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scallywag

☼ Scallywag: Cymbalta - skipping doses didn't work, time to taper

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scallywag

Day 9 after first 10% cut (20 mg to 18 mg):  I'm feeling well generally. I've been cooking regularly for myself which is a major improvement and, of course fosters other health improvements.

 

Over the last few days, there's been some slippage later of my go-to-sleep times.  I'll give the melatonin another round and add 10-15 minutes to my daily walk to reset. I may also try a forced earlier wakeup, then sit for a blue-light treatment that's been helpful for me in the winters.

 

My motivation to tackle long-deferred tasks is increasing . I try to remember that I can do these things in steps, not all of them require 100% completion in one go.

 

I've been reviewing the supplement protocol the orthomolecular-med naturopath recommended for me 3 years ago, after many blood hair and other samples. My problem with the plan then, and 10+ years ago, was that it was too much too fast. I'm considering adding the supplements and making the dietary changes slowly, no more than 1 supplement and 1 dietary change a month.

 

There are strong similarities with his plan for me and with what people here have found useful: His recommendation included high quality high-EPA omega 3 oil (1.5 g EPA + 0.5 g DHA/day spread betw. 2 doses) and magnesium glycinate (~350 mg/day).

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scallywag

Another day, another chart. This one shows how the metabolizing doses stack up to reach steady state. Again this is for Cymbalta or another drug with a 12-hour half-life.

 

cd1y291xr5pj5516g.jpg

 

Notice that what gets steady is the daily transition from maximum and minimum, 133% and 33%, the same cycle every day.

 

steady state chart - scallywag - 24 hour intervals.xlsx

Edited by scallywag

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scallywag

I just read another member's thread and my heart sank. The member's sister posted that her brother acted on his suicidal ideation and died. I'm so sad for him -- he was suffering so badly that he could see only one way to end his pain.

 

It's emotional for me to hear or read about suicide.  I lost the love of my life to suicide 4 years ago.  I miss him every day, more intensely on days like today.

 

Time to allow myself grieve again and be gentle with myself.

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mammaP

Scallywag I am so sorry to hear of your tragic loss, I can imagine how hard it is to read about others when you are grieving yourself. (((mamma hugs))) 

 

I've noticed that you said blue light helps in winter, I have SAD in winter and use a lightbox, what is the blue light? 

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scallywag

Hi mammaP Thanks for your message and kind thoughts. About blue light:

 

The blue end of the light spectrum is the component of TV and computer screens that has the greatest stimulating influence.  Posts in the thread (Symptoms and self-care forum) about limiting TV and computer use in the evening touch on this.  Applications for phones/tablets and software programs for PC/Mac have been developed to warm up the screen temperature, reducing the blue light component.

 

At the other end of the day rather than avoiding blue light, its stimulating and energizing effect is useful. An article summarizing research, published by Psychology Today in 2014.

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scallywag

Day 16 at 18 mg: Sx continue to be minimal. Energy & motivation slowly returning.

 

I was visiting family and friends for a few days. Lovely break from my usual solitary days.

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scallywag

I posted today in another Lakelander's thread about some thoughts I have about a possible source/cause of depression for me. For my own purposes, I'm duplicating it (±) here.

 

I have a strong suspicion that my depression is a symptom of thyroid issues. Long after I took my first anti-depressant, I discovered that I have at least 5 relatives with hypothyroidism on both sides of the family (mother, aunt, grandmother, uncle, grandfather) and it's possible that my dad is too.  Despite having normal TSH levels, I have many symptoms consistent with hypothyroidism or iodine+selenium deficiency. At times I want to scream at having suffered for years and had a lower quality of life by all measures possibly because this has gone undiagnosed and untreated.

 

I may have brought it on myself (or brought out a predisposition) with what I now call "diethead" -- thinking during my teens and 20s that I was grossly overweight and acting on that conclusion. Because I'm taller than average, 15 lbs (6-7 kg/1 stone) over recommended weight is only mildly overweight. I took on one unhealthy faddy eating style after another, probably perturbing a central nervous system already predisposed to issues and endocrine glands adjusting to puberty's hormonal changes. Absent that foolishness, who knows. 

 

Looking forward, all I can do is test my suspicion about hypothyroid and the habitual negative thought patterns and behaviours that have developed over the years as a result of that being untreated.

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scallywag

Day 19 at 18 mg:  I continue to do well.

 

Today I noticed an improvement: The last few days I've been waking up at a reasonable hour without an alarm, and more importantly waking up feeling rested and refreshed. Something I'm doing is making a difference.

 

I am keeping notes of what supplements I take, when I take them, and when symptoms occur. If this continues, I might try to figure out what's making the difference. On the other hand I may choose to enjoy it without analysis, which sounds like a lot less work.

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Altostrata

I'm seeing a fair amount of discussion with newcomers about skipping doses.  I've created a spreadsheet that shows the % concentration decay, comparing daily dose, alternate day dosing and skipping 2 days. This chart is for Cymbalta (duloxetine) or a drug that has a 12-hour half-life.

 

The chart is in a spreadsheet (.xlsx).  I'm going to refine it, maybe showing every 12 hours instead of every 24 and setting it up so that any half-life can be "inputted." Then I'll attach it to another post.

 

The blue line is taking daily doses; green is every other day dosing; red is every 2 days.

 

 

Another day, another chart. This one shows how the metabolizing doses stack up to reach steady state. Again this is for Cymbalta or another drug with a 12-hour half-life.

 

What gets steady is the daily transition from maximum and minimum, 133% and 33%.

^Brilliant work, scallywag!

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brassmonkey

Congratulations on becoming a modertor. Welcome to the team.

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scallywag

Thanks Alto & brass! I felt compelled to do the steady-state spreadsheets because there's already a great spreadsheet dose calculator by nz11!

My update: no news is good news.

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cymbaltawithdrawal5600

But you are now a mod and that is great good news!

 

Par-tay at Scally's!!!

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scallywag

I'm noticing something that I call "tired behind the eyes." I experienced this during the times that led up to my requests for an AD prescription. I'll hold at 18 mg a while longer rather than take the next step down which would have been on Sunday June 19. Why suffer, there's no rush.

 

I've kept a wonderful quote that I read in the Jaminets' book, Perfect Health Diet, p. 4

 

Increasing marginal toxicity of toxins was first noticed by the medieval physican Paracelsus, who formulated the toxicologist's rule: "the dose makes the poison." Toxins are not dangerous at low doses; but at high doses they can be deadly.

 

I'm down so much since the start of the year when I was taking 60 mg, lower dose = lower toxicity. It's probably time to work on other changes anyway, such as walking daily and starting brief mindfulness meditations. I've slowly come to the realization that I can no longer pretend I've got the resilience of a teenager or 20-something. I need to establish sustainable routines to support well-being. There's no shortage of lifestyle additions or changes I could make while on longer holds.

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savinggrace

I thought I noticed a promotion...congrats...you deserve such status and you are a great member to a great team.  Now, if only I could understand those charts.... :)

 

 

Grace

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scallywag

Grace thanks for the lovely compliment. 

 

I'm up too late, making a negative contribution to sleeping problems so   ... scally OUT.

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scallywag

The "tired-behind-the-eyes" sensation hasn't resolved yet. I'll hold at my current dose of Cymbalta.

 

I will focus on establishing/re-establishing 2 habits conducive to both good overall health and psych drug recovery:

  1. Daily gentle exercise: 30 minutes walking outside, rain or shine. I once created a catchy name for this that I'll use again: 24 in 24 (24 minutes every 24 hours). If I can do 24 minutes, I can do 30 and probably will.
     
  2. Getting up at the same time every day, and sleep hygiene.

My intention with these two habits is to have a less variable sleep onset time. It has reduced tremendously with a consistent dose, and there remains room for improvement. I'll update about completing those 2 habits each day.

 

My main distraction instead of going to bed is computer time. I have set up site-blocking for my most used websites, including this one, between 10 pm and 5:30 am local time. I may put my router on a plug-in wall timer with the same operating/closed hours for a while. 

 

I'm in the North American Eastern time zone (e.g. New York), GMT - 5. If you see me online after GMT = 0300 and are looking for a brief and useful distraction, please feel free to PM me with the subject "Want to go to sleep? Get off your computer."

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scallywag

Today's my 30th  day at 18 mg and symptoms are barely noticeable, aside from finicky sleep onset, and are stable.

 

Reporting in on 2 focus habits:

Sunday: no exercise; bedtime 11:30 pm, asleep by midnight, woke up without alarm just before 7am

Monday: no exercise; PC off by 10:30ish, bedtime: 11:30 pm, restless -- got up for a bit, awake until 1 am, woke up without alarm at 5:20 am

 

Keeping in mind that no action + a good reason ≠ the intended action: Exercise excuse: too humid, problem solving: there are in fact bathing facilities -- a bath/shower -- available in my home to cool off after. -_-

 

I'm thinking my delayed sleep last night might have been a hormonal issue (adrenal  - cortisol?) due to having my last meal with substantial protein before 3 pm.

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tntd

Hi Scallywag, 

 

I was interested to read your thread since you have been so helpful to me. Congratulations on your recent promotion to moderator, I know I appreciate you :)  

 

I'm glad to see that you are feeling pretty well while holding steady in your taper. I like your 24 in 24 idea. So far I haven't been able to exercise, it is too stimulating but I will use your method when I can start gently adding exercise back in. I'm so glad you can exercise because I know how much it can help with keeping our moods stable. 

 

Thanks for all you do, hugs.

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scallywag

Day 1 @ 16.2 mg:  Additional 15-20 minutes in the morning in front of my blue-light has addressed my "tired-behind-the-eyes" feeling. I've  stepped down to the next 10% tier.

 

Thursday: Out for a walk yesterday; bed just before midnight, sleeping almost immediately.

Friday: up and out of bed at 6:30

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tntd

I hope your step down continues to proceed smoothly. Glad you found the blue-light helped with your "tired-behind-the-eyes" feeling.

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JanCarol

 I lost the love of my life to suicide 4 years ago.

 

Scally, I am so sorry for your loss.

 

I am widowed twice, and yet never.

 

The first love of my life - lost to - cancer?  I may never know.  He died at home in his sleep.  He was just 54.

 

My first husband took his own life in 2008.  He wrestled with trauma, and was polydrugged when he committed the act.  He and I had been divorced for 13 years at that point - I didn't find out until 2014.  Our dog had to be put down, because he was "her boy."  She was old - 15 years old - but still.

 

So my deepest empathy for whatever it is you are grieving here.  I suspect that my ex-husband was a casualty of pharmaceuticals, but I can never prove it (even though I know he was polydrugged).  So it applies to SA, and he was, for all the commotion he caused (his 2 step kids went off the rails after that, they thought he loved them!) - he was a gentle soul who was basically running, his whole life to avoid conflict.

 

Whatever your story is here, you are not alone.

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JanCarol

Looking forward, all I can do is test my suspicion about hypothyroid 

 

As you may know, this can be exacerbated by psych drugs.  People who were hypothyroid on the drugs, become normalized after a few years off.  (something to look forward to).

 

Additionally, Hashimotos antibodies have been known to be reduced by a Low Histamine Diet (I know, the "D" word, I hate it too).  Read more here:

http://survivingantidepressants.org/index.php?/topic/1593-thyroid-symptoms-hypothyroid-hashimotos/  

 

 It's probably time to work on other changes anyway, such as walking daily

 

My daily "sun-walks" have been a life-saver.  It gets me moving (when I don't want to move - a lot of pain when I wake up) and I get light.

 

I know you don't live in as sunny a place as me - but you can still get 5000-6000 lux on a cloudy summer's day.  Awesome for your blue light, melatonin, mood, and healing.

 

My sun walk is just 10 minutes, and then I do a tai chi form while hubby runs wind sprints for HIT (High Intensity Interval Training).  I got pulled from the wind sprints due to hip pain.  But the tai chi feels good!  

 

Maybe there is a tai chi class near you?  It's awesome stuff for withdrawal.  Gentle, stimulates the endocrine system, soothes the nervous system, strengthens muscles, improves balance and concentration.  It's like acupuncture, only you do it yourself.

 

  1. Getting up at the same time every day, and sleep hygiene.

 

This is my current demon.  All it takes is one night of being sick, and I'm all messed up again.  Maybe you and I can make a pact?  I used to do my own CBT.  I put stars on my calendar, like a kindergarten class.  Blue star = bed before midnight.  Green star - nutritious day.  Red  star - up by 10 am.  Gold star - I made it to work.  Silver star - some kind of exercise. 

 

I no longer use the star system, I just kind of juggle them in my head.  But you get the idea.  The last one I read was a fitbit sleep adjustment for delayed cycle sleep.

 

Use the fitbit to tell you how many hours you actually slept.  If you lay in bed for 8, but only slept 6, then the next night, you only sleep 6.  You do this until your sleep normalizes.

 

I used to not worry about delayed cycle sleep, but now that I'm battling ye olde metabolic syndrome, the "normal sleep hours" is a huge contributor to reducing fatty liver, visceral fat, insulin resistance, blood sugar, cholesterol, and weight loss.  It's like a win-win.  So why can't I do it?

 

Heck, you're out of bed at 6:30 am?  You're a marine, compared to me!  (I sleep more like a rock star.  Like a rock - but at the wrong times!)   :D

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downtongirl

Day 1 @ 16.2 mg:  Additional 15-20 minutes in the morning in front of my blue-light has addressed my "tired-behind-the-eyes" feeling. I've  stepped down to the next 10% tier.

 

Thursday: Out for a walk yesterday; bed just before midnight, sleeping almost immediately.

Friday: up and out of bed at 6:30

 

Great progress Scallywag!  Are you taking melatonin for sleep now?

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scallywag

Update Day 2 on 16.2 mg
Symptoms: nothing noticeable, so 3 cheers
Friday: walk for 20-25 minutes, sleepy at 12:30, asleep ~23:30
Saturday: woke up at 6:45, back to sleep, out of bed at 10:15
______________

Hi tntd: How thoughtful to stop by my intro to say hello. Thanks!  It's early after this dose drop, but so far so good.


JanCarol:
Sorry to hear about your experience with losing a sweetheart and a former love. It's an absolutely rotten situation. I sometimes call it "The Loneliest Planet - The destination nobody wants to visit."
 
I'll definitely keep a close eye on hypothyroid symptoms as I taper off Cymbalta.  I do think that I had symptoms,  even before my first round with Effexor in the 90s, complicated by likely fatigued/"burned-out"/stressed adrenals at that time. 
 
As I research the hypo-T issue, I need to understand a number of things, including Hashimotos vs. typical hypothyroidism. Rather than diet, I now call such things a "healthy eating plan" or "custom nourishment plan"  I have a visceral positive response to the word "nourish". :)
 
That 6:30 wakeup was an anomaly -- trust me!
 
 
downton: No I don't take melatonin on a daily basis. I use it if I need to reset the time of when I start to feel sleepy.  So if I have a couple of days where I'm not getting to sleep until 1 am or later, I'll take the melatonin at dusk or 2-4 hours before going to bed until I get naturally occurring sleepiness.  Melatonin is a powerful hormone. I don't want to take it every day.

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savinggrace

Hi Scalliwag,

 

Just read your whole story...

 

Can you briefly describe your experience with a blue light?  Do you find a noticeable difference?  I know I need sunlight but I often can't get myself out of the house....though I try hard every day.  It's especially hard at this latitutude to get enough sunlight and I am absolutely certain I suffer from SAD though it's hard to sort out from regular depression, so I am wondering if a blue light would help.  I just feel generally happier when the sun is shining...even if I don't go outside.  The first thing my husband I did when we bought this fixer-upper condo 3 years ago was take down walls and put in a 9 foot sliding door and everything else we could to naturally lighten up the place.  I don't know how people live in dark houses...they must have way more serotonin or endorphins than I do!

 

That's a very low dose of melatonin you take, right?  I have read a lot about poop-out factor but maybe it won't happen at this dose?

 

Grace

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scallywag

Grace

 

There are 2 issues related to sunlight:

- skin being exposed to manufacture vitamin D3 or its precursors for the body to metabolize and distribute.

- stimulating the brain through the optic nerve to alleviate low mood, low energy and other winter-season symptoms.

 

Blue light only address the second point. It is stimulating -- that's the reason experts recommend shutting of TV, computers and other electronic devices at least an hour before bed, or wearing "blue-blocker" lenses. Our topic about it:

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

I have a device, Philips goLITE BLU Light Therapy Device. I purchased it at Costco years ago.

 

The melatonin dose I've taken is a small amount, and I only take it when I need to reset my sleep cycle. 

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savinggrace

Thanks, Scalliwag.  I understand your blue light exposure is part of your attempt to regulate your sleep cycle.  I wonder if is too stimulating for someone easily stimulated.  I have a lot of problems with sleep and depression and I get more depressed with less sleep.  Do you use this as a "pick me up", kind of like coffee?  Do you feel the results? Does the stimulation last for a significant amount of time, or is it just enough to get you going?  I realize its effect on everyone will be different.  Just wondering about your experience...

 

Grace

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scallywag

Grace, I use it daily in 40-minute sessions while I have breakfast and catch-up with overnight happenings here at SA. I usually feel the results within 2 days of starting treatment, sometimes within hours if I've let symptoms deteriorate to a very low level. <sigh> It happens more than I'd like to admit. <sigh>

 

Concerns about the stimulating power of light therapy have been addressed in the design of modern light "boxes." My goLITE BLU has adjustments for both the intensity of the light in 20% increments and the duration of a session.

 

There's a topic here about light therapy. If I recall correctly the Philips website provides benefits of the device I'm using and explains the advantage of blue light over full-spectrum light for symptoms called "depression."  Our good friend Dr. Google could probably point you to some decent information.

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scallywag

Day 5 at 16.2:  I continue to feel well.

 

Last few days have been a write-off wrt exercise and sleep hygiene. Today will be better.

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scallywag

Day 8 on 16.2 mg:  First week at new dose is uneventful.

 

Sleep routine: I've been sitting for 40 minutes, twice as long as I used to in front of my light box. It seems to help keep my energy levels up and to regulate my sleep cycle.  Late at night I've been off the computer for the most part and knitting a baby blanket for a cousin's new arrival due later in the summer. It's a bulky yarn project for which my eyes don't need bright light. If I go without my reading glasses, my eyes get tired and I go to bed.

 

Exercise: I'm declaring my previous walking initiative complete.  I'll create a new one sooner or later, probably within the next few days.

 

For the Canadian traditionalists: Happy Dominion Day!  For the every other Canadian: Happy Canada Day!  (149th)

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tntd

Hey Scallywag,

 

I'm so glad to see that your doing so well on your current taper. I hope it continues. That light box is interesting to me. I don't think I could currently handle it. I still have to keep my shades drawn becasue the light bothers me but I am definitly interested in one eventually. 

 

I  love making baby blankets and I'm so glad that you are able to sit and knit. I don't knit but I do crochet and I know I find it quite relaxing if it's an easy pattern. A new baby, how exciting. 

 

I was wondering if you had a holiday this weekend. Do you have something planned? If you do I hope you have a good time.

 

Healing and hugs being sent your way.

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scallywag

Day 13 on 16.2 mg:  Again, my withdrawal experience is boring, so lucky me. No new supplements added and no increases or decreases. I'm amused and bemused by my newfound ability to resist tinkering (fine-tuning, whatever you want to call it) with what I'm doing. Maybe, just maybe the message of "if it ain't broke, don't fix it" has sunk in? 

 

Also, I woke up today and yesterday before my alarm went off. And I was rested and refreshed. Amazing!

 

 

Hi tntd!  The blanket is finished and am more than a little pleased with the end result.I tossed it in the laundry for a round in the washer and dryer and it still looks good. :D I used a chenille yarn (Bernat Baby Blanket) for the first time which took time to get used to; it has no natural stretch. The coziness of the fabric was worth it the learning adjustments. I am glad I was making only a small blanket during summer temperatures -- my lap and legs were warm.

-- When you want more details about the light device, let me know.

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tntd

Hi Scallywag,

 

I'm so glad to hear that you are having a good spell. I hope that it continues. It is nice to have a break from the symptoms. It sounds like your sleep is going good too and that it wonderful. I'm so happy you are having a good spell.

 

I'm glad your blanket turned out nice for you. It's always interesting using a new type of yarn. I tried making a scarf last year with a new type of yarn and could never get it to work. It would start out ok but then I could never get it going again if I put it down because I couldn't figure out where I had left off. It was crochet though. 

 

I hope you are enjoying your day.

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scallywag

Day 17 on 16.2 mg: My good fortune continues - no major symptoms. Recently I've noticed burning skin on the soles of my feet, much more on one foot.  It doesn't interfere with my ability to sleep, it just makes me aware of my feet in a way that I haven't been.

 

I'm not certain about it being a w/d symptom because there's been a weird skin texture differences between my left and right feet for 20-25 years. Lots of medical people have looked at it -- MD, dermatologist, podiatrist, naturopath, esthetician -- and no explanation that has produced an effective solution. 

 

I'm off for a few days on business out of town, combined with hanging out with Pappa-san for his birthday and seeing friends. More time earning income and in face-to-face interaction = less time online and posting here.

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elbee

Hey Scallywag,

 

Since you've been commenting on my thread I wanted to read yours and learn more about you. I'm really happy for you that your tapering process appears to be going so smoothly. You definitely seem to be proactive and motivated to try different things that might be helpful/useful to you. It does seem like folks on here who can find ways to keep a positive/hopeful attitude (and follow through with the helpful/useful actions) seem to do better.

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scallywag

On Friday after 21 days at 16.2 mg symptom-free, I cut Cymbalta dose to 14.6 mg.

 

I had a great week visiting family and friends. Business was, well, it was business. ;)

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