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Hi Everyone,

 

Here's my story... I was diagnosed with depression shortly after the birth of my 4th child 13 years ago. I tried talk therapy for a year or so as I did not want to be put on medication. Eventually, though, I was still low enough emotionally that I consented to see a psychiatrist. Of course, I was put on medication - Cymbalta, I believe 60 mg. I now know that seeing a psychiatrist = prescription. Full stop. Wish I had stayed with my original instinct and stayed away from the psychiatrist/medicine.

 

Anyway, the Cymbalta seemed to help me at first and my mood lifted. (Side note - many people in my life have no idea that I suffer from depression. I am high functioning and seem to always "soldier on" no matter how bad I am feeling internally. Self-contempt is probably my dominant struggle and it is not uncommon for me to wish I could end my own life, though I have never attempted to do so.)

 

A year or so later, I was at a low point again and discovered that a family member had success with Wellbutrin, so we decided to add it. I started at 150 mg. I cannot recall my initial thoughts or perceptions about whether it helped.

 

After 3 years of talk therapy (plus 2 years of meds), I had a period of stability and felt ready to discontinue talking with my counselor. I was up and down emotionally after that, but did not return to the counselor. I found yoga in that season which taught me about meditation and the breath and found some relief there.

 

At one point, I had felt well for a season and told my dr that I wanted to get off Cymbalta. He advised me according to the package instructions to quickly bump down, alternating days and then stop within a week. Big mistake! The blackness of my depression returned with a vengeance. I went back to 60 mg of Cymbalta immediately.

 

About 4 years ago, I learned about the MTHFR gene mutation and how taking methyfolate could help with depression. My doctor agreed to put me on Deplin 15 mg. I later did a 23andme genetic test and found that I did not have the mutation and discontinued the Deplin.

 

I had an additional season of feeling well and talked to my dr again about getting off Cymbalta. This time, we used a compounding pharmacy to make capsule doses so that I could bump down more gradually. I went from 60 mg to 45 mg to 30 mg to 15 mg without incident. I don't remember exactly how long I stayed at each dose, but it was roughly from June - August that we attempted this taper. However, once I got to 15 mg, all my depression symptoms returned.

 

This year, I have experienced another very low season beginning in June. I've been experiencing insomnia and lethargy as well as a loss of interest in social activities. About 6 weeks ago, my doctor suggested I up my dosage of Cymbalta to 90 mg. Although I did not really want to do so, I agreed since I was so miserable. I still feel miserable and don't see any real improvement. 

 

Throughout the past 13 years, I have attempted to change my diet and exercise significantly, moving toward less processed foods, lifting weights for a season, eliminating sugar (except for alcohol - see below) and yoga. It's interesting, though, that I have felt at times like maybe I have an eating disorder when I haven't been able to stick with the changes I want to make and have used food for emotional comfort.

 

I will also add that in these years, after being a teetotaler until my 30's, my alcohol use has increased significantly. When I first found that I enjoyed the occasional drink (probably 12 years ago), I would have a glass of wine or a margarita with my husband or with friends when out to dinner. Little by little in the past 2 years, I have started to wonder what is wrong with  me - it's as if I have no off switch. If I have one glass of wine, I am more likely than not to finish the whole bottle. This summer, I have experienced loss of memory after an evening of finishing a bottle of wine. I've started to wonder whether I'm an alcoholic. Then I googled Cymbalta and alcohol and found a lot of anecdotes about others experiencing similar problems with having no off switch! Astounding! I don't want to put all the blame on Cymbalta, but I have to realize that at the least, it's working against me. I wonder if my food issues are similarly driven. 

 

In short, I am more convinced that ever that I want to get off Cymbalta. I think I need to find a functional medicine doc who can help me with this.

 

I welcome anyone's input or feedback. I've been reading this site and others and have seen the tapering recommendations. 

 

Is there any hope for me in being successful getting off Cymbalta?

 

 

 

 

 

 

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  • Moderator Emeritus

Hello Mammoth -- Welcome to Surviving Antidepressants (SA)
 
I hope you'll find the information in the SA forums helpful for your goal of discontinuing Cymbalta. I'm sorry that you are in the position that you need the information, but am glad that you found us.
 
You may notice from my signature that I'm tapering Cymbalta as well.
 
Thanks for creating a signature -- That helps us help you! Would you update your sig with your current dose of Cymbalta?
 
A few links for you relevant to your situation

Before you begin tapering
What is withdrawal syndrome
Why taper by 10% of my dosage?
Tips for tapering off Cymbalta (duloxetine)
Counting beads in a capsule versus weighing

Increased alcohol craving is a known side effect of SSRIs (Cymbalta, Effexor & Pristiq are SSRIs below certain dosages).  There's a post on Dr. David Healy's site by someone who experienced this and investigated the issue: http://davidhealy.org/out-of-my-mind-driven-to-drink
 
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If you're searching for something that is two words, e.g. brain zaps, put the words together inside quotation marks, "brain zaps"

 

Please read the topics I've posted and have a look around the forum. If you have any questions about your dosage or symptoms, please post your questions here so that all your information stays in one place.

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

Hi Mammoth -- Welcome to the group, I'm glad you found us.  Looks like Scally just beat me to the punch on giving you a bunch of links to read.  They'll be a good place to start.

 

Drinking and ADs are a tricky combination. Check my signature.  These drugs have a bad habit of increasing ones desire for alcohol and lowering your resistance to refusing it.  We have a good number of members who developed drinking problems while taking ADs. But I've seen very little evidence that it actually leads to alcohol addiction. We have several members who are struggling greatly with alcohol but I think there are other factors involved.  Giving up the drinking is a good place to start on your path to healing.  Alcohol tends to cause greater problems with tapering and has been know to derail the entire process at times. Boy, I made that sound dire didn't I. Excessive drinking is just one of those symptoms we really have to pay attention to.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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Hi Scallywag,

Thanks for replying to my post and for the links and other info about this site.

 

The David Healy site was one of the ones I read which alerted me to the fact that at least in part, my alcohol cravings have likely been fueled by Cymbalta. I'm also aware that I have been self-medicating to try to further numb my emotional pain by using alcohol and food. 

 

Hi Brassmonkey,

Thanks also for your response. I agree that giving up alcohol is a good place to start on healing. I have been able to cut way way back these past few days and am already noticing that I feel a little better. I've also gotten back to eating very low carb which always helps me feel better when I stick with it. My guess is that it's due to the reduction in inflammation that it promotes.

 

A friend who also suffers from depression gave me some information about genetic testing via a company called Genesight. I found a thread here addressing that type thing. Lots of mixed reactions from SD members. Not sure what to think.

 

I'm seeing my doctor tomorrow. Not expecting for him to be helpful... I know he can only do what he's been trained to do, which is prescribe medicine. Sigh. There is a doc who has an MD and functional medicine background here in town who I am hoping to see this fall. He may have some other ideas for treatment besides staying on Cymbalta and Wellbutrin for my entire life.

 

I made the decision at the end of last week to cut back on a few of my extracurricular activities which have been causing me additional stress in juggling the different aspects of life. I think this also has helped me to feel a bit better. 

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So in reading some other threads, I see that moderators here often recommend that people look at the medicines they take to find out whether there are drug interactions. Holy moly - here is the major one for me:

 

 

Interactions between your selected drugs
Major bupropion  duloxetine

Applies to: bupropion, duloxetine

Talk to your doctor before using buPROPion together with DULoxetine. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of DULoxetine, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Uh - yeah - why has my doctor had me on both duloxetine (generic Cymbalta) and buproprion (generic Wellbutrin) for YEARS?! I have not had a seizure, but wow. Also, it seems like the alcohol thing is a serious issue and that I never should have started having any alcohol while on these medicines. My doctor told me it was not a problem when I asked. Sheesh.

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From something I read, I had the idea a few minutes ago that perhaps one approach to take would be to taper Wellbutrin first before trying to taper Cymbalta, since Cymbalta is such a doozy to get off. So I found this thread http://survivingantidepressants.org/index.php?/topic/877-tips-for-tapering-off-wellbutrin-ir-sr-xr-xl-bupropion/page-3 . Read the whole thing.

 

Boy, the more I read people's posts on SA, the angrier I get with my doctor! He doesn't know ANYTHING about tapering. AT ALL. And I also realize that I have been very cavalier about just following his advice and that I may have suffered quite a bit more than necessary due to not "doing my own due diligence." Wow! Super maddening. 

 

I want to GET WELL! I don't freaking want to be on these medicines for the rest of my life. The pharma industry has really done a number on my life. And I let it happen. Not to mention that the pharmacy can switch from generics by one manufacturer to another without even bothering to mention it. They aren't necessarily the same. They really aren't.

 

I am so frustrated. 

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  • Moderator Emeritus

Hi,

 

I can understand your anger but you've now found the right place to get information and support.

 

You might find these helpful:

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).

 

What should I expect from my doctor about withdrawal symptoms?


How do you talk to a doctor about tapering and withdrawal?

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Hi Chessie,

Thanks for those links. I read through them. Whew - it's a lot of information! Feels very hard to sort out what to do.

 

I am grateful that over all these years that I've been taking Cymbalta and Wellbutrin together, I have not had a seizure. I wonder whether that means I am not likely to have one going forward. This is relevant bc it is going to take me close to 5 years to wean off the Cymbalta at 10% per month. It would be slightly shorter to wean from the Wellbutrin, but I do think Cymbalta is the more harmful drug.

 

Gosh it is hard not to go down the road of regret.

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I called a compounding pharmacy to find out what it will cost to get in between doses made. Not too bad - $65/month. I was expecting worse. While I had her on the phone, I asked about the contraindication between Cymbalta and Wellbutrin, and her information (for pharmacists) did not indicate a problem. Hmm. I wonder why the drugs.com site indicated that it was major. What to think?

 

Saw my doctor and told him that I have experienced more anxiety while on the 90 mg Cymbalta (which he bumped me up to in late July 2016) and that I have had passive thoughts of not being here anymore (no plans to harm myself). Both these things are true. Asked if I could wean slowly back to my former dose of 60 mg where I had been relatively stable for a long time. He agreed. It took me awhile before the appointment to figure out what I planned to say to him so that he would agree to let me start tapering. I will begin 80 mg hopefully in a few days. The prescription wasn't approved by my insurance since it's a non-traditional dose - 4 x 20 mg. 

 

It's true that I am not doing all that well emotionally. In some ways, I feel just "fine," but I also am pretty numb and my alcohol intake is at an all time high. I also binge watch Netflix most nights with my husband once the kids are squared away with homework. So, I'm not really "fine." So why do I want to taper? I feel kind of detattched  from everything. I wonder if this summer, I hit what people call "pooping out." Where I had been fine on 60 mg for a long time, then after a rough go for several months, in order to try to get the same benefit, we had to up my dosage. The increased dosage did not, in fact, provide much help.

 

In the meantime, I have two new doctors I am looking into. They both have some context for other supports beside the traditional RX. 

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  • Moderator Emeritus

Glad your current doctor is supportive of starting to reduce your Cymbalta dose. That makes things easier.

 

You may want to read these two topics before you meet the other docs to interview them,

 

How do you talk to your doctor about tapering and withdrawal

What to expect from your doctor about withdrawal symptoms

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

 

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.

 

 

This was a response to me from Chessie Cat on MMarie's thread - I wanted to put it here so that I can easily find it again. Important to note!

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Glad your current doctor is supportive of starting to reduce your Cymbalta dose. That makes things easier.

 

You may want to read these two topics before you meet the other docs to interview them,

 

How do you talk to your doctor about tapering and withdrawal

What to expect from your doctor about withdrawal symptoms

 

 

Thanks, Scallywag. I've read these forums (both now, upon your recommendation and before I went to my dr appt). So full of good info!

 

One person posted a study documenting antidepressant discontinuation syndrome. http://www.aafp.org/afp/2006/0801/p449.html

That's helpful.

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This letter resonates with me. I wish my doctor could read it. 


 

Here's a letter a woman wrote to her psychiatrists asking the same question that I ask, Why don't doctors know?
(www.madinamerica.com/2014/04/dont-know-letter-doctor/)
 
I need to ask: why?
Did you know this was possible? Did you know there was a possibility I would suffer like this if and when I tried to rid myself of this evil drug? And if so, why wasn’t I warned and if you didn’t know, why didn’t you?
Why was I prescribed this regularly for six years when the FDA recommends only four weeks? Why is a severely toxic mind-altering drug given out for burning tongue, restless leg, tinnitus and a host of other simple ailments?
Why, when this drug is only recommended for two to four weeks and there are no FDA follow-up studies on long-term side effects (at least that I am aware of), are patients being disregarded, questioned, and scoffed at when they report these symptoms as withdrawal? Shouldn’t the FDA, doctors, and drug companies be alarmed and searching for answers? People on the forums are regularly blown off by their doctors and ridiculed. My own neurologist, after hearing all my symptoms and reviewing my test results, shrugged his shoulders, gave me a quizzical look, and walked out.
Why, when I experienced insomnia and panic as the result of one stressful period in my life and had no prior history of mental health issues, was I put on three mind-altering drugs and left on them (and more) for seven years? How is this O.K.?
Why, when I asked if the electric current I was feeling was my body needing the drug, didn’t you say, “Maybe it is”? Instead you said, “No, that’s the anxiety.” I was convinced I had an incurable chronic case of severe anxiety.
Why, when I asked if I was becoming addicted to the drug did you say, “No, you don’t have an addictive personality”? Why didn’t you know about physiological dependence, or if you did, why weren’t you honest with me about the possibility?
Why, when the depression began in 2009 and I asked if the drug might be causing it, did you dismiss my question and keep playing Russian roulette with my brain, convincing me I had clinical depression and trying more and more drugs?
Why didn’t you realize that the side effects of benzos and other psych drugs can mimic what our society calls “mental illnesses” and keep patients in a zombie-like, drugged state until (hopefully) one day they say “Enough!” and fight their way out?
Why wasn’t I told about informed consent?
Why, after I (stupidly) cold-turkeyed three drugs in 2006 and told you it felt like bugs were crawling all over me, did you tell me I “sounded like a six-year old” when I now know it is a side effect called formication. Why didn’t you know that?
Why are there tens of thousands of others suffering alone, without medical support?  Why isn’t this acknowledged in the medical community?
Why are we told there is a “chemical imbalance in the brain” when there is no diagnostic test to prove this?
Why was it OK for you to keep assaulting my brain with multiple mind-altering drugs without any proper accountability and even, it seems, awareness of how disabling they are?
Why, in our modern day, educated, socially networked society is this happening?
Why haven’t you looked on the internet to find out what is really happening in the lives of innocent victims of psychiatric drugging? (And if you have, what are you doing about it?) People are losing jobs, marriages, homes and lives trying to break free from the hold of these drugs. Is ignorance bliss? I hope not.
Why does the human experience need to be labeled? Why can’t someone be sad, anxious, melancholy, agitated, pensive, shy, hyper, aggressive, rebellious, irritable or just “different” without it being a “disorder”? Without it being drugged? Is it about money? Power? Pride? Ignorance?

 

 

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One explanation of withdrawal syndrome. I'm trying to learn and understand what may happen as I taper and why.

 


Admin note: For discussion of lamotrigine (Lamictal), see Lamictal (lamotrigine) to calm post-discontinuation withdrawal symptoms


 

This following is an article that has propagated all over the Web, by someone named Altostrata. It has been updated for this post:

As I've been suffering from Paxil withdrawal syndrome since October 2004, I've studied the medical literature on antidepressant withdrawal syndrome. What I've learned about the alerting system and glutamatergic system in antidepressant withdrawal syndrome may be informative.

Antidepressants cause downregulation of serotonin receptors. In a mechanism of brain self-defense, the receptors actually disappear, becoming more sparse so as to take in less serotonin. It is thought among withdrawal researchers that people who experience the worst withdrawal are slower than others to repopulate serotonin receptors.

Others believe those who suffer the worst are those whose brains are highly neuroplastic and adapted more thoroughly to the influence of the medication.

Relative slowness to upregulate receptors doesn't mean there's anything intrinsically wrong with our brains, it just means there's variability (of course) among nervous systems.

Even among people suffering the most severe antidepressant withdrawal syndrome, repopulation of serotonin receptors probably occurs long before symptoms disappear. However, while the serotonin system is repairing itself, an imbalance occurs in the autonomic nervous system. The locus coeruleus "fight or flight" center becomes disinhibited and the glutamatergic system becomes more active than normal. This is called disinhibition of the alerting system, and it generates symptoms that are awful: panic, anxiety, sleeplessness, and dreadful imagery among them.

This paper explains the mechanism in withdrawal causing alerting disinhibition: Harvey, et al: Neurobiology of antidepressant withdrawal: implications for the longitudinal outcome of depression; Biological Psychiatry. 2003 Nov 15;54(10):1105-17.

Once disinhibition of the alerting system takes hold, it becomes self-perpetuating. The whole question of neurotransmitter imbalance -- a chimera of psychiatry anyway -- becomes moot. No manipulation of serotonin, norepinephrine, or dopamine is going to help. In fact, it usually makes the condition worse.

Noradrenergics -- buproprion or Wellbutrin; mirtazapine or Remeron; SNRIs such as Cymbalta, Serzone, Effexor; and St. John's Wort, rhodiola -- stimulate "fight or flight" activation, as will most SSRIs. Drugs and substances that are stimulating should be avoided.

Even drugs that are calming may cause a paradoxical reaction as the alerting system fights to stay in control.

My guess is: The first phase of withdrawal, the acute phase, is the initial shock of withdrawal, with the most defined symptoms, such as brain zaps and nausea and possibly waves of unusually intense "depression" and "anxiety" -- actually, emotions generated by the neurological upset. Later, glutamatergic hyper-reactivity and autonomic instability take over. Often the autonomic instability causes wide hypersensitivity to drugs, supplements, and even foods.

Out of control, unrelated to environmental or psychological triggers, the alerting system sends intense, spontaneous signals to the adrenals, which produce the stress hormones cortisol and adrenaline.

This is not strictly brain damage. Brain damage means some physical part has been permanently removed and can never be recovered. Rather, this is iatrogenic neuropsychiatric damage.

According to established principles of neuroplasticity, the nervous system can repair itself and regain functioning that is close to normal. In cases where there is no apparent iatrogenic cause for autonomic dysfunction, it often spontaneously resolves. Low stress, good nutrition, and as much sleep and gentle exercise as possible are key.

[ironically for those suffering from lamotrogine (Lamictal) withdrawal -- too-fast Lamictal withdrawal causing glutamatergic rebound -- lamotrigine is a drug that tempers the activity of the glutamatergic system, incidentally reinforcing an intact GABA system. Microdoses of lamotrigine can assist recovery from antidepressant withdrawal syndrome. I am being treated with about 5mg per day and it is helping me recover.

Cautionary note: Lamotrigine may not be a universal treatment for withdrawal syndrome. If you want to try it, make sure you consult a doctor who is very familiar with using it and start with very small doses -- .5mg to begin, slowly titrate up to 5mg or more; stay at the lowest effective dose. Nausea and headaches are signs of too high a dose. (2mg tablets are available by request from GlaxoSmithKline; 5mg tablets are available by prescription; lamotrigine can be made into a liquid by a compounding pharmacy.) In too large a dose, lamotrigine, like everything else, can make your symptoms worse.]

In the medical literature on antidepressant withdrawal, symptoms of alerting system disinhibition -- anxiety, panic, sleeplessness, irritability, agitation among them -- are sometimes misidentified as "unmasking" or emergence of bipolar disorder. This leads the clinician to medicate with a cocktail of drugs upon which the patient does poorly, the neuropsychiatric damage from antidepressant withdrawal being compounded by additional medication and attendant reactions.

In Anatomy of an Epidemic, Robert Whitaker describes this process as the way many children, suffering adverse effects from antidepressants, are led into a lifetime of medications for misdiagnosed bipolar disorder.

It's always the victim who's blamed, not the drug. It's about time we took a closer look at what withdrawal does to the nervous system, and question whether the chronic downregulation of serotonergic receptors caused by long-term antidepressant prescription is a benign condition.

 


For discussion of lamotrigine (Lamictal), see Lamictal (lamotrigine) to calm post-discontinuation withdrawal symptoms
 

 

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  • Moderator Emeritus

Hi Mammoth,

 

You might find these helpful.  I did.  They really helped me to understand SA's tapering and holding recommendations because when we take the drug our brain changes.  By reducing the drug slowly and then holding it allows our brain to adapt to not getting as much of the drug.  They have also helped me to stay patient, throw out the calendar and listen to my body.  It's not a race.  We want to get off with the least amount of withdrawal symptoms possible.  Tapering SA's way is a harm reduction method.

 

Brain Remodelling (Rhi's Description of Brain Healing)


Video:  Healing From Antidepressants - Patterns of Recovery

 

Healing isn't linear and there can be Windows and Waves Pattern of Stabilization.  Also some members find that the lower in dose they get they have to slow down their taper.  That is where listening to your body is very important.  As you dose lowers you will most likely start to feel your old self returning.  I did, things like finding something funny and actually laughing out loud, seeing something and actually enjoying looking at it.

 

Learning non-drug coping techniques is also very important:

  1. Acceptance
  2. Acceptance and Mindfulness
  3. Claire Weekes' Method of Recovering from a Sensitized Nervous System
  4. "Change the channel" -- dealing with cognitive symptoms
  5. Change cognitive framing - Redirect - Another Way
  6. Cognitive Behavior Therapy (CBT) for anxiety, depression
  7. Cognitive Behavior Therapy lessons

You may also experience Neuro Emotions

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Thanks for the helpful links, Chessie Cat.

 

I'm still waiting for my insurance company's approval to get the reduced dosage of Cymbalta.

 

The reason (like I said previously) is that it didn't help to bump up to 90mg (my dr's idea in July), so he agreed to let me slowly taper back to my former dose of 60mg. (I figured I didn't need to win the whole war at this point, just the battle of starting to taper.) Thus, I am moving to 80mg (11% reduction - I hope that it isn't too aggressive) and he suggested taking 4 x 20mg so that I could have only one co-pay. I guess it's an unconventional dose, so there is a delay getting it approved. I'm kind of nervous about getting started, but I also do really want to get the tapering process started. I will stay at the 80mg for as long as necessary - hopefully 4 weeks or so. Then I'll use a compounding pharmacy to bump down either 5% or 10% according to how the original drop goes. I'm expecting this process to last quite a long time. If I go at 10% intervals, I calculated that it will take 5 years to completely get off! Well - slow and steady gets there eventually.

 

I also made an appointment with a doctor who is an MD with a board certification in integrative medicine. The appointment is in a month as he only takes 1 new patient per week. If I like him, I will switch over from my current doctor. My hope is that he knows something about tapering down and that I can have his help in this process.

 

One other thing I decided to do is a 28-day healthy eating challenge. No gluten or dairy or sugar. This has been helpful to me in the past, it just takes discipline to stick with it. 

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Two things I'd love some input on, if you would like to weigh in:

 

1. Sleep problems - I have very disrupted sleep now, even though I have not started WD. I toss and turn a lot almost every night. Some nights, I go ahead and get up to read for a little while and then try to go back to sleep. Other nights, I never go back to sleep and am up for good around 3-4 a.m. Rarely do I sleep through a night without being up for at least 30 minutes or an hour at some point. Kinda worried about how much worse it could get during WD. Sometimes I use melatonin patches and they occasionally seem to help, but not always. I sleep in a dark, cool room and use white noise. Try not to be online in the hour or two before bed and try to maintain a fairly consistent bedtime of about 10:30p.

 

2. Supplements - I started on an intensive supplement regime with a nutritionist in April. Now I am wondering if it's wise to be on so many supplements as I contemplate WD. My nutritionist is experienced in her field, but not with antidepressant withdrawal. Does anyone here have experience with discontinuing supplements?

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  • Moderator Emeritus

From what other insomniacs have posted, it is good if you can learn to accept and relax even if you aren't asleep.  You might find some help in these topics:

 

Sleep Hypnosis, Guided Meditations, Calming Videos


Sleep problems - that awful withdrawal insomnia

 

These are the supplements that SA recommends trying:

 

Magnesium


Omega-3 Fish Oil

 

See also:

 

Supplements - what helps, what doesn't?

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Thanks, Chessie Cat! I also found this thread http://urvivingantidepressants.org/index.php?/topic/606-important-topics-about-tests-supplements-treatments-diet/

 

So I wonder whether I should just stop taking a number of the supplements that I currently take. 

 

There are some I think would be good to keep taking:

 

Magnesium - I take both glycinate and citrate (restless legs, constipation, sleep)

Probiotic  (gut health)

Potassium (I eat very low carb which has a diuretic effect & makes it easy to become deficient in potassium)

L-Carnitine (prevents accumulation of fatty deposits around liver and heart)

Estrofactors (my body doesn't detox estrogen well - learned this via a 23andme genetic test)

Melatonin (sleep)

Vitamin D & K2 (most people are low in D, K2 helps get Calcium where it should go and keeps things like kidney stones away)

Deplin (methylfolate - dr says it's support to CNS)

 

It's hard to know about the B6 (P5P) and B12 (Adensoyl/Hydroxy). I've read that they can be agitating, but also have some benefits.

 

I used to take Omega-3, but my nutritionist says that it oxidizes too easily and that it's better to get them from food sources. I don't know - I don't end up eating very much fish.

 

All of the above is still a lot, huh? 

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  • Moderator

Hi Mammoth-- I'll answer your question from my thread here so you'll have a record that is easier to find.

 

There are two "feel good" supplements that are very popular which should not be used in combination with any of the drugs we see here.  They are Sam-E and 5-htp. Both of these work on the same nerve receptors and neurotransmitters as psych drugs.  The same systems we are trying to repair by reducing the drugs that effect them, so adding more things that effect them is not a good idea. They also both increase the level of serotonin in the body and when combined with prescription drugs that work with serotonin levels can cause a dangerous increase in serotonin levels. This can trigger serotonin syndrome which can be very deadly.  Also from past experience they tend to be very ineffective in treating depression and can do a very good job or derailing a careful and successful taper.  All in all it really is best to stay away from them, and we can't recommend their use.

 

One very common side effect of WD is the need to research everything.  Dr Google can provide a lot of good information on many of the topics we see, it just takes a bit of digging.

 

http://www.webmd.com/vitamins-supplements/ingredientmono-786-same.aspx?activeingredientid=786&activeingredientname=same

 

http://www.webmd.com/vitamins-supplements/ingredientmono-794-5-htp.aspx?activeingredientid=794

 

These two links have a very good summery of the supplements in question.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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Thank you, Tom! Those are both helpful summaries about Sam-E and 5HTP.

 

I will let my nutritionist know that she should not recommend either to people who take AD's. She knew about 5HTP, but not Sam-E. 

 

The whole supplement thing is just tricky, isn't it?

 

I really appreciate your response!  :)

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Mammoth. Supplements can be very tricky in withdrawal , particularly if you are taking a lot - as you are. When you are on so many it is very difficult to know which ones might be causing any reactions or symptoms that you might be having. This is common in a sensitized system and most of us are.

 

It helps to cut right back to the basics, and start of at low doses perhaps introducing one at a time.

 

When I started withdrawal, I was taking many supplements but during the process cut right back to just the fish oil and magnesium. I started juicing and green smoothies instead as you get the full spectrum of vitamins and minerals in an easily absorbed and " whole" manner.

I found it helpful to keep it simple.

Ali

Many SSRI's and SSNRI's over 20 years. Zoloft for 7 years followed by Effexor, Lexapro, Prozac, Cymbalta, Celexa, Pristiq, Valdoxan, Mianserin and more - on and off. No tapering. Cold turkey off Valdoxan - end of May 2014

 

                                                  Psych Drug - free since May 2014
.
         

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AliG - thanks. It makes sense to cut back to the most basic supplements of fish oil and Mg. Like you said, if we make intentional choices with food, we can get a lot of the nutrients we might otherwise be missing. A number of wise people here have said essentially the same thing. I'm listening.  :) No need to reinvent the wheel or suffer when those who have gone before have offered their experience.

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"The biggest mistake patients and doctors make is coming off these drugs too quickly." -Ann Blake Tracy

 

I'm struggling with the idea that it will take a minimum of 5 years (that would be if everything goes smoothly) to wean from Cymbalta by dropping 10% of the current dose per month. And even then, I will still be on Wellbutrin. Sigh. 

 

In the meantime, I am still waiting for insurance approval to get 4x20mg = 80mg for my first drop down dosage. If they won't approve it, I'll just go the route of using a compounding pharmacy. I don't think I have the patience to count the beads myself. 

 

I've been a little obsessive about researching the withdrawal process, I confess. But I do need to understand it well so I know what I'm getting into and so I can teach my husband and others.

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from the Neuro emotions thread:

Neuro-emotion: (n.) Exaggerated emotion as a result of iatrogenic drug reactions, does not indicate relapse or emergence of mental illness. 

Good to know.


I see that people recover, and I choose to believe that this is all reversable. If there is one thing we all need to hold onto, it's hope. Loss of hope is what is killing people in this situation more than anything. I just haven't seen evidence that people don't recover, though for some it can take a long time. I think like Starlite, that nothing is permanent. It does have a lot to do with our beliefs. I recovered from first signs of emphysema several years ago. How is that possible when it's supposedly cell destruction that is irreversible?

 

 

This is a positive and hopeful way to look at life.

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I talked to my doc. Insurance won't cover the 4x20mg duloxetine. But I can have a compounding pharmacy make 81mg (which is exactly 10% decrease from 90mg) for only $68/month. I will pick it up tomorrow and get started on my first bump down. 

 

I had to hold my tongue when speaking to my doctor. I have some anger toward him for putting me on such a hard medicine to taper off. I remember once saying something about that at an appointment and he was like, "Thank God you aren't on Effexor. It's even harder to get off than Cymbalta." Dear me. I wanted to punch him. He's a nice man, I think, just misguided. Really the field of psychiatry in our world today is such a farce. I'm not a conspiracy theorist, but I may become one as I continue to research withdrawal from psychiatric medicines.

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  • Moderator Emeritus

Glad you've found a way to simplify getting tapered doses.  Ask the compounding pharmacy which manufacturer produced the duloxetine.  Pay attention to any symptoms you have. Some people find they react differently to fillers and binding agents used by different manufacturers.

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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Glad you've found a way to simplify getting tapered doses.  Ask the compounding pharmacy which manufacturer produced the duloxetine.  Pay attention to any symptoms you have. Some people find they react differently to fillers and binding agents used by different manufacturers.

 

 

Yes - planning to keep a journal. Also asked the pharmacy to always use the Citron manufacturer so that there will not be unexpected changes. Thanks, Scallywag. :)

 

 

Ok question for all you Cymbalta people - I am also in a Facebook group for Cymbalta withdrawal. According to them, the way to reduce the dosage is not by reducing 10% of the milligrams, but rather 10% of the beads in the capsules. As I read here, it seems like some people reduce by milligrams per dose.

 

Is it not the same thing? Take out the number of beads which would make up the new dose at 10% less?

 

What is the common wisdom here? I'm confused. 

 

Tomorrow, I am supposed to pick up a dose of 81 mg (10% reduction of my current 90 mg dose) from a local compounding pharmacy. Is this going to be a problem? Not sure what to do.

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  • Moderator Emeritus

Mammoth, the 10% is what matters not whether it's the number of beads or the weight of the beads in the capsule. Who ever is suggesting this on the facebook group has either a poor understanding of arithmetic or anxiety/fear of it. All you need to do is pick the method that makes the most sense to you and use it each time. That said, most people count Cymbalta beads because it is simpler than weighing.

 

Feel free to ignore the rest of this post if you're willing to take my word for it. Otherwise, read through an example:

 

My 60 mg capsules had 540 beads on average. I never weighed them so for this exercise -- this is not actual weight -- let's say that the beads removed from the capsule weigh 100 mg. The beads will weigh more than the dose because the manufacturers add fillers and coatings, etc.

 

bead counting: 540 beads/60 mgai: 9 beads = 1 mgai (mg of "active ingredient)

bead weighting: we'll use a measure "mgbw" (mg bead weight)

60 mgai weighs 100 mgbw, so 1 mgbw = 0.6 mgai

 

To reduce by 10% from 60 mg by

  • counting beads, I would subtract 10% or 54 beads from 540 beads and create doses of 486 beads
  • weighing beads, I would subtract 10% or 10 mgbw from 100 mgbw and create doses of the remaining 90 mgbw.

Working back to dosage:

486 beads @ 9 beads/mgai = 54 mg active ingredient

90 mgbw @ 0.6 mgai/mgbw = 54 mg active ingredient.

 

Hmm, the end result is the same regardless of the method. And this concludes our bead counting vs weighing tutorial for Sunday Sept. 11, 2016. ;)

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

Mammoth, the 10% is what matters not whether it's the number of beads or the weight of the beads in the capsule. Who ever is suggesting this on the facebook group has either a poor understanding of arithmetic or anxiety/fear of it. All you need to do is pick the method that makes the most sense to you and use it each time. That said, most people count Cymbalta beads because it is simpler than weighing.

 

Feel free to ignore the rest of this post if you're willing to take my word for it. Otherwise, read through an example:

 

My 60 mg capsules had 540 beads on average. I never weighed them so for this exercise -- this is not actual weight -- let's say that the beads removed from the capsule weigh 100 mg. The beads will weigh more than the dose because the manufacturers add fillers and coatings, etc.

 

bead counting: 540 beads/60 mgai: 9 beads = 1 mgai (mg of "active ingredient)

bead weighting: we'll use a measure "mgbw" (mg bead weight)

60 mgai weighs 100 mgbw, so 1 mgbw = 0.6 mgai

 

To reduce by 10% from 60 mg by

  • counting beads, I would subtract 10% or 54 beads from 540 beads and create doses of 486 beads
  • weighing beads, I would subtract 10% or 10 mgbw from 100 mgbw and create doses of the remaining 90 mgbw.

Working back to dosage:

486 beads @ 9 beads/mgai = 54 mg active ingredient

90 mgbw @ 0.6 mgai/mgbw = 54 mg active ingredient.

 

Hmm, the end result is the same regardless of the method. And this concludes our bead counting vs weighing tutorial for Sunday Sept. 11, 2016. ;)

 

 

Ok - thanks! That is what I thought. It has to work out the same way, regardless of whether you count beads or milligrams. Otherwise, how would the dosages be made? I'm not the math whiz of my family, but I am generally a smart person. Still, I thought perhaps I was missing something. :)

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Really good! Re-posting so I will have easy access to it.

 

 


 

PS - it may have been me who posted some steps for surviving neuro-emotions.  Here's what I wrote - I hope it helps (even if it's not the one you're thinking of):

 

 

Neuro-emotions are so difficult, because they seem so real.  There is just enough truth - a speck of sand - inside the whirlwind storm of emotions, that the whole experience seems hyper-real.  

 

So what to do about it?  It's a tangle of thoughts and emotions, and it helps to untangle the thought from the emotion.  

 

You can distract, by taking a walk,  color in a coloring book, listen to music, call a friend, play a stupid game on facebook, watch children's TV shows.

 

You can make fun of the thought (I just learned this one today, from ACT).  Here's how they did it in Harry Potter:

Harry Potter - Ridiculus spell for Boggart

 

Another suggestion I've heard is to take the happy birthday song, (or a silly children's song) and sing your thoughts to that song over and over until the thought is burned out, and you are detached from the emotion in the thought.  

 

Then, you can say, "It's just a thought." Accept the thought - that's what your brain is designed to do - make thoughts.  "It's just my brain making another thought." 

 

You can go into mindfulness.  Find a furry soft toy, and stroke it against your face, feel soothed by the simplicity of that.  Drink a warm cup of herb tea, feel the warmth and flavour of the liquid.  This is where I like colouring - putting colours on the page is so pleasureable to me.  Follow your mindfulness into pleasure.

 

Breathe, and know that you are alive, and breathing.  All you ever really need to do is breathe.  Sometimes ten breaths is all it takes to bring you back to yourself.

 

Jon Kabat-Zinn writes:

Quote

"The fact that you are breathing means there is more right with you than wrong with you in this moment."

 

 

We all need a regular, daily practice.  Something we can go to, fall back on, that supports us.  Sometimes it's the blindfold in the dark quiet room. Maybe it is a favorite song like Pharrell Williams, "Happy."   Sometimes it is yoga or tai chi.  

 

Turn off your fight or flight reactions with this yoga pose - less than 5 minutes (but you can stay longer):

Legs on the wall - shorter, no blanket

 

Or here is 7 minutes of magic of Chi Gung (you can find hours and hours of Chi Gung on YouTube, and it will heal your body!)

Qi Gong: 7 Minutes of Magic for Health

 

Sometimes it is breathing, sitting still. Many people here like guided meditations on YouTube.   I like to take walks in the sunlight, it is really helpful for setting my mood straight.

 

Now here's the thing:  these practices cannot fix withdrawal symptoms.  The symptoms are chemical, and often too extreme for one session of yoga or mindfulness to fix.  

 

But the more you have a regular practice, the stronger your "bank" of fortitude and adaptability.  Then you have something to draw  on - a comfortable place to go when you are uncomfortable, and it is easier to live through the symptoms.  Additionally, they improve your stress response, so that you are less likely to fire your nerves to begin with.

 

Then, when you do your 7 minutes of Tai Chi, you can feel the shift, because the practice is familiar, and pleasurable, and you feel the goodness of the practice help with your symptoms.  The symptoms don't go away, but your relationship to the symptoms shifts.

 

If you push on the symptoms, they often get worse.  But if you wait, they will pass.  These are some suggestions to help you get through it.

 

From <http://survivingantidepressants.org/index.php?/topic/12391-tntd-severe-anxiety-with-agoraphobia-in-cold-turkey-withdrawal-dr-increased-benzo/page-5#entry246747

 

 

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Had some down feelings today. Didn't feel like talking to anyone after church service. Talked to one friend and then left pretty quickly.

 

Some thoughts of not liking myself and wishing I had a personality that is more fun like my husband or best friend came to mind. Didn't drag me down too much, but I did notice that I felt that. 

 

Made me realize that last week, I wasn't feeling as down. 

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  • Moderator Emeritus

"The biggest mistake patients and doctors make is coming off these drugs too quickly." -Ann Blake Tracy

 

That is soooooo true, Mammoth! 

 

I'm sorry you were feeling down yesterday. I'm glad you noticed that you were feeling better last week. I hope today is better!

Current: 2019: 0.04 mg Paxil!! This is real. Soon, after taking Paxil my entire adult life, I will be free.

Long story short: After 18 years on Paxil, "tapered" almost completely off over a month, at doctor's advice in July 2015.

Self-care includes magnesium, reasonable exercise, mindfulness, this forum and nutrition/eating enough food.

Also on 100 mg Zoloft unfortunately!! (which I now will have the knowledge to taper properly)

-------------------------------------------------------------------------------------------

Longer version: On Paxil since 1996--anxiety & depression caused by (undiagnosed) under-eating / eating disorder.

Doctor kept increasing dose, up to 60 mg; it never really helped but said it really was the best "med" for me.

Rapid doctor-led "taper" July 2015, down to 5 mg, with Zoloft as a "cross-taper" = Essentially a cold turkey. 

Severe withdrawal but didn't know it; believed it was my "underlying condition," and kept tapering, 5mg to 4 to 3  to 2 to 1.  

Feb 2016: Found SA! As of June 2016, tapering from 1mg at rate of 5-10% per month, Brassmonkey Slide! 

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Thanks Sky Blue.

 

So I'm debating what to do. The compounding pharmacy was supposed to have my new 81 mg dose ready today, but now it won't be til noon tomorrow. I finished the last of my 30mgx3 dose today. I do have some 60mg capsules leftover from a previous dose. 

 

Options:

1. Wait for the new dose of 81mg and take it as soon as I pick it up. Maybe noon or 1:00. (I usually take my current dose at 6:30 am.) Worried this will cause me to sleep poorly tomorrow night.

2. Attempt to make an 81mg dose myself so I can take it at 6:30 tomorrow morning by counting beads using a few of the 60 mg capsules I have in my medicine cabinet. Then I can start with the pharmacy's capsules on Wednesday.

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  • Moderator Emeritus

Hi Mammoth,

 

"I finished the last of my 30mgx3 dose today. I do have some 60mg capsules leftover from a previous dose."

 

It would probably be better to make up your dose from the capsules you have rather than waiting.  It will only be for 1 dose.

 

If you have been taking 90 mg, you could take a 60 mg capsule together with a partial amount of another capsule.

 

Half a capsule would be 30 mg.  Don't try and get 81 mg.  You haven't started this amount yet.  If you are concerned that you might take more than 90 mg you could halve the amount as accurately as possible and then remove a few beads from the dose you are taking.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Hi Mammoth,

 

"I finished the last of my 30mgx3 dose today. I do have some 60mg capsules leftover from a previous dose."

 

It would probably be better to make up your dose from the capsules you have rather than waiting.  It will only be for 1 dose.

 

If you have been taking 90 mg, you could take a 60 mg capsule together with a partial amount of another capsule.

 

Half a capsule would be 30 mg.  Don't try and get 81 mg.  You haven't started this amount yet.  If you are concerned that you might take more than 90 mg you could halve the amount as accurately as possible and then remove a few beads from the dose you are taking.

 

 

Hi ChessieCat - thanks. That makes a lot of sense. I will make as close to a 90mg dose as I can from 1 and a half 60's for tomorrow morning. Then I can do what I had planned tomorrow morning and go to the pharmacy in the afternoon and can start with the taper on Wednesday morning. 

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