MMarie - Tapering Cymbalta

[KarenB]

It is frustrating, I know.  I'm on a micro-taper too.  I'm just wondering how long since you've held for longer than a week.  My pattern is four weekly drops, then hold for a month.  Brassmonkey - another micro-taperer - has a pattern that includes longer holds too.  Perhaps it's time for you to have one? 

 

You'll get there, it's just going to take a while.  But you're streets ahead of me - I'm still on about 133mg (though I will get there too). 

[MMarie]

Hi Karen,

I held 24.9 mg for 6 weeks prior to this cut. My plan was to reduce weekly for 4 weeks then hold an additional week or 2, or longer, if necessary. I am also contemplating making a 10% cut monthly though that seems risky. I seem to be obsessed about how long it's going to take to be done with this insanity. I want what's left of my life back and I am losing my patience with how long this is taking. Acceptance - struggling with it.

[brassmonkey]

Hi Marie-- It's so frustrating in how long it takes. It's not about how long it takes, but rather seeing the improvements and starting to rejoin life as we want it to be.  The improvements are very subtle at first but increase as we go along. I can't count the number of times I've posted how frustrated I am with how long it's taking but we do get there eventually.  Your plan for four drops and a hold is a good one and will be much gentler then a straight 10% drop would be.  Keep it up and the improvements will be showing themselves.

 

(((((((((((((HUGS)))))))))

[MMarie]

Yes, I agree. Whenever I get like this, I want to rush it. It's crazy, I'm obviously having withdrawal angst yet I want to speed it up. This has become one of my symptoms, actually. Thank you, Brassmonkey!

[MMarie]

I am really struggling with crazy rage, irrational thoughts and fears and overall insanity. I held 23 mg for 2 weeks and today, I only decreased by .3 mg, 1.25%, 3 beads. It has occurred to me that perimeno/meno is having a much bigger impact on this process than I realized. Reading over the symptoms, they appear to be quite similar to AD withdrawal. How joyous. I have an appointment next month with a GYN to discuss my options. I pretty much hate everyone around me right now and I'm sure they aren't thrilled with me, either. This is so much worse than I thought it'd be - both tapering and perimeno. If anyone else has had a rough time with this, I'd love to hear your experiences.

[MMarie]

Putting this link here so I can easily access it. Appears to be a study on 5TT occupancy for Cymbalta/Duloxetine.

 

http://www.academia.edu/15180544/A_dose-finding_study_of_duloxetine_based_on_serotonin_transporter_occupancy

[woof]

MMarie

 

Thank you so much for posting this article.  It so clearly illustrates the rationale and vital importance of tapering slower and with reduced % cuts at lower doses - smaller cuts and longer holds are ostensibly necessary.  Its taken me a while to accept this, but seeing the science behind it makes it a lot easier for me to accept.  You can do it - just keep on going low and slow as you are doing.

[scallywag]

Marie, that paper is a great find.  Thank you for sharing your search and research.

 

I've posted it in both the Why taper paper: dose-occupancy curves and the Tips for tapering off Cymbalta (duloxetine) topic

[MMarie]

I have updosed, as of today, to 23 mg. I have been sinking into a black hole. I'm beginning to think I have damaged my brain with 25 yrs of these drugs.

 

I have been waking with weird adrenaline surges at around 6 am - been going on since April. Now, the insomnia is worsening and I woke up at 2 am last night unable to fall back to sleep. Once I did, I had violent dreams. I applied Progesterone cream at 2 am but I don't think it's the cause of the dreams. Been using it for over a year.

 

I am exhausted! I feel so very heavy and totally can't see my way clear of this hell. I also just began therapy with a therapist trained in EMDR. I have wanted to try this for years so I am very much hoping it helps me. She is concerned that I am not at a therapeutic level for it at this time. She also thinks it's going to take a long time with my history. She doesn't want me tapering while in therapy - maybe down the road. I suppose this makes sense. She says EMDR can be pretty powerful. I haven't experienced a trauma recently rather I experienced a traumatic childhood. I feel like hope is running out for me - I don't feel especially well fully medicated and I don't feel especially well now, either. I have been to many therapists and look how far I've come (sarcasm)!

 

I also think hormones are to be factored in. I read that low estrogen leads to low serotonin. Certainly do NOT need any less serotonin right now!

 

I have been struggling for a few months now, maybe since 30 mg even - the pattern has changed and it's all very concerning. I might need to be medicated forever but I want off Cymbalta and I don't know how I can do that without adding in another medication which risks serotonin syndrome.

 

If I need to updose again, is it best to do it in small doses every 7 days maybe or is it best to do 1 or 2 mgs at a time? I am looking to be at the very lowest possible dose, obviously. How long should I wait to feel better? It takes 4 days to register a dose change so should I expect to feel better at the 4 day mark?

 

Thanks to anyone who responds,

Marie

[scallywag]

Marie, if you want to updose it's best to step up slowly as you've done. You've increased to 23 mg today from 22.7 mg;  you could increase to 24 or 25 mg and then hold for 7 days. Because you're wanting to find the lowest dose to stabilize, increases of 1 or 2 mg followed by a hold of 7-10 days are probably the best way to find your minimum effective dose.

 

The new dose takes about 4 days to reach a steady pattern in serum concentration. It can then take a few days (3-7) for the CNS to adjust to the increased dose, possibly reducing the signals that are causing the w/d symptoms. Holds of 7-10 days are enough time for most people to determine whether the dose increase calms symptoms.

[MMarie]

Thanks, Scallywag. I am wondering if this is even withdrawal at all. I think maybe this is me, under-medicated. I had a couple decent days at 23.7 mg, according to my journal. Just a couple, though, and I was only on that dose for a week. It's so complicated to figure out what's what. I don't want to go any further up unless absolutely necessary. Hate to lose the progress I've made. Then again, how much progress has been made if I feel horrid?!

[Mammoth]

MMarie - just wondering how you are doing with your Cymbalta taper. When I tried a dose of 15 mg (several years ago without knowledge of the idea of 10% decrease, so I went from 30 mg to 15 mg), I experienced similar struggles with heaviness and blackness as you describe in your 14 July post above. I didn't know about withdrawal syndrome, so I just assumed it was my depression coming back and went back to 60 mg immediately. Sigh.

 

Hope you are feeling better.

[MMarie]

Hi Austinite,

 

I am hanging in there but each day is a challenge. I recently had adverse reactions to 2 medications, Cytomel and Vancomycin,and it landed me in the hospital for 6 days. I opted to go up to 30 mg while there rather than experience withdrawals going down to 20 mg. I am depressed and extremely anxious. I tried HRT and that resulted in a 5-day long panic attack. I don't think the Cymbalta helps my depression anymore and hasn't helped for a long time. I just happen to be a prisoner to it. I'm not sure what my next move will be but I am sick of feeling the way I do.

 

I'm sorry you are stuck on Cymbalta, too. It's a beast, for sure. How big were your drops prior to reinstating to 60 mg? I hate being stuck on medications that are handled so recklessly by doctors. They should know by now that these drugs cause people horrific withdrawal. There is no excuse for this ongoing ignorance.

 

Take care,

Marie

[MMarie]

Austinite,

 

Were you on Wellbutrin at the time you tapered the Cymbalta? It didn't help the withdrawals at all, it sounds like. I was half tempted to add in a drug then taper off Cymbalta a little more quickly (fear of Serotonin Syndrome) but I'm hearing one drug doesn't fix the withdrawals from another.

[Mammoth]

Hi Marie,

 

Thanks for your replies! Six days in the hospital!!! That is awful. I'm so sorry. And sorry that you had to move back to 30mg Cymbalta during that time.

 

The first time I tried getting off Cymbalta, my doctor had me follow the package instructions. I've forgotten exactly, but it was no more than a weeklong process. Something like "take a half dose for 3 days and then stop." What in the world?!

 

The second time, I had read something about tapering more slowly. (Isn't it crazy that the non-MD was the one who was driving the whole ship!!) So we used a compounding pharmacy and went from 60 mg - 45 mg, the 45 mg - 30 mg, then 30 mg - 15 mg. When I hit 15 mg, I cried uncle. Both times I tried to get off Cymbalta, I was also using Wellbutrin and did not change that dosage. I guess the Wellbutrin was not helpful with withdrawal symptoms. 

 

It's really a mess isn't it? These are our lives we are talking about here! Seriously, I took a peek at the lawsuit against Eli Lily to see whether I want to join. I have never sued anyone in my life, but I wonder whether I indeed ought to be compensated for the additional years of suffering this medicine has caused me.

 

Keep me posted on how you are doing.

[MMarie]

Hi Austinite,

 

I am sorry for your troubles with this medication. I am holding at 30 mg until I can figure out what is needed for me to get some relief from this depression and anxiety. Once I feel better, I plan to resume tapering the Cymbalta. Do keep in touch!

 

Take care,

Marie

[Mammoth]

Hi Austinite,

 

I am sorry for your troubles with this medication. I am holding at 30 mg until I can figure out what is needed for me to get some relief from this depression and anxiety. Once I feel better, I plan to resume tapering the Cymbalta. Do keep in touch!

 

Take care,

Marie

 

 

Seems like a reasonable plan. Have you tried other things such as supplements, acupuncture, exercise and the like? (Not trying to be cliche, just honestly wondering what you have tried and whether any of those things proved helpful to you at all. I'm currently looking for a new doc who has some of these other modalities in his repartee of options. My current doc is all RX, all the time.)

[ChessieCat]

Here is SA's topic on acupuncture

 

And some things to note:

 

They should do nothing that arouses your nervous system.

 

make sure that they understand that you do NOT want detoxification.

 

Make absolutely sure your acupuncturist understands you want calming treatments, not stimulating treatments. Some may make the same mistake doctors do, thinking your "depression" needs some kind of stimulation.

[woof]

Hi MMarie!

 

How is it going with your updose?

 

Are you getting some relief of your  at 30 mg?

 

Thank you so much for sending me your post with your kind words and empathy,

 

Woof

[MMarie]

Hi Woof,

 

You're very welcome. I am so sorry you're struggling right now, I know how truly awful this can be. And, scary, so very scary. I am feeling better on the 30 mg. I just now posted on your thread with a few more details. I am holding my taper for the time being. I just need a break right now. I think everyone around me needs that break, too. It's draining on everyone and I let it consume me. It became the central focus of my life and I don't want that. So, I need to get through this menopause transition, hone my coping skills and then hopefully taper off this last 30 mg with a little more ease. A girl can dream!

 

Thanks for stopping by,

MMarie

[scallywag]

Glad you've been doing well after your updose.  30 mg is a lucky endpoint for that, what with it being a standard capsule dosage.

[MMarie]

Thanks, scallywag. It seems odd that updosing by just 6 mg made this big of a difference. Night and day, 2 different people. When I was tapering, I didn't feel this normal when I passed by 30 mg on my way down to below it. I sure wish I knew how much of my misery was due to the Cytomel, Progesterone then the Vancomycin on top of all. It bothers me that I don't know for sure exactly what happened. I am afraid to resume tapering because of how badly I felt. It was very scary.

[scallywag]

There's nothing wrong with taking an extended hold of several months, even a year or more,  at a dose.  It's neither a race to zero mg, nor a competition in suffering.

 

It can't be detrimental to consolidate the improvements from the previous taper, stabilize your CNS, reflect on what you did previously and what you learned from that.

[woof]

Marie,

 

If I were to do this over, once I made the one 10% cut from 20mg and felt good other than 6 vs. 8 hours sleep, I would have stayed there for at least a year to let my CNS stabilize.  And now I have gone too fast, but I will recover with time.

 

So from my experience you are absolutely making a wise decision.  You can see from the Cymbalta receptor graph that after 30mg begins to speed up and less that 20mg things really get steep.

 

Woof

[MMarie]

Thanks for your kind words, Scallywag!

[MMarie]

Woof,

 

I wonder if this hold will even matter since I still have the hardest cuts to go yet (according to the graph). I am dreading it. This has been the worst year of my life (I hope)! I hope you are feeling better, by the way

[scallywag]

Don't worry about future dose reductions and your CNS response. Enjoy your time being steady and stable. Who knows, it could be that your plan to hold for an extended period will make the last phase of your taper a piece of cake?

[woof]

MMarie,

 

I just wanted to thank you so much for posting on my thread a few weeks ago. 

 

You helped give me the courage to updose. 

 

I have updosed twice now and I feel most excellent!

 

All of my withdrawal symptoms are gone!

 

My insomnia has even gone away for the first time since my CT almost a year ago. 

 

Thanks again,

Most Sincerely,

Woof

[MMarie]

Hi Woof,

 

I am so glad you're feeling better! Do keep in touch!

 

Sincerely,

MMarie