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Clyde: Cymbalta questions


Sugar

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I am new here and writing at this time on behalf of my son (53) who is in the very beginning stages of AD discontinuation. Diagnosis: Major Clinical Depression. He has been on numerous ADs in the past 10-15 years, but these last 6+ months it is 120 mg Cymbalta, 600 mg Lithium, 300 mg Wellbutrin. He also is on other meds for diabetes, hi blood pressure and cholesterol, feels like a walking pharmacy, and desperately wants to come of the ADs. He has been feeling absolutely terrible for a long time, and there have been many times when I feared for his life (has made an attempt before). The last psychiatrist simply pileed one med upon another whenever my son reports all the symptoms he is experiencing (hi anxiety, panic attacks, terrible fear,  relentless depression, night sweats, brain zaps, etc.). He has been with the same  CBT therapist for 10 years, and is currently also attending a NAMI support group. I also have told him about this site and hope that in time he will join himself (he isn’t much of a writer but otherwise very articulate about what he is feeling). 
 
After a long and arduous search I found a holistic clinic where he is currently receiving acupuncture, massage, chiropractic manipulations, nutrition and, most importantly, is seen by an M.D. who is managing the AD discontinuation, starting with Cymbalta in 20 mg slow increments (unfortunately, there is no 10 mg capsule). He was told by his pharmacist (confirmed by the M.D.) that  if  one opens the capsules (Cymbalta) then the formulation is destroyed and the med releases in different parts of the body incorrectly.  This can be dangerous and can cause mood swings, which he has been experiencing.  There is no way of knowing how successful the work at the clinic  will be. Having gone this route myself, I know how slow and excruciating it is. BTW, MCD seems to be generational and runs in my family which, of course, had remained unrecognized until my adult life. Needless to say, he gets very discouraged. Amazingly, though, he is still able to soldier to work every day (as a digital matte painter at a major film studio) where he apreciates the “normalcy” of the day’s structure and interaction  with colleagues. However, he is terrified of losing the job and never finding another. He is in an extremely vulnerable state, cries easily, gets terribly frustrated and hits himself. I guess this is a state that has been called neuro-emotions?
 
I have yet to find any useful  information about what would minimize  these terrifying withdrawal effects. Cymbalta only being one (and possibly the worst), followed later by Lithium and Wellbutrin. Nevertheless, this website is very helpful and I thank the operators for keeping it going. Lastly, I apologize for this rambling post…..

 

 
Edited by scallywag
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  • Moderator Emeritus

Sugar, your son is lucky to have you at his side and covering his back.
 
The pharmacist and MD are not fully informed and have given your son incorrect information about Cymbalta beads.  There are a dozen or so members actively posting here at SA who are tapering Cymbalta by counting beads. 
 
There is a great deal of information in Altostrata's first post in the Tips for tapering off Cymbalta (duloxetine) thread. You may not have seen a research study she linked that examined the effectiveness of several ways to consume Cymbalta pellets (beads) after opening up Cymbalta capsules:
 

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....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.
---------


It sounds as if your son is employed in a well-paid position and *might* be able to afford compounded doses. Insurance usually won't cover compounded doses. Compounded doses allow for dose cuts much smaller than the manufacturer's produces capsules. He can request quotes for a quantity of the same dosage from different online and local compounding pharmacies. With that information, he could ask his MD about a prescription for compounding.

 

I have investigated this and will probably get my doctor to prescribe a compounded dose when my current supply of Cymbalta runs low.

 

Compounding pharmacies -- US, UK

 

I hope your son feels well enough to start an introduction for himself.

 

s

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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  • 2 weeks later...
  • Moderator

Hey Sugar,

 

what Scallywag said, with one more addition:  if he is having symptoms, he needs to hold, or even reinstate to the last dose where he was less symptomatic.

 

Symptoms are a clear message that you are tapering too fast.  

 

While he may be eager to come off the drugs, getting off them sooner, doesn't always mean getting off faster - because the fallout is much harsher when you go too fast.

 

He's 53 - can he write to us in here?  It's always better to talk directly to the person doing the tapering, even if you are his primary care person.  If he can speak for himself, it will help him understand the process better.  Then it can be something he is into doing instead of something he is told to do.

 

And antidepressant withdrawal is not something I recommend lightly.  He needs to be fully informed and understand what is happening to him, and the best way is to communicate with us directly.

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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  • 2 weeks later...

Hello,

 

I just registered so that I can join the conversation.

I want to say that I am deeply grateful for the support that my mom has given me during these very difficult times.  I think with out her support I would ber very deep trouble.

Over the past few months, I have been experiencing a terrible depression down turn and have attempted numerous AD cocktails with several doctors. The result were near disastrous, severe side effects of all kinds including insomnia.  The most persistent however has been reduced memory recall and impaired cogitative abilities.  Needles to say this has been alarming to me in lew of my occupation with is a challenging combination of creativity and technical attributes.  Also, just being able to think thing though has become a very frustrating experience. I've since decided that I want to come off of all ADs since, frankly, they are causing me more harm than good.

At this point, I'm working with an MD to slowly reduced the meds (since all to the psychiatrists I have been deeling with simply don't care and just throw more pills at me and making things worse).  The MD I'm working with is very understanding and has experience with helping other patients come off of ADs.

We have begun a reduction of the first of a cocktail of three ADs. Wellbutrin, Cymbalta and Lithium. We are stating with Cymbalta since it seems to be the most difficult to come off of.  As off a month now, we reduced by 20mg from a very high dose of 120mg. We dropped 20mg the first week with no real side effects.  So, the second week, we tried an additional 20mg and ran into trouble.  Severe side effects.  So we returned to the last reduction which is now 100mg. During this time, we learned that the recommended reduction about is 10mg per month.  My doctors wrote a prescription for 10mg dosages which would have to be prepared at a compounding pharmacy.  This was done, the pharmacist located a manufacturer  that made 5mg Cymbala tablets and encased tow of them into capsules.  So we have now been on the reduced amount of Cymbalta (100mg) for about a month now and we wiil be attempting a 10mg reduction this week.

 

Finally, to make it clear, we are doing one med at a time.  I'm hopeful but also a bit impatient since I litterally want my brain back. I feel that it's been so trashed by this junk and I hope I can manage with out them.  Sorry, this is such a long entry, but I really wanted to share my situation and welcome any feedback anyone in this forum might have.

Medication History:

Welbutrin approx 10 years ( had a low dosage for about a year in the early 1990's)  Was on a combination of Welbutrin & Lexapro for about 9 years.

Prozac approx 2 years                                                                                                 Currently on a combo of Welbutrin 300mg, Cymbalta 120mg (reduced to 100mg) Lithium 600mg            

Lexapro approx 9 years

Abilify approx 5 months

Olanzapine approx 1 month

Rexulti approx 1 month

Effexor approx 11 months

 

 

 

 

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  • Moderator Emeritus

Clyde, I moved your previous post to another introduction thread because I didn't realize that you are the person we asked to post in this thread. I'm going to change the lead name on this thread to your username.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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  • Moderator Emeritus

Clyde -- Welcome to Surviving Antidepressants (SA)

I'm glad that you have a supportive doctor. So many people don't.

As you discovered, reducing your Cymbalta dose by 20 mg per week is likely to cause problems. We recommend dose reductions of no more than 10% per month. The 10% reduction is calculated from current dose, not starting dose so the taper follows an exponential decay curve rather than a straight line. These topics on our forum will give you more information.

Why taper by 10% of my dosage?

Tips for tapering off Cymbalta (duloxetine)

What is withdrawal syndrome
 

 

When a someone is taking multiple medications, we ask that that you post an interactions report. Follow the link below to get your report. Just select the text, copy it and paste it in a post here.
Drugs-dot-com Drugs Interactions Checker.

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, especially those in the last 12 months? Any drugs prior to that can just be listed with start and stop years. Please put your withdrawal history in signature

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to post
  • 1 month later...

10% is the maximum recommended dose but as you get lower in dose you may need to adjust to a lower percentage. There are 3 basic ways to taper bead, scale and compounding pharmacist. Glad you found a compounding pharmacist that knows what they are doing. Not everyone can get a doctor to write the compounding taper so bead counting (if you have the right kind of beads-must be uniform in shape, micro sized, round) or scale method (useful with irregular shaped beads) are two good options. Do not drop down while in the throes of withdrawals. Slow and steady wins the race.

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  • 2 months later...

I have posted here before -- many months ago -- regarding my adult son (53) coming off Cymbalta (as well as Lithium and Wellbutrin), but  can't find my post, nor the replies.

Repeatedly I have suggested to him to come here but he won't, says it's too complicated to navigate the site.

He has a long history of clinical depression (as I do). To make a long story short: currently he is on 80 mg Cymbalta (down from 120!), 60 mg Lithium, and Wellbutrin (dosage I don't remember). The side effects of these meds were pretty devastating, which made him decide to come off everything.

For the last 4+ months, his medication tapering is being monitored at a holistic clinic where he concurrently receives acupunctrure, massage, nutritional supplements. He also has been working with his CBT therapist for 10 years. Furthermore, he attends NAMI and EA meetings. He has been evaluated by a neurologist with the result that there is no brain damage. This did not convince him because he can barely think straight, has memory problems, difficulty learning new stuff at work, no interest in anything -- all causing tremendus frustration and anger and fear and high anxiety.

The Cymbalta tapering is done VERY slowly, in tiny increments. The Lithium reduction is only being started now.

He feels absolutely horrible. The depression borders now on suicidal ideation, he can barely function and is scared to lose his job of 10 years. He is convnced that if that happens, his life will be over; he sees no alternatives. He tells me he will end his life then.

Needless to say, all of this affects me deeply. We speak on the phone frequently; I am with him; but I am running out of knowing what to say and/or do. I know that I cannot save him. 

From time to time I contact the doctor; he just reassures me that this is a slow process...well, yeah, but what if he does not survive it? His agony is beyond description -- unnecessary here anyway since most people here have gone through something similar.

Frankly, I just don't know what to do, what to say anymore, so I decided to come here once more.

Thank you for reading this.

 

 

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