get the medication past the stomach acid, which destroys it. Other than the Prozac switch, he said counting pellets is the only way to taper. See more about the Prozac switch http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/ Here is more discussion about switching from Cymbalta to Prozac: NOTE Also see 2009: FDA hears testimony about Cymbalta discontinuation syndrome Study finds some Cymbalta withdrawal "severe and persistant" Doctor is shocked at severe Cymbalta withdrawal symptoms Cymbalta Withdrawal Lawsuits Progressing in US
  3. Hi! I read Robert Whitaker's anatomy of an epidemic in June 2019 which started me on my tapering journey. I originally assumed that the rate psychiatrists used to cross taper using the existing doses available was okay. As a result I did a fairly fast taper partly psychiatrist supervised from 160 mg of my ziprasidone to 120 to 80 to 60 mg. I also not at the same time of course, tapered off attarax 25 mg 3x daily to 25mg 25 mg and 20 mg. Than 25 20 20 mg, 20 20 20 mg and than 10 10 10 mg and than 0, 10 mg 10 mg and so on with minimal rebound anxiety which I waited for it to pass before tapering more, tapered off 100 mg of trazodone going from 100 to 75 to 50 to 25 to 0, and tapered down my cymbalta from 90 to 60 to 30 mg. This took me from June 2019 to the end of september 2019 which i understand is fast and im luckily i experienced little to no withdrawal symptoms. At the end of september I came across the withdrawal project, Links on Robert Whitakers website, and this site and realized I'd been going fast. Oct 8th I started a liquid titration of my ziprasidone going down to 50 mg. No problems yet. I am currently at 50 mg ziprasidone, 30 mg Cymbalta and 2 mg of Xanax which I take twice a day but am slowly shifting to spreading the dose to three and than four times a day (half a mg each). The plan if all goes well is to taper off my ziprasidone, wait 2 weeks, start tapering my cymbalta, wait two weeks and start tapering Xanax last. From my research the Lay tapering community reccomends 5 to 10% of the month's previous dose once a month if you are doing cut and hold and psychiatrists who specialize in tapering reccomend 10% of the original dose every 2 to 4 weeks doing cut and hold. I decided to go closer to 10 percent of the original dose for now every two weeks and if I run into any problems I will slow it down and do a smaller taper. So that's my introduction for now! Thank you for being here.
  4. Hey, I've been taking cymbalta for 5 years, I dropped from 120mg to 60mg without issue but when trying to drop to 30mg things went badly. My doctor is great and offered me 50mg (20 + 30) of generic, but I've had bad experiences with generic brands so I thought I would taper. I am just having difficulty understanding all the measurements, I am really terrible at maths. I have some questions? Do I remove 10% of the weight from each capsules? Are all the beads the medication or are some "filler" Thank you, - lleksam
  5. Hello all, Apologies in advance for the length of this post – it’s essentially a combination of an introduction and a success story – I know that members can only post success stories after a full year off all meds – I’m seven months now off all meds and am feeling far better now than when I was taking pills so I reckon it’s only a matter of five months before I post an actual success story. I was given a diagnosis of bi-polar by a consultant psychiatrist in the autumn of 2011 after years of volatility in my mental health and began taking meds six months later. I started with Lamictal (Lamotrigine) – after a few weeks on a low dose, the dose was increased – the next day I noticed a rash all over my body and stopped taking it. I was then given Abilify – I was on this over for a month or two but stopped taking it since it caused me insomnia and really intense pain in my wrists. Next, it was Olanzapine/Zyprexa (5mg) to deal with my elation – the 5mg worked well but when the dosage was increased to 10mg and 15mg, it caused nothing but depression so I went back to 5mg. I was then given Prozac to deal with the depression side of things – this however, caused me the worst depression I ever experienced. I was on it for a bit over a month until I could take no more and stopped taking it. My psychiatrist then prescribed me Venlafaxin/Effexor in September 2012 – I started at 75mg and eventually made my way up to 300mg. As the dosage increased, my depression did get better but the side affects most certainly got worse – constipation and intense sweating in bed at night. Also, I always felt the medication was causing me brain fog, despite what my psychiatrist was telling me – ‘all these meds do is treat depression’, I was told and basically, how limited intellectually I felt was in fact an actual reflection of the abilities I was born with. I was really getting fed up the side affects and decided to do what a lot of people in my situation do – come of the meds without telling my doctor. I slowly tapered down the anti-depressant but came off the Olanazpine quite abruptly – result, disaster. The depression came back in a big way. Around this time, I remember one sleepless night lying in bed just saying to myself over and over – ‘I just want to die – I wish I had the courage to kill myself’. Went crawling back to the psychiatrist in July 2015 and told him the truth – needless to say, he was quite annoyed but prescribed me Cymbalta/Duloxetine (60mg) and agreed to reduce my dosage of Olanazpine to 2.5mg. The Cymbalta no doubt stabilized my mood at that time – I was pretty down low, as you can imagine. Once again, I felt it was limiting me but after the volatility I had experienced, I was happy for a bit of stability. In the summer of 2017, I began to learn a lot about the affect diet and exercise can have on mental health. Up until that time, I thought I ate and exercised healthily – how wrong I was. Over the course of around a year, I completely changed my diet and exercise regime – I experimented a lot and ended up with my current diet which is essentially a Mediterranean diet – meat, dairy and eggs a few times a week but primarily plant based food – all unprocessed and organic. A lot of my free time now is spent cooking and preparing food. After I started with Cymbalta and before I changed my diet and lifestyle, I felt that my depression/elation cycle was going on in the background but the medication was keeping it in check. As my dietary and lifestyle changes kicked in, I began to feel that the cycle was longer there – I was essentially stable. I got married in July 2018 to the woman who stuck with me through the diagnosis and all the mental volatility over the years. Immediately, we started trying to conceive – I really wasn’t mad about the idea of trying to conceive while I was on medication – I know that women are advised to come off meds before becoming pregnant and I wondered if my own meds could have an affect on any potential child I conceived. Did a bit of research – heard a bit about meds possibly causing fertility problems but nothing about meds causing birth defects etc. For a number of months after the wedding, we tried hard to conceive with no success. Consequently, I made the decision to start tapering. Not surprisingly, my wife was initially reluctant given what happened previously when I tried to come off meds – this shook my confidence a bit but I really believed that I could cope this time round, given the dietary and lifestyle changes I had made. Unlike the previous time, I told my psychiatrist who to my big surprise, did not object in the slightest. He initially suggested that I stop taking the 2.5mg of Olanazpine altogether – he told me that according to the research, 2.5mg has no real anti-elation effect – it only really aids moderate anxiety and sleeping. I genuinely believed that the olanzapine was indeed helping my sleep so I decided to continue taking it and instead drop the Cymbalta from 60mg to 30mg at the beginning of November, 2018. I was on the lower dosage for three months – I didn’t notice any major withdrawal affects during that period. Consequently, when I saw my psychiatrist three months later, I suggested to him that I stop taking the Cymbalta altogether – once again, to my big surprise he was very supportive. I continued to take the Olanzapine for another month – I had planned to stay on the Olanzapine for three months but given what the psychiatrist told me previously about 2.5mg not really having any anti-elation affect and given how I hadn’t experienced any major withdrawal affects up until that point, I decided to come off completely at the end of February 2019. A part of me was worried that my sleep would go to hell without the Olanzpine but once again, I really believed as long as I stuck to my diet and lifestyle, I would eventually enter into a natural, healthy sleeping pattern – this transpired. Also, around four or five weeks after I ceased the meds completely, I started having definite withdrawal effects – my nervous system seemed to react and consequently, I felt very edgy and jittery and my concentration levels went down significantly – obviously, work was quite difficult during this period. This was quite severe for around five weeks and then gradually started to diminish. I fully expected some withdrawal affects so they did not surprise me one bit when they came. Once again to stress the point, self-belief was hugely important at this stage – I just knew that as long as I stuck to my diet and lifestyle – essentially, the way I was designed by nature to eat and exercise – the withdrawal affects would pass and I would reach stability. I am now off all meds for seven months and I’m feeling good – still not one hundred percent but a lot better than when I was on medication. The Cymbalta didn’t cause me major side affects but I realised when I completely came off it that it contributed to some minor side affects which I wasn’t really aware of – my skin improved (I’ve always had problems with acne), my gums stopped bleeding when I brushed my teeth and my hands didn’t dry up so easily the way they used to, for example. I still have a bit of brain fog which is a bit frustrating but not unexpected – I started taking meds in mid 2012 and ever since, I haven’t felt as if my brain has been operating at its optimal level. I do believe this will come back with time – I just have to patient and allow my brain to adjust fully to the meds being completely out of my system. I should also mention that for most of my life, my brain has not being operating at its optimal level - for the most part, since my early adolescents I’ve been miserable and it wasn’t because of some chemical balance in my brain which would have been triggered no matter what – I had to deal with some personal problems which were really inhibiting me. Like my medication, those problems have been put to bed – I’ve been married for over a year and if everything goes according to plan, I’ll be a father at the end of November. As I mentioned above, I stopped taking the Cymbalta at the end of January 2019. In mid-April, my wife found out that she was eight weeks pregnant, meaning she conceived around mid-February, two and a half weeks after I stopped taking Cymbalta. Maybe ceasing the Cymbalta didn’t have any effect on my fertility whatsoever – in any event, I’m delighted I don’t have to go down the IVF route! I have no problem saying that I have the bi-polar gene. I experienced all the symptoms and those closest to me can verify that. However, I don’t consider myself mentally ill and do not believe that I was born with a chemical imbalance in my brain. As long as I live the way I was designed to live, my bi-polar gene will be completely suppressed – it simply won’t be an issue. For the most part, I believe that the symptoms I experienced were in part simply a reaction to all the things I was doing wrong – my diet, my exercise routine, my work environment, my past relationships etc. I plan to keep my bi-polar gene suppressed for the rest of my life and in order to do that, my life is going to be quite mundane – no substance abuse, regular moderate exercise, healthy sleeping patterns and I’m going to have to continue to spend a hell of a lot of time cooking and preparing healthy food. However, I will take ‘mundaneness’ any day of the week over mental volatility and side affects from psychiatric medication I’ve had to endure over the years. Having come through all that, the stability and contentedness I’ve found are all the sweeter – ‘spring would not be so welcome, if we didn’t have to go through winter’. Once again, apologies for the length of this post – I promise my subsequent ones won’t be as long! As I mentioned above, I feel my brain still isn’t operating at one hundred percent after seven months of all the meds so if anyone can provide me with some advice in relation to this issue, it would be greatly appreciated. Many Thanks Francisco
  6. Hello, my name is Manny. I was diagnosed 0CD and schizophrenic in 2008, but I been taking benzos and amiptriptiline since 2005. Currently,taking abilify 20mg,risperidone 2mg,cymbalta 60mg,biperiden 4mg. I am tapering klonopin down to 0,27mg from a dose of 1,25mg. I went to see my doctor this week because a blood test that I did. He said my hepatic transaminases are high because of the medication that I take. I am assuming the APs that I take. What can I do to get my liver function well? I know, quitting the APs, but I can t cold turkey. Any advice,please.
  7. Hello everyone. I had been on this forum many times before reading all the posts, usually in the dead of night when feeling so desperate and alone with insomnia but did not sign up until now as hoping I would be feeling a bit better by now. I don't. I came off Duloxetine/Cymbalta, 60mg,in June 2016 cold turkey, probably a huge mistake to do it this way but I had been in touch with my doctor and he suggested to change antidepressant to Citalopram 20mg which I tried for a week and felt strange so ended up ditching both. I went through a terrible time of adjustment for the first 100 days but then seemed to manage slightly better, although it was tough I had hope for a while apart from the no sleep. After another few weeks all kinds of symptoms came at me like an express train and these now remain. I feel generally unwell all the time, depressed, no interest, no zest for life and just not functioning very well. I do have Citalopram tablets, 20mg, here in the house and feel tempted to take them but unsure of what to do. I also have Diazepam which I have taken on and off for 8/9 years 2mg. The Diazepam does not help me sleep at all but does calm me down a little but I feel it is not helpful to my withdrawal off the anti depressents and may be making symptoms worse. Would like to ask advice as to whether or not to reinstate antidepressents for a while as struggling so badly with suicidal thoughts and of little hope in recovering. 8 months of feeling so ill everyday is such hard work and is like living less than half a life. All hope I had in feeling better has gone, I cant believe I can feel this bad and still continue to try and get on with the days activities. I keep thinking that I should be in a hospital being looked after but of course any doctor would just dose me up, seems appealing today. Any suggestions would be appreciated very much.
  8. Hello everyone My name is Eva, 20 years ago I gave my power to someone in lab coat and believed them that I have serotonin deficiency and need to take antidepressants. I was on one at the time on regular doses but don’t remember now. Over the years they would poop out and that’s when I would be changed to a different one always did really well with transition had no side effects either so I kept on taking them. Always was told by doctors that antidepressants are not addictive, never was advice to get off them even for years I did not have any symptoms of depression which was the reason I was put on them. I came to USA from Poland at age 23 in poursuit of American Dream ,was very home sick did not have friends, was working nights at dive bar, and studying in the morning, for two years I slept only 4 h at night and ate very poor diets that’s why I got depressed. In past 10 years I tried to get off twice with doctors help was tapered down too fast as doctors do, and as soon as I was on 0mg I would “relapse” now I know it was withdrawal. Second time it was the same story. For past 4 years I was in the best shape of my life i did yoga and other fitness at least 5 times a week I was very happy mother to my daughter and wife my husband is awesome and I love him dearly. I was in great shape mentally and physically. I kept asking myself this question why am I taking antidepressants I’m not depressed, I want to know who am I without this drug because I started to believe that I never should take them in first place. In February 2018 my cousin gave me medical marijuana ( i only smoke couple times in my life, never was attracted to it) i started to smoke and all the sudden i had that idea that I didn’t need to take antidepressants anymore so I stopped cold turkey in February 2018 from 60mg Cymbalta to nothing. Almost instantly i went into mania state, was euphoric and nothing was bothering me, i slept only couple of hours at night, i could not eat food that i ate my whole life, my tast became very sensitive, I lost appetite and had diarrhea for over month. Nothing was alarming me because I was in mania. That went on for 6 month it was starting to loose its high towards the end. And in the end of August I started to notice that I was crushing my memory was becoming very impaired, my cognitions too and I had anxiety that was scaring me because I had never had anxiety in my life. I was sure I’m relapsing and was very scared because my symptoms were much was then ever before. I started to take 60mg Cymbalta because I still had it in my house, that was August 2018, I called my doctor and she said I was relapsing , gave me Benzodiazapine for my anxiety 0.5 mg. My condition became worse I was not improving but getting worse. I could not sleep I couldn’t not eat, I could not think my cognitions was gone, I started to have sucidle ideation ( never in my life I had them before) I became dead a zombie. I had insomnia and sleeping pills were not helping ( never before in my life I had issues with sleeping) Between September 2018 and February 2019 I was switched to new antidepressant every two months. After Cymbalta it was , Effexor, then Remeron. I was in hell and totally in the hands of people who where making my condition worse but at that moment I didn’t know it I was sure I’m going crazy. In the January 2019 I did ketamine therapy but that made me worse. I was in hospital 5 times between September 2018 and February 2019. After ketamine I went to hospital again and agreed to have ECT at that time I did not care anymore I was devastated from smallest atom in my body I was broken chemically broken. After 4 session of ECT I felt better first time in 7 months I went home and was able to function some what. I got back my cognition to the point where I started to look back at what has happened to me and looking for answers, deep down inside of me I knew that it was not my body making me sick I knew that something was happening to me that was outside of my body control. That’s when I found this site SA which explained everything I was searching for, I was crying I was so relieved but also became so angry at doctors at whole system. I understood that after I started to take Cymbalta in August 2018 my body rejected it and it made me lot worse. After ECT my doctor put me on Zoloft first 25 mg and then up to 100 mg. It was March 2019 end i was saying to my husband I’m so scared i don’t know why because i know I’m safe but I’m scared. After I found S.A. I understood that the only way to heal for me is to be drug fee I understood that what has happened to me was severe withdrawal symptoms from Cymbalta. I realize that I will never trust doctor again I know that I have to heal my body and no doctor will help me to do this. I wean myself of Zoloft and have been drug free for 1 month, I also stopped taking Benzodiazapine I was only on 0,5 mg as needed but was very reluctant on taking them because deep inside I knew that this is not right. And it was not it was very wrong everything that has happened and the way we are being lied to about devastating withdrawal and addictives nature of antidepressants . So now I’m one month drug free. I have anxiety about doing basic things like grocery shopping and cooking it’s extremely difficult, my short term memory is very bad, my cognitions is better then between August 2018 and February 2019 but still not as normal, my appetite is still gone I have to force myself to eat I’m 16 Ib underweight, my sleep is broken but much better then it was before. I have tormenting thoughts like I cannot stop my brain from thinking, it’s usually related to what has happened in past year, I have depression very hopeless like a child very helpless like a child, I’m ashamed of myself for being in this condition even though i know it’s not my fault, I cannot enjoy enjoy anything that I loved in the past, I feel very disconnected from outside world and every human being. My daughter is my main reason I decided to get through it, but I feel so guilty for not being able to take care of her the way I would before withdrawal. My husband is been my biggest support and I’m worried that he will get tired of me being like this it’s must be so hard on him. I am totally different person now , I was highly functional and happy very social with everything organized. Now I’m like a child helpless hopeless afraid of my own shadow. Emotional suffering is beyond anything I have ever experienced, I cry every day for no reason other that the pain inside of me. Physically I only have problem eating and extreme blotting after I do eat. I know I’m very lucky compared to people who went through physical hell too. I’m not myself and I’m so scared that I will never be who I was before. I’m scared I not going to feel happiness and joy. I don’t even remember how it is to be happy. Please help me to get through it I feel so lost most of my friends think I’m crazy because I decided to take charge of my life and not to trust doctors but they don’t understand that trusting doctors are the main reason I’m suffering now. I feel so lonely Please help me to get through this hell Thank you Ps. This website gave me hope and probably saved my life, I do want to thank the man who created it , thank you from all my heart even though I cannot feel my heart Its still there because I’m alive.
  9. DavidfromTexas

    DavidfromTexas

    Hi, everybody. My name is David. I just discovered these forums a couple days ago as I was searching the internet for answers and hope. I'm in pretty bad shape right now, even as I am typing these first lines I am starting to cry. I feel better about asking other people who have been through the same issues as me, as opposed to a psychiatrist that just wants to put me on medication. Warning: this is going to be a long post, I apologize and thank you in advance for reading. LONG-TERM MEDS HISTORY: I am now 30 years old, and have been on Anti-Depressant medication for 20 years. I was diagnosed with pretty severe OCD/Anxiety around age 10 or 11, and immediately started on Anti-Depressant medication. (It was warranted, I was in such despair and largely unable to function even in everyday activities like school and doing normal kid things, and was never going to be able to get through any kind of Behavioral Therapy at that point in my life). SO we started with Zoloft (Sertraline), and it made a HUGE difference pretty immediately. I was able to be much more of a "normal" kid, though I did have setbacks here and there. After the better part of a decade, when the Zoloft seemed to not be working as well anymore, we switched to Cymbalta (Duloxetine), which I have been on for approximately the last decade. Which brings me to... SHORT-TERM MEDS HISTORY: Sometime in 2017 (I think), I decided I finally wanted to try going without my medication. I began a tapering with my prescribing psychiatrist that lasted 6+ months UNTIL the beginning of 2018 when I dropped COMPLETELY off of the medication. The tapering process was 90mg down to 60mg, then down to 30mg, then eventually down to nothing. I had NO physical withdrawal symptoms when I did this, and I remained off of the Medication for maybe around 3 months. The only REAL reason I decided to go back on the medication after those 3 months was because I had been feeling much more down/sad since being off of them, BUT I was unsure how much of that was normal (my 4-year first-love relationship finally died at the end of 2017) and how much of that was possibly a side-effect of being without the medication. SO, by April of 2018 I had decided to go back on Cymbalta, and I pretty quickly went all the way back up to 90mg. The plan was to be on it for a little while longer to give myself time to heal from the loss of this relationship. By the end of Oct. 2018 I had made it back down to 30mg, where I would stay for the next 5-6 months. (I think I tried dropping off the medication once during this period but went back on pretty quickly because I started feeling some physical withdrawal symptoms that I hadn't before. At this point, my memory is kinda blending it all together.) I tried dropping off again this April and felt the withdrawal effects worse than I did the previous time. So once again, I went right back on it. THEN I started seeing a different Dr (a nurse practitioner) who has experience helping people wean off of meds. Following her suggestions, THIS TIME I weaned from 30mg down to 20mg daily for 2 weeks, then started taking the 20mg ever other day for 2 weeks, then down to half of the 20mg pill every other day for 2 weeks (opening capsule and pouring out approximately half of the beads), and then finally taking half a 20mg pill every 4 days for a couple weeks. Doing it THIS way prevented the physical withdrawal symptoms I had experienced the couple times before. BUT now it's the emotional despair that I am worried about... WHERE I AM NOW: I have now been completely off of the medication since July 2nd. If I can just get through this depression and sadness, I just KNOW that I will be able to handle the issues that originally plagued me 20 years ago. I have lived through it all, and with the experience and memories and knowledge that I have now, I should be able to cope with it much better. I am just worried that it's the worst timing ever. Here we are, over a year and a half since my relationship was fully dead, and I am struggling with it worse than I have at any point since its death. I have only recently decided I need to do whatever I can to get past it because it is CERTAINLY not coming back (talked with her a few days ago). BUT what is now troubling me, is that I'm not sure if my current depression is due to the loss of the relationship OR if it's due to me being completely off of medication now and my brain having to re-wire itself and recover. OR if it's a really bad combination of both. I've never been through heartbreak like this before, but it seems to be getting progressively worse, where in normal circumstances it should be getting progressively better as time wears on. How can I tell the difference between true, natural depression and depression that's an effect of withdrawal? I assumed (maybe naively) that if I didn't have any physical withdrawal symptoms then I probably wouldn't have any emotional symptoms either. Just looking for some thoughts/insight from people with similar experiences. I am scared that I will have to remain on Anti-Depressants for the rest of my life, and who knows how THAT might even damage my health. I have been researching alternate, more natural forms of therapy for someone like me with Serotonin issues, the use of things like magnesium supplementation and whatnot. MY MAIN CONCERN IS BEING ABLE TO BE HAPPIER AGAIN, and I'm just hoping I can do that without Anti-Depressants. (I'm also dealing with other smaller physical issues like PE, which began as soon as I started weaning and gradually got worse the less amount of meds I took. But again, at this point, the more important thing to me is my mental health and mood. I don't want to feel heartbroken and hurt anymore.) Thanks for reading. I appreciate your time. David
  10. I haven't been able to reduce my Cymbalta dose for two years because of the horrible withdrawal symptoms I have experienced with both attempts (a year apart). I spent three years dropping from 60 to 30 mg. I have pretty much given up the goal of eliminating Cymbalta - afraid to cause more damage by tapering the than that caused by continuing to take 30mg. I am unwilling to risk further trauma and drama, so I haven't tried the crossover either. Prozac was too "activating" for me in 1989. I don't think it's likely to be a solution in 2012. I still have restlessness, sweats, problems with balance, an incredibly trigger-happy startle reflex and frequent headaches. After feeling progressively less brain fog during my three year taper, my cognitive processes are really abysmal at this point. I can't keep track of simple stuff, can't handle financial transactions, have problems with noise, light, just stimulus in general. And I haven't changed doses in two years. I wonder, do SNRIs poop-out the way the SSRIs tend to?
  11. Worthy

    Worthy

    Hello. I am wanting some advice on withdrawing from the drugs I am currently on. I am taking 60 mg cymbalta, 5 mg zyprexa and 7.5 mg mirtazapine. I would like to withdraw from all 3 at the same time. Is this possible
  12. gardenlady

    gardenlady

    Moderator's note: Link to gardenlady's benzo thread I would like to taper off of 60 mg Cymbalta. However, I am in the middle of a taper off of Valium and am now at 11 mg/day. The horror stories I have heard about Cymbalta withdrawal terrify me. Should I cross over from Cymbalta to another AD and then taper off? And, should I wait until I finish my Valium taper? I cross tapered from 1.75 mg Ativan to 13 mg Valium and am now down to 11 mg. It's going to be a long time until I'm off of it. I am horribly depressed since switching to Valium, but the anxiety from interdose withdrawals on the Ativan were unbearable. I want off of ALL of these psychotropic drugs but realize I have to go slowly. I just want my life back. Any advice would be much appreciated.
  13. scarletknight3

    scarletknight3: 20 plus years

    Hello. I have been a prescribed patient on Lorazepam, Wellbutrin & Cymbalta for the better part of 20 years. Lorazepam 4 mg Wellbutrin 150 mg XL Cymbalta 60 mg I was diagnosed in 1996 with depression and generalized anxiety. I believe graduating from college and all the stressors of new jobs etc. caused a situational anxiety for me. Early morning wakenings, dread, muscle tightness in chest, etc. I have only experienced withdrawal, or interdose withdrawal when accidentally running out of mail orderpharmacy scrips. Akathasia, denationalization tremors, and on. In approximately 2015 I had started to increase my evening dose by 2 or 3 pills for a couple of months, thinking it would help me sleep better, as getting to sleep is EXTREMELY difficult for me. It has led to nighttime eating and probably 30-40 pounds. After downdosing back to my regular amount I began to feel parasthesia and burning and tingling in my right ear which has been pretty much daily but intermittent and differing in how strong. My Dr. says it is an affect of the screwing around with doses and may last for a long time (which it has already). That, and I am probably at tolerance as well. Add in some severe hypochondria as well, but this may be an effect of hitting a milestone age, and losing some firneds and my father, although Ive heard hypochondria is a symptom of the med and withdrawal obviously. After discussing tapering with my Dr. off of the benzo, she seems to think that since I am functioning at a high level at work and with family, that maybe I should continue on them and taper at a time in my life where raising a family and holding down my job aren't my daily functions, like later when the kids are grown (I have a teenager and soon to be teen) and a wife. Besides my parashtesia, I am wondering what next steps I should take.
  14. This is my first posting here and I apologize in advance if the topic of LDN is well known. LDN is the acronymn for Low Dose Naltrexone. Naltrexone has been used for many years to help treat opiate and alcohol addictions. I was put on Cymbalta in 2010 after the death of my 21 year old son in a car crash. I was in shock (still am) but I also felt like my body weighed 3000 lbs. The Cymbalta DID help relieve me of that unbearable heaviness. I did eventually reach the max dose of 120mg. I had run out of my prescription a couple of times, due to forgetting to pick it up etc. I do recall becoming tearful and the "zaps" in the head. The last couple of years are much a blur anyway. My most recent incident occurred during a trip out of state to see my brother. I ended up staying an additional week to help him with a number of things but had only packed my "pillbox" for a 5 day stay. Needless to say I started to feel terrible pretty quickly. I remembering saying to my brother that I could relate to the heroin addicts that always feel sick until their next fix. I at first thought that I could tuff it out. No I could not! By day 3 I called my PCP for a script to be faxed over to an out of state pharmacy. That was in October 2013. I did discuss this event with the psychiatrist that prescribes my Cymbalta and it seems to be a rare occurrence according to him ? Well I did go from 120mg down to 90mg after that appt without a problem. Fast forward to January 2014, I am doing some research on autoimmune disease as my siblings and I have developed a few. I came across the use of LDN ( low dose naltrexone) in a number of auto immune disorders and requested a prescription from my PCP 2 weeks ago. I read as much as I could find and it made sense to me to try to further reduce my heroin like addiction to Cymbalta to see if the LDN may reduce the awful withdrawal symptoms. I am currently taking LDN 4.5mg at bedtime along with only 30mg of Cymbalta! And I am happy to say not only do I feel a little better from the LDN I have not experienced a single uncomfortable symptom from the reduction in Cymbalta. I am a bit nervous about going from 30 to 0, I may wait a couple weeks. I did want to put this info out here tho. LDN is not very well known, it's cheap, off patent etc. Just google LDN and educate yourself. It may not work for everyone. BTW, my auto immune disorder was/is Transverse Myelitis. My withdrawal symptoms had NOTHING to do with the TM. I had TM in 1977 with a 90% recovery.
  15. I need some advice. I was on cymbalta for 7 years and very functioning on it. I was reduced from 120 to 60 mg from my doctor and slowly started to mentally decline. Physically too, not able to eat. My doctor thought I was just depressed, which I know now I was in withdrawal from a dosage reduction. He tapered me off in 2 weeks and placed me on lithium and abilify. I hated being so sedated and shouldn’t have been switched to anything at the time, I know now. I was then taken off those in 2 weeks and placed on Zoloft. That had my heart racing so fast I couldn’t take it. I was on that for 5 weeks and felt like I was dying. Tapered off in 1 week. Now I have been on Effexor for 10 weeks. I know now that my brain has been kindled. It’s in no shape of getting any good effects from any medicine because none of them help, especially if I am in Protracted withdrawals all along from reducing the cymbalta dosage. I hate the Effexor. It has no positives and I know I cannot slowly taper until my brain starts to stabilize. I just have been on Effexor for 10 weeks, in Protracted withdrawal, and don’t know how my brain will stabilize while still on Effexor. I know this is going to require a lot of time to heal. I just wish I could slowly taper Effexor and then I would feel as if I am healing. I know now that I should not have allowed myself to take another antidepressant after cymbalta. I should have re-instated the 120 and slowly weaned off. Too late. Now i I feel like I have brain damage and cannot find any joy in life at all. I’m scared because I am barely functioning and I will never allow my doctor to give me another medicine. Which he is trying to. Please help!
  16. Hello everyone. I'll try to organize this as best as I can. There is a lot going on. I was on benzos from age 17 to 36 and on Cymbalta from age 35 to 36. Went off both together for a 2 year nightmare. Absolute pure hell. I wont get into the details and symptoms of that withdrawal in this post as it is it's own little novel. Some things improved during those 2 years and I feel I've beat the benzo part of the nightmare even still, but at age 38 I was still suffering enough that I agreed to go on Lexapro to see if I'd improve. I did improve hugely but it stopped working as well after 3 years and I was switched to Prozac. I have taken the Prozac ever since and it felt like it was failing around 4 months ago. I missed a lot of doses around 3 months ago and just tried to stop CT for just over a week around a month and a half ago. I started feeling withdrawals so I went back on and the withdrawal feeling is still getting worse. My memory and focus went first, then the inner restlessness and anxiety started and dizziness. I am also having the disconnected dream like feeling 24-7. I am so depressed and fearful all of the time. I've been taking the Prozac without missing a dose for over a month again and this is still happening to me. It's as if the combo of Prozac tolerance and coming off for the short time has started a withdrawal that even going back on can't stop. My doctor wants to take me off the Prozac after a slow taper and start me back on the Lexapro. The hope is that since it worked before and I've been off of it for almost 3 years that it could pick me back up and end this nightmare I'm back in. I am really considering just tapering the Prozac and staying off all ssris; so no going back on Lexapro in that case. I am so afraid of entering back into a nightmare like a was in coming off benzos and Cymbalta. My current state is terrible but the previous experience was truly worse; being benzos and Cymbalta together. It is really hard t say what withdrawal symptoms were coming from which pill. There were so many. I am so terrified of how I am feeling right now, but mostly for the days to come. If I come off the Prozac entirely I know my current state will worsen. I will be thrown back into a situation similar to the first nightmare. If I taper the Prozac and go back on Lexapro and it actually works, I'll still be doomed because I'll be back on another pill waiting for it to stop working again and most likely going through it all again. If I go back on the Lexapro and it doesn't work I will just aggravate my current symptoms with throwing more chemicals on my already hurting brain. The first time around withdrawal I had terrible akathisia and I am already feeling it brewing and I am still on the Prozac. I don't want to go through this again! Also from what I've been experiencing this month it seems a lot of what I assumed were due to the benzos were possibly due to the Cymbalta withdrawal as it's so similar. Also, I forgot to mention that I am on 500 mg of Depakote XR as well. I was put on this a couple of months after the Prozac as I felt a bit agitated. It helped but I got worried about my liver and quit it after 4 or five months and had a mild withdrawal from that but it passed. Just a couple of weeks ago after my current situation started I went back on the Depakote to see if it would help and it hasn't. I'll most likely be stopping it again as well. I had an account on Benzo Buddies during that ordeal and it gave me an outlet and some hope. I've set this account up here and got my story out in advance as I am leaning towards just stopping the meds and I'll be needing all of the support I can get! I'm seeing my doctor on January 3 so whatever I decide to do it will be starting then.
  17. hey, my new heroes... I am feeling afraid and lost. This started for me in February 2018 when my retired psychiatrist's replacement said that I had to come off the klonopin or I would end up with dementia like my mom. (I will be 60 in August). With no suggestions as to how to taper, I found myself on Dr. Goggle and cut 1/4. Horrible withdrawals while maintaining a stressful position at work. Adding to my stress was a new partner who had moved from another state to move in with me. We never had time to stabilize our situation before my taper began and mom was diagnosed with advanced dementia. I had a maddening search for a doctor to help me through this process and found an internist who upped the cymbalta to 90 mg and then later to 120 mg late summer after I tapered the klonopin to .25 mg and back down to 90 mg in the fall. (I had been on cymbalta 60 mg and .5 klonopin since 2006. I started out with 75mg effexor and the .5 mg klonopin but I had withdrawals from the effoxor after missing 4 days of meds when out of town. Psychiatrist started me on the 60 mg Cymbalta. I remember the transition being a smooth one). In an attempt to continue with my Klonopin taper and to deal with the debilitating withdrawlas from what I now were Cymbalta-related, a different psychiatrist (still searching for competency at this point) was trying to cross me over back to the effexor and off of cymbalta. BIG issues with this process. In February she dropped me to 60 Cymbalta and added 37.5 Effoxor. I did this for 2 weeks then dropped the Cymbalta to 40 mg and continued with the 37.5 mg effexor. I did this for 2 weeks but ended up in the ER with what I think was akastaisis. Was discharged with both a script for a beta blocker and an antihistamine. I finally was able, in my fear-induced panic, to take the antihistimine and sleep in the ER. To date, I have used neither. I've white-knuckled and CBTed my way through the last couple of months. I saw the psychiatrist in a few days after my ER visit and she dropped the cymbalta to 20 mg and stopped the effexor. I opted at this point to take my Family Medical Leave option and entered a 2-month long out patient CBT program which started on March 18th. During this time I was working with a psychiatrist for meds. The psychiatrist affiliated with the outpatient program was a young man whose name I recognized and it turned out that he had developed a name for himself as a benzo withdrawal expert (Mad In America continues to ask him to blog). The entire two months in the program I did nothing but cry and I had my first full blown panic attack in 20 years. Meds at this point were 20 mg Cymbalta and .25 mg klonopin. I was being told that I needed to make another klonopin cut so I chose the date of April 19th, Good Friday, as I thought that fitting for my need for symbolism and to make a spiritual connection. I started by cutting that little pill into pieces but have ended up using a compounding pharmacy and have been taking 7.5 ml (.1875 mg) daily. He kept telling me that I was on such a low dose of the klonopin that I could jump if I wished. We never discussed the issues related to what I think are cymbalta withdrawal symptoms. I told me that I could be med free soon and regaining my new life. The program ended on May 18th and I left with no med changes. Life got worse. I've had some good days but mostly they have been filled with crying and dread; a lack of meaning and a huge sense of loss. (I was having to make decisions about the future of my professional career which ends on July 24th. I've had no income now for 2 months and became eligible to apply for our agency's Disability plan on June 19th. I have applied and am waiting, hopeful, but waiting. My new relationship is suffering and I feel very misunderstood.) Within the past 2 weeks I finally found doctors in town that have successfully tapered others off of benzos and Antidepressants. Three different opinions on med changes but they all share the thought that I need to stabilize before finishing the benzo WD. Yet, I question the plan. I need your wisdom. SOOOOOOO, they all wanted to try new meds while finishing the cymbalta taper which wasn't even registering in my mind as a cause perhaps for my current state of being. One wanted Lamictal, one suggested Lexapro and another zoloft because I have family members living mostly stable lives on this drug. (multiple SSRIs from 1986 - 1998 were tried, nothing worked for me until we found the cocktail with klonopin). Diagnosed as GAD. The plan that was written up is this: Start .25 zoloft on 6/24/19 and take this for a week with the 7.5 ml klonopin and 20 mg Cymbalta. So far, I have been less anxious but the foggy head and fear are still fairly high. I hate this spacey feeling. I've spent a lot of time alone in my room, afraid and tired but not able to sleep. My night time sleep has been affected a bit since starting the zoloft. I have trouble getting to sleep.) tomorrow she wants me to start 50 mg zoloft and drop the cymbalta while maintaining the klonopin. OR, take the cymbalta every other day. She wants me to stay at 50 mg to see how I am doing. We will up it if needed. (I felt an almost immediate shift in attitude the first two days on the .25 Zoloft but this has since gone downhill. I am triggered by the thought of putting new meds into my body.) How long will it take me to get off of the cymbalta and is switching over to zoloft a good idea? I AM SO FREAKING AFRAID!!!!!! Please share your support and wisdom. HOPE, is there hope for me. The compounding pharmacy will fill cymbalta capsales but I need a plan as I fear that dropping another 20 mg is too much, too soon. How long can I take the cymbalta and zoloft together without SS? Looking forward to hearing back soon. Trying to make today a good day but I am feeling victimized and adrift. With much appreciation. fearbegone
  18. I was prescribed cymbalta a year ago. Tried to withdrawal from Cymbalta many times. Last time it ended in a severe heart cramp but nothing major came of it. I decided to reinstate at 30mg and taper over 3 months removing beads. Tapering went well these last three weeks I went from 50beads to 30 to 20 to 15 then I quit 5 days ago because my medication ran out. I’m not having any terrible withdrawal symptoms like I had before BUT now I am experiencing asthma attack like panic attacks a few times a day and feel like I can’t breathe. This hasn’t happened before during previous withdrawal. My chest hurts and my Kardia device keeps saying “unclassified” heart rhythms. Before now I always had normal readings, maybe palpitations are normal for withdrawal? I’m concerned that I need to reinstate back to 20 beads and taper slower? I wish I could do the 10% reduction method but my glucose levels are dropping and my hair started falling out😬
  19. Hi, Read an article in the New Yorker called The Challenge of Going off Psychiatric Drugs. The story of tons of medication combos with hospitalizations and withdrawal over years resonated with me. This forum was mentioned and honestly a relief because there hasn't been a ton of help with withdrawal. With insurance/doctor issues ive stopped cold turkey off Cymbalta multiple times throughout the past year but recently tapered off with help of my doctor. (lowering by 35 mg a week). In the month of coming off I've had severe tremors, crying spells, hypersensitivity, and bizarre vivid dreams (with the history of no dreams at all). I'm not unfamiliar with these flu-like symptoms from past cold turkey withdrawal but it frankly makes me wonder if I'm just too weak to adjust lol. Also having been on many high doses of various medicines since puberty I dont have a baseline for myself or my disposition. Is my true nature extremely agitated or is it withdrawal? But given my young age I wanted to possibly experience life not on drugs - also being on Seroquel really messed up weight gain and hope for some metabolism bounceback. Medication history is currently vague due to memory loss, high stress, and young age at the time of many changes. Trying to piece it back together.
  20. I’ve been taking anti-depressants and a mood stabilizer for 20+ years. I want to wean off duloxetine first. I’ve experienced horrible withdrawal symptoms when I failed to get a refill about 3 years ago. After about 2 days not taking duloxetine I was in full blown withdrawal and it was a flipping nightmare. That experience led me to believe I would never be able to not use the drug. I am to the point of being tired of dry mouth, dry eye, constipation and sweating. This may not be a good time to wean as I’m planning my daughter’s wedding for next fall and going to school part time. I will be 59 in 2018. Finding this forum is a godsend for me and hope I can be active even if I’m unable to start a taper right away. I’m really scared that I will never feel like the self I was before taking these drugs. I’m not even sure if I remember, which is even scarier and causes some anxiety if I focus on it too much. Thanks.
  21. So this whole disaster started when I was in high school. I had been recently diagnosed with ADD, and was prescribed Retalin (a form of Adderall [for you Americans], and a sh*tty one at that). Before long I started having tachycardia, lack of appetite , I was jumpy and irritated and and was not fun at all. Now, the same neurologist, (as I believe he was) who prescribed me the drug, didn't not prepare me for all of this; the bastard didn't even scheduled a follow-up appointment or something, and didn't inform that there are other drugs at this family of drugs and if I develop any of the symptoms above to an unbearable extent I should just stop and switch to another drug. But as behooves an unprofessional and cynical bastard, he didn't bother. And so, in the midst of a Math test, junior high, I had my first panic attack🤙🤙 I, of course didn't have clue of what happened to me, I seriously thought I was going to faint and thought it was just a one time thing. But of course, life had more devious plans for me than that--next test I had another one. My mother, who suffers as well, understood what was unfolding immediately, but was reluctant to say and diagnose in fear of scaring me or just misdiagnosing. I decided to to get off Retalin, (I have been taking it for almost a month), but what a surprised--the panic attacks persisted. Not only that it persisted, it expanded--it now harried me in class and other places. Then, I was told, diagnosed and referred to specialist. I started CBT with an amazing young therapist and prescribed Citolpram with the starting safe-net of some Benzos. It worked wonders! But I was now another person, much more confident, too much confident to the point of insolent and aloof even. Nothing could distress me. Panic attacks were rare, and when they visited I have managed to reduce and level them out. I finished high school, and decided to fly to Berlin before my induction to the army, (a mandatory 3 years of service in Israel). And then, it's when I remember (it may have started before), that I started sleeping 3 hours a day every early afternoon. Plus waking up was a real pain in the ass. But nontheless, I thought it was normal, that I could stop sleeping everytime I command myself to it, and that everybody's morning looked like that. It took me 2 and a half years to realize that maybe I was wrong. Now the real whirlpool of disasters began. My psychiatrist, a new one, my second one, suggested that I try Milnacipran, I don't remember her thinking about it too much, her decision was very arbitrary. No gradual weaning off the Citolpram, just "take straight away after the old one". I was beset with hellish migraines! I then tried Prozac, Cypralex and fluvoxil, every one for 3 months or so. They all were the same as the other--the fatigue persisted, and they didn't cover the anxiety to a satisfying extent. The fatigue was worsening and I decided that first time in 5 years to wean off them. I stopped Flufoxil CT, of course I didn't know what it mean "Cold Turkey" at that time, because the new Psychiatrist I was seeing didn't believe it exists. The fatigue did go away, which was reassuring, but I was mentally unstable, and suffered from debilitating acute anxiety at night before sleep. This lasted for months without end. One profound anxiety attack of a different order of magnitude made me go back to a different psychiatrist. He prescribed me with Cymbalta. Now, ladies and gentlemen, the real orchestra of diabolic dissonance is about to play! This pill, I kid you not, upon the first day of taking it has killed my libido flat! Sugar was too much to bare and life was a big numb. After two weeks it got worse, I started having crippling migraines that last for 3 hours each and made me puke my soul on each one's end. On my 22th birthday, we went to the local lake, and I suffered such a extensive migraine that I remembered the thought that I wanted to be put to sleep, comatose, for at least a year. I was seriously considering it. I came off it as well, also with no gradual tapering off, and waited until I felt clean. Although I didn't, and it was worse than the cleanse. My mental state deteriorated and I was put on Brintellix, and was promised it was a new ground breaking drug that will solve all of my problems! Even take care of my ADD. I ended taking it for 4 months or so, upping the dosage this time, thinking maybe that some of the symptoms are from the previous pill, and they will pass either way. It ruined my stomach, and made acidic as hell. They didn't. This time, I was determined to cleanse off gradually as I have seen in some forums like this. I have started reading more on the internet and trusting less the institutionalized system of Pharmacology. I am now 4 months after my last pill of Brintellix, and there is no light in the end of the tunnel. I am experiencing a plethora of symptoms that doesn't seem to go away or even abate: my stomach acidic, my brain is foggy, I suffer from light migraines through out the day. I can't concentrate, and I have horrible fatigue attacks that can't be beaten by any amount of caffeine. I am not sharp as I used to be, I suffer from panic attacks and back pain. AND IT ALL GOES AWAY ONLY BY TAKING Lorazepam, but that makes a bit disoriented and tired as well. But only on benzos , my symptoms seriously abate and I am free to live. What should I do? I CAN'T WAIT YEARS ON END LIKE THIS, I need to earn a living and continue my life which has been on hold for 5 months or so. Should I come back on the pills? will it make the symptoms go away? I don't trust any pharmacological solution to get me out of the mud. I have lost hope, and I want to get my life on track. what should I do?
  22. Hi, So I finally understood that it is strongly recommended to write a little something about my experiences here. I will just copy some parts of my posts I have shared in this forum to sum up. Recent developments: I myself have intolerable withdrawal symptoms even reducing 5% of the drug. They are unbearable, both physically and mentally. They totally incapacitate me for weeks (I sleep up to 15h a day, terrible brain fog and dizziness up to the point where I cannot walk, of course the brain zaps and lots of pains in different parts of the body etc) (I will not mention the mental effects, they are really bad...) and then on it is still bad but keeps stabilizing very slowly. At this point (after tapering for years) I am seriously considering coming off the 8,44 mg altogether because I am just unable to go through the symptoms that come after a reduction so many times any more. Because the withdrawal symptoms are extreme for me I am thinking it would be better to cut off the drug now at 8,44 mg and hope the nervous system will start balancing itself out than to go through this hell for at least another year (which is the very optimistic time frame). Note: I have decided to go with this idea - I am going from 8,44 to 1 mg in 8 days. (today being the 3rd day: April 3rd 2015 ). Before judging please read the history of my experiences to understand why I personally have decided to take this approach now in the very end of tapering. My experience: I have been tapering at different pace throughout the process. Since the beginning I have made the reductions by 10% or even 5 % when I realised that the symptoms were directly caused by the reductions. I was aware (theoretically) that my symptoms can be caused by the drug, its side effects and withdrawal, but I didn't really believe it for a long time. Or it would be more correct to say I always had doubts whether it was still more me being crazy and ill. So for a long time in the beginning (I have been tapering for over 2 years) I kept tapering with intervals that I now realise were not nearly enough for my brain to stabilize, but I was not fully aware that the withdrawal symptoms could be so severe and last for so long that I figured the reason had to be somewhere else. I just tapered according to the planned schedule, keeping aprox. 3 week intervals (and unfortunately, optimistically 2 week intervals). I also tried micro tapering every week, but needless to say that proved to be harsh on my nervous system and was keeping me in a constant state of agony. During the last 9 months or so I have had to keep longer periods between reductions in order to stabilize (I realised more and more that what I was experiencing was due to the reduction of the medication and the link got clearer by the day), but I cannot even estimate the stabilization point. For some of my friends it is perfectly clear - their withdrawal "cycle" is short and simple: they know that their symptoms will come 1-2 days after the reduction and last for about a week (max). This is not the case for me. One week for me is the extremely acute period (which would correspond to maybe the 1st 1-2 days of my friends' cycles) and as much as I would like to see a noticeable improvement during week 2, I can only say that it gets slightly better than the extreme, but not nearly enough to function to a standard that would/could be acceptable or tolerable. After recently having a 6 week and a 2 month gap between reductions I can say that during the 2 month gap I guess you cold say that I started to feel like the symptoms were starting to actually stabilize for the fist time for me subjectively. That enabled me to observe how the affects of withdrawal came about abruptly and directly connected to the reduction. In more detail: I'm having a hard time remembering exactly how long I have been taking certain drugs. Seems like forever. I was first prescribed Fluoxetine when I was 17. I am 30 now and for 13 years I have constantly been on and off different antidepressants - the whole spectrum of them. For a very short while I was even on antipsychotics (a month or so). I have always had awful side effects and have discontinued the drugs after a while, switched from one drug to another etc. It wasn't until a few years ago when I finally became aware and educated myself on the topic of antidepressant withdrawal and the harm they cause. (I would really suggest two books for a real eye-opening: Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime by Peter R. Breggin and Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker). When I think back on the years on these meds and realising now what they have done with me, it makes me indescribably angry and sad. I have had awful side effects for years and discontinuation effects that I only realise in retrospect for what they were. Last drug I discontinued before Cymbalta was Venlafaxine (Effexor) which is another nightmare next to Cymbalta. Unfortunately then I was not aware of the methods of slow tapering and the discontinuation symptoms literally almost killed me (the "brain zaps", disorientation and dizziness were so severe that I almost tumbled in front of a moving car one day). By then I was already google-smart on the discontinuation side effects these meds have but was still unaware how to slowly taper. I was very reluctant to start taking Cymbalta but was convinced it was necessary by mu doctor. I started with the idea that I would only be taking the drug for a few months. Well, months become a year before I started tapering. I was taking 60 mg of the drug. When I started tapering it was very difficult for me to distinguish between the effects of withdrawal symptoms and my usual symptoms. A lot of the time I did not believe that the drug could be causing all the mental and physical symptoms and was afraid that it was just me. By know (as I described in my previous post) I have realised that a lot of this has been the drug's effect, but I am still afraid whether these effects can be undone. I have no way of knowing whether the decade of these drugs has caused permanent damage on my nervous system. I have tapered using different strategies. I have never tapered more than 10% of the last dosage, but I did reduce very often for a long time (after making a schedule I tapered every 2-3 weeks). It was because I could not really believe that my symptoms were so severely caused by the withdrawal. Later when I tried longer stabilizing periods I experienced how the withdrawal effects were sudden and obvious and followed a certain pattern (for Cymbalta and for me it is 1st day - no different, 2nd day slightly lowered mood, mild brain zaps etc, 3rd day - hell!). Withdrawal symptoms: The first week, on day 3 I start to have terrible crying spells. Literally for days I keep crying. Well, of course not 24/7 but for most part of the first days I am in tears. I am not sure how long that lasts but at least half a week. At some point the crying is replaced by despair and major depressive feelings. This is the worst symptom and the best I know to describe it is that while having this I feel that I cannot bear living for another minute more. I just want the suffering to stop. And it doesn't. And that can get better for half a day or even an entire day, but still last for... well, an unknown amount of time. I know I could handle any kind of symptoms - all the pain and crying and everything, but this is unbearable. The only thing that helps is numbing the feelings with Xanax. I do not drink alcohol but I can totally understand why people would choose to numb their pain with it. I suppose it is not at all different from taking Xanax - they're both a sort of a poison for the body and the brain. From physical symptoms the strongest ones I have is exhaustion (up to the point where it is ridiculous even), I have strong neurological symptoms (brain fog, brain zaps - they are a sort of a mini seizure, extreme sleepiness - sleeping up to 15h a day, not being able to shake the drowsiness and fogginess for the most part of the day, I have strong neural pain in the left side of my body - in the left arm, shoulder, back of the head, behind the eye, vision problems, extreme sensitivity to sounds (!) and a general sensory oversensitivity, nausea of course. Oh, I remembered for some period during the tapering I sweated extremely. I usually sweat really little. I also sweat a lot during the night. The flu-like symptoms occur. Ohwell... the list is so long it is embarrassing. And these symptoms don't really seem to pass fast. They just last and last so that I get to thinking it is ridiculous. But it still keeps happening. Oh and from time to time comes the agitation and irritability. I can feel how my thinking gets impaired - it slows down, the memory gets really-really bad, I cannot remember words and names (I used to think it was just me or a symptom of depression, but now I have established a clear link between the symptoms and the reduction of the meds). Oh, and the restless legs of course. My method of tapering: I have developed a method for myself for tapering off Cymbalta that I have not encountered in this forum or any others so I thought I should share it. For the very reason that the beads inside a Cymbalta capsule are not the same size (two capsules might not contain the same amount of beads) and I do not have a scale to measure such small portions, I have come up with an alternative. What I did is I folded a paper in half from the middle, creating a void where I could pour the beads and they would stay in a straight line next to each other. In that way I created a measurable line of the contents of a capsule. Right now I use a 30 mg capsule which creates a 25,5 cm line (fits on a regular A4 paper), but when I was using a 60 mg capsule I had to devide the beads into portions and measure them all and calculate from there on. Now I am not particularly fond of mathematics, but with a few simple calculations and a lot of concentration ( ) I was able to calculate how many mg of the medicine was in a line of the medicine of a certain lenght. So when 30 mg of Cymbalta is 25,5 cm, that meas for example, that 15 mg of Cymbalta would be 12,75 cm etc. (This is specific to the capsules I use bought from Estonia, yours could be very different so you should always measure your own medication!) I use the same folded paper (with markings on it) every day to pour a certain amount of beads out from the capsule. So if I am using a 30 mg capsule and I am - let's say - at 20 mg daily dosage I would have to calculate how many (what lenght) beads I would have to extract from the capsule before taking the medicine. So I have established that 30 mg = 25,5 cm. That means 20 mg = 17 cm. I know that there is 25,5 cm of beads (30 mg) in the capsule so I have to pour out 10 mg = 8,5 cm. It really makes no difference, if you calculate it in cm or mg after you have established the relation between the two. So I have a marking on the paper and each day I pour out a 8,5 cm line. And if i reduce the dosage I just make another marking. It is actually very easy to do the reduction just visually, when you have drawn the lines beforehand and calculated what necessary. You also have the history of your reductions right there under your eyes. I always write the date of the reduction next to the specific line every time, so I have a good visual overview of what, when etc.
  23. I was glad to see this topic as it describes me and how I have functioned my entire life. I have been on 90 mg cymbalta and 159 mg Wellbutrin for more than 4 years now and about one month ago I tapered off Wellbutrin with an every other day dose for two weeks. I am feeling a bit spacey... very tired, a bit nauseous and anxious. After reading some posts I now can give myself permission without judgement to rest and relax my brain. That is what it feels like. If anyone has suggestions from experience I would appreciate it.
  24. I started on Cymbalta 60 mg 4 years ago, (after 1-2 weeks @ 30 mg); the scrip was from a psychiatrist for major depressive disorder. My depression lifted significantly. After 1 year (+/-) the psychiatrist and I agreed that my family practitioner would handle the prescription and supervision. I was ready to go off the cymbalta and was planning to go of the meds until a couple of deaths close to me occurred. I agreed with my doc that it wasn't the time to make changes in the meds. About 15 years ago I was on Effexor XR and had a helluva time getting off it, even with bead counting. After having read the slow pace recommended here, I probably decreased too quickly. I remember the roller-coaster ride of symptoms (physical, emotional, and cognitive) but forgot about the bead counting. When I started both Effexor & Cymbalta, I had nausea for a couple of days. On my FP's advice, I started going off cymbalta in Feb. by taking 30 mg every other day for a few weeks, then every 3 days, etc. This last week I was starting with 30 mg every 4 days. Fortunately I was using a calendar reminder in my google calendar to keep the schedule. I say fortunately because on Tuesday I had nausea and on Saturday. When I looked at my calendar to mark the reminder as "done," I realized that the nausea was probably related to the cymbalta. Now that I think of it, I started having disrupted sleep and messed-up wake/sleep cycles in March. A web search (DuckDuckGo instead of the big G) led me here and reminded me that slow tapering and counting the granules worked better for me before. My plan now: I have 6 capsules leftover from 60 mg doses. I'll split each into 3 doses, approx. 20 mg, and try 20 mg/day for 18 days (to use them up), making adjustments if necessary. Based on how that goes, I'll either continue at 20 mg or start a 10% taper to 18 mg over 28-30 days.
  25. Hi everyone, I am looking to restart cymbalta and hopefully get myself back to a stable place. I would love input. My doctor (psychiatrist) seems to think I could start with my previous dosage of 20mg, but after a horrendous experience trying to get back on celexa starting with just 5mg, I am VERY hesitant and don't want to go through anything like that again. Here is my history: ~12 years successfully on 20mg generic celexa --> successful switch over to ~2.5 years generic cymbalta --> slow-ish (I thought at the time) taper off over ~1.5 months (stopped 12/17) --> currently 8.5 months off and not doing well at all.7/2018 Tried to go back on generic celexa starting at 5 mg. Stuck it out for ~9 days, never made it up past 5mg. Had a terrible reaction to it. Dr thinks maybe because it was a different brand from the 10 years before. He questioned whether it was just my anxiety in reaction to it, but it was entirely too physical to be just my thinking-- Gripping panic, terror, crazy thoughts, felt possessed, arms and hands suddenly dead and heavy like they stopped working, immediate emotional numbness, genital numbness, inability to cry, appetite zapped gone (had to force every bite I ate for those 10 days, got down to my lowest weight ever, and not in a good way), unable to work or think straight, agitation, thought I would need to be hospitalized.8/2018 Tried Remeron. Wanted something that would not cause sexual side effects, so even though I had never taken it, dr recommended it. 7.5mg. First night bad restless legs. Got up to 15mg for ~2 weeks. Munchies. Slept. But neither in a nice way, more a zombie-ish way. Very tired and fatigued. Continued inability to think straight or work. Anxiety was sedated. Depression was sedated. More emotional numbness. Literally could not think. The depression did feel like it might have been starting to lift, but I needed to be able to think, and didn't want to keep experimenting with whether I could get to a dose that would not be so sedating, so I went down to 7.5mg/day then to 3.5 mg /day and have still been taking this just to try to stabilize. Having severe anxiety and depression though still.Currently experiencing: panic, depersonalization, depression, and for the first time in my life pretty severe anhedonia (pleasurable feelings and other emotions feel offline and physically inaccessible... including 'tools' I would use before: gratitude, feelings of spirituality, humor, warmth of relating).Looking to try reinstating generic cymbalta 9/2018.Doc suggested starting at 20mg, we agreed on 10mg (since I had such a strong reaction to attempt to restart celexa at 5mg). I would love to hear people's thoughts on slowly restarting cymbalta to try to get back to a stable place. I basically cannot go on in the panicked, anxious, depressed state that I am in. I have tried to white knuckle the panic the past months and it has only seemed to lead into a depression with anhedonia and my emotions shutting off in a way I have never experienced before and which is terrifying. Restarting at 10 mg cymbalta seems ok... and I'm looking to make sure it's the same brand as before... but I did have an intense bad reaction to just 5mg of celexa, so I think I might be very sensitive at this point. Also my Dr. recommended I stop the 3.5 mg remeron the same day I restart the cymbalta. Thoughts?
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