Keri: Stuck on cymbalta - does prozac bridge work?

[Keri]

I have been on cymbalta for 14yrs.  Over a year ago my GP said in order to get off I had to take it every other day for a while and then quit.  I went into horrible withdrawals months later.  A psychiatrist put me back on it now I am tapering.  I am at 16.75mg and I cannot handle the withdrawals.  Many have said to bridge to prozac.  Will that work for someone like me who's nervous system is so screwed up?

Edited January 5, 2018 by scallywag
update title with member's username

[Gridley]

Hello, Keri, and welcome to SA.  I have moved your post to our Introductions and Updates section.

 

To start, we ask all of our members to fill out a signature so that all of your information can be read at a glance.  This helps moderators determine you current situation and we would ask that you follow the instructions at the link bel.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
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• Please leave out symptoms and diagnoses. 
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• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

It is little wonder that you had terrible withdrawal systems trying to taper taking Cymbalta every other day.  The half-lives of almost all psychiatric drugs are too short for this to make any sense. It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse.  It is like playing ping-pong with your brain.

Your brain likes stability, to be treated gently.  It is ideal if you can accommodate it to lower and lower dosages. Move it slowly down a ramp by gradually decreasing dosage by an amount it may hardly notice. SA recommends tapering by 10% of your current dose with a hold of at least 4 weeks before your next decrease.The 10% taper method is a harm reduction approach to going off psychiatric drugs. This is explained in the attached link:

 

Why taper by 10% of my dosage?

 

A Prozac bridge is a possibility, and I have quoted at length below from a post from Alto, our administrator, about the pros and cons of a switch to Prozac. 

But before taking that route, please consider tapering your Cymbalta more slowly.  Please let us know the rate you've been tapering Cymbalta.  Even 10% per month is too much for some people.  I would work with a slower taper first to see if that works before switching to Prozac.

 

Some options that are good for people who have very sensitive nervous systems:

 

Brass Monkey Slide

 

Rhi's "Start Small, Listen to Your Body" Taper Plan

 

Micro-taper instead of 10% or 5% decreases

 

To get you familiarized with the protocols followed by SA, I am linking a few topics so that you have a better understanding of what is recommended here. 

 

Before you begin tapering what you need to know

What is Withdrawal Syndrome?

Brain Remodelling

 

PROZAC BRIDGE by Altostrata

 

Switching or bridging with another drug, usually of a longer half-life, is a recognized way to get off antidepressants, particularly those that people find difficult to taper.
 
Many people with failed tapers from venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil), and duloxetine (Cymbalta) find they need to bridge in order to go off the drug.
 
Fluoxetine (Prozac) has the longest half-life of any of the modern antidepressants. Because it takes about a week for a dose to be metabolized completely, if a switch to fluoxetine is successful -- that is, does not cause withdrawal symptoms from the original drug -- a careful taper off fluoxetine is easier for most people -- see information about Tapering off Prozac. And, at least fluoxetine comes in a liquid.
 
(Citalopram or Celexa and its sibling escilatopram or Lexapro have half-lives of about 35 hours, a relatively long half-life among SSRIs, and are other candidates for a bridging strategy. They also come in a liquid form. The drawbacks and advantages of switching to another drug to get off the first drug, described below, apply to a switch to citalopram or escilatopram as well as fluoxetine.)
 
While going off fluoxetine usually has less risk, one might still develop withdrawal symptoms going off fluoxetine. No bridging strategy is risk-free.
 
You must find a knowledgeable doctor to help you to with a bridging strategy. You might wish to print this post out to discuss it with your doctor.
 
When to switch or bridge
A direct taper from the drug to which your nervous system is accustomed carries less risk than a switch to a new drug. You may have a bad reaction to a new drug, or the substitution may not work to forestall withdrawal symptoms. This is the "the devil you know is better than the devil you don't know" rule.
 
The risk of a switch is justified if you find a  taper from the original drug is simply too difficult. Usually people will do a switch when they find reducing the original antidepressant by even a small amount -- 10% or even 5% -- causes intolerable withdrawal symptoms. (I have heard doctors say they don't even try tapering off Effexor and Paxil, they do the Prozac switch from the beginning.)

 

Sometimes when people go down to a low dose of an antidepressant (such as paroxetine), they find further reduction is very difficult. Substituting a longer-acting SSRI such as fluoxetine may be worth the risk.

If you're thinking of switching simply as a matter of convenience, you need to weigh the risks against the amount of convenience you would gain. Generally, switching for convenience is a bad idea.

Risks of bridging
For most people the switch goes smoothly but for some it doesn't. A bridging strategy has the following drawbacks for a minority of those who try it:

• Adverse reaction to the bridge drug, such as Prozac.
• Dropping the first antidepressant in the switch causes withdrawal symptoms even though you're taking a bridge drug.
• If withdrawal symptoms are already underway, switching to a bridge drug doesn't help
• Difficulty tapering off the bridge drug. All of the bridge drugs can be difficult to taper themselves.

So, like anything else, the Prozac switch is not guaranteed to work. But if you are having intolerable withdrawal from another antidepressant, it may be worth risking the worst case in the Prozac switch: It doesn't help and you have withdrawal syndrome anyway.

 

CAUTION: A switch to a bridge drug is not guaranteed to work. It's safer to slow down a taper than count on a switch. A switch really should be used only when a taper becomes unbearable or there are other serious adverse effects from the medication. You must work with a doctor who is familiar with bridging, in case you develop severe symptoms.

 

Edited January 3, 2018 by Gridley

[scallywag]

Keri -- Welcome to Surviving Antidepressants (SA)!

 

I started my journey off Cymbalta in early January 2016, almost 2 years ago exactly. I had similar counterproductive medical advice about alternating doses and large dose reductions.  Once I found this site, I increased my dose a bit, held there for a month to stabilize then counted beads from my Cymbalta capsules to discontinue. I started at 20 mg (approx. 185 beads/day) and worked my way down to zero. I figure I counted more than 38,000 of the suckers! You can read my introduction at the link in my signature.

 

Please read the information Gridley posted for you -- carefully and often.  I didn't get as far down in dosage as you are before I noticed a problem. Sometimes being sensitive to medication has an upside.
 

Let us know what you choose and how you're doing.

[Keri]

Thank you so much.  This site is wonderful and so full of information.  I am tapering using a compounding pharmacy by 1/4 to 1/2 mg each month or so.  Which comes to about 3% or less. I still cannot get stable.  I feel brain damaged from the every other day thing. 

[scallywag]

The least risky thing to do is to stay at your current dose.  Give your CNS (central nervous system) time to catch up to your current dose. Have a look at the first post in the How your brain responds to psychiatric drugs - aka "Brain remodeling"  topic.  It's given many people a useful way to understand what's going on with their symptoms.

[Keri]

I am only dropping 1.5 to 3% every 3 to 6 weeks.  The withdrawals I get are awful.  

[scallywag]

Many people have found holding for a long time, 3 months or more, works to settle things down.  Doing that allows you to see what symptoms are "withdrawal normal" and then when you start to reduce dose again you can identify what symptoms arise and when because of the reduction.

 

Are you keeping track of your symptoms? If not it may help you -- keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

During my taper I used an excel version of a daily list of symptoms found in the first post of this topic:

Glenmullen’s withdrawal symptom list.

 

[Keri]

Would bridging to something else help me get off this stuff?

[Keri]

I have been tapering 1 to 3% every 3 to 6 weeks to get off duloxetine.  I feel like I am having drug induced anxiety. Any help or advice please.  I need to get off asap or I will have a heart attack 

Edited January 7, 2018 by scallywag
merged from "Duloxetine tapering"

[RealMe]

On 1/5/2018 at 4:40 PM, Keri said:

I have been tapering 1 to 3% every 3 to 6 weeks to get off duloxetine.  I feel like I am having drug induced anxiety. Any help or advice please.  I need to get off asap or I will have a heart attack 

I don't know anything about tapering Duloxetibe.  I just read your post about anxiety and want to offer you some words of hope and encouragement.  Sometimes eating yogurt or drinking milk or taking a warm shower helps my anxiety.  I hope you find some relief.  Sending good thoughts of healing.

Edited January 7, 2018 by scallywag
merged from "Duloxetine tapering"

[scallywag]

Unless you are having an adverse reaction to a medication, it's best to follow the advice given about going on a date "Dance with the one who came with you." Translation for psych meds withdrawal situations: taper off the drug you started.  Crossovers can work, can take more time than expected to work while making things worse for a short time, and can make things worse period.  If you can manage your life with your current symptoms, it's best to stay at your current dose and gradually taper down.

 

What are your current symptoms?  Is there a pattern to them within a day, or from day to day?

Edited January 6, 2018 by scallywag

[Keri]

I am living in a constant state of anxiety.  I am fatigued, I have the shakes, and just feel awful.  I reinstated Way outside the window after an every other day taper.  I can't stabilize no matter how long I hold.  I have held for months at times.  This is ridiculous.  I need relief 

[gardenlady]

Keri, I'm really sorry no one has responded to your post.  Perhaps they just don't know what to advise.  And, perhaps this website just doesn't get much traffic. I've noticed that sometimes I don't get responses for a very long time.  Everyone is busy, I suppose. 

 

If you are still miserable, I certainly would investigate bridging to Prozac as nothing else has helped.  I bridged from Ativan to Valium and did so much better on the Valium....it was impossible for me to taper Ativan due to the short half life.  Cymbalta also has a short half life, so perhaps crossing to Prozac would help.  You may still have Cymbalta withdrawal symptoms, though.  No way to know unless you try. 

[Keri]

Thank you!

[gardenlady]

How are you feeling, now, Keri?  Have you been able to taper any more beads?  My heart goes out to you as I know what a rat poison of a drug Cymbalta is.  I will resume my taper of the remaining 48 mg as soon as I've recovered sufficiently from my recently completed benzo taper. 

[nz11]

Keri 

Sorry you are still struggling.

I assume you are on duloxetine alone and not adding benzos or friends.

Were you stable at the 20mg before you started to taper ?

It would be helpful to put the dates in the drug sig when you did your drops. 

 

On ‎1‎/‎6‎/‎2018 at 10:40 AM, Keri said:

I need to get off asap or I will have a heart attack 

 Who has said this the doctor? Why do you think this?

I like SW's term 'Dance with the one you came with' it is so true. 

Any switch is high risk.

nz11

 

 

 

 

 

[Keri]

I am actually doing much better after my last drop. It's almost like my body needed for me to drop in order to feel better. Strange. But my next drop is next week and I'm nervous again.  I think I will keep slowly dropping on duloxetine until I need to stop and hold again.  Thanks for all the replies 

[nz11]

Well just goes to show what an extra 2-3 week hold can do.

Great news 

[nz11]

Keri any update?

[Keri]

I am doing okay.  I am doing a micro taper and still have some withdrawals.  I think a lot of my problem is that I took it every other day for 6 months then stopped and months later reinstated.  I think my brain is damaged beyond repair.  I will just keep doing what I'm doing and hope for the best.  I don't understand how to put my med history in the sig section 

[Keri]

I am tapering duloxetine cymbalta and stuck at 14.5mg.  I can’t even drop one bead.  I am extremely kindled.  Should I try to add in 5mg of prozac and keep tapering.  

[Altostrata]

Keri, when was your last decrease? How much was it? Did you feel better before that decrease?

[Keri]

I have a weird story.  I was on it 14yrs. In 2016 my doctor told me to alternate days.  I did this for 6 months.  Then stopped. Went into withdrawals and they put me on Trintellix for 2 months.  Had a reaction then stopped cold turkey. Then went back on cymbalta a month later.  Tried to stabilize and started slow tapering.  I don’t think I have felt good for 2yrs.  I feel as if I am now toxic to the cymbalta. It seems I just feel bad no matter what I do.  Would adding in 5mg of prozac and continue with my taper help?  I am literally micro tapering and only dropping one bead and having problems 

[MMMM]

Hi @Keri how did this go for you?

[Keri]

I never did it.  I’m still slow tapering the cymbalta