Esha: tapered off Prozac 3 yrs ago, Effexor two months ago, experiencing dread

[Esha]

Hello. As in my signature (which I see may need to be edited for specifics): I went on Prozac in 1994, off two or three years later, but then seemed to need it again and was told I had the profile of someone who should be on it indefinitely. I was on from 1997 or 1998 until in 2014 I tapered off over several months. After a few months off, I developed constant fear with ruminations about death and the end of the universe. Went on Effexor in January 2015, switched to Cymbalta later to attempt to reduce tinnitus, switched back to Effexor again (no longer sure when, probably summer 2017).

 

Then, I tapered off from November 2017 to mid-March 2018, then had a few weeks of dizziness and thumps in the head, then was fine. In mid-May 2018, the constant fear and ruminations returned. I immediately started on about 7.5 mg of Cymbalta (a quarter of the beads in a capsule), since it was what I had left from my US doctor (I'm in the UK for some months at least), then saw a doctor. I was concerned about future discontinuation syndrome with the SNRIs, so in discussion with the doctor I started on 20 mg Prozac on May 23. I wanted to overlap with the Cymbalta because I'd read Prozac is used for transitions, but the doctor said to stop the Cymbalta in case of overdose, so I stopped after a few days. After eight days on Prozac, I told her I remember that it takes a few weeks to build up but that I was struggling, so on June 1 she switched me to 30 mg of Cymbalta in hopes of faster relief. I'm afraid that because Cymbalta was what I still had left from my US doctor and I wasn't in the best mental state, I mistakenly told her that's what I'd last been on, but it had really been Effexor - unless I'm now permanently confused.

 

Now, six days later, I'm feeling slight relief but still free-floating fear. I'm having some dry mouth, occasional heat at the back of my head, and fidgeting with my legs, all of which are manageable - but after some reading here, I'm wondering if I should lower the Cymbalta dose anyway. On the other hand, I'm desperate for it to take effect as soon as possible.

 

I've been reading some of the other introductions that mention Effexor/venlafaxine and Prozac/fluoxetine and am wondering if I should immediately ask my doctor for a new prescription of Effexor to reinstate instead of proceeding any further with Cymbalta/duloxetene. I'm also wondering if I should try the Prozac again instead, though it had seemed to stop working and I've been off it since about May 2014 - but it seems safer than the SNRIs.

 

By the way, I am American but currently in the UK, and in this system one has to start with a GP before a psychiatrist will accept a referral. My GP seems to know a bit (she was aware of possible cardiovascular effects and has ordered an EKG for me), but I doubt she knows enough (if anyone does). I'll have to find out if I can proceed to a psychiatrist more quickly if I use my US insurance (which will start in July) to pay privately.

 

Thanks for any thoughts.

[Esha]

Can't seem to edit this any more, but just wanted to add that I'm on 10,000 units of vitamin D daily due to a deficiency so severe it's probably genetic. I want to start magnesium and calcium but not until I've had my blood tests next week, because vitamin D can actually lead to overly high calcium levels. I've also read that magnesium can have some sort of effect on norepinephrine, which is the N in SNRI. Meanwhile, I've taken 15 mg of Cymbalta just now instead of 30.

[Petunia]

Welcome Esha,

I'm sorry you are going through this difficult time. I know what it's like to feel dread every day, that was one of my withdrawal symptoms.

 

Did Cymbalta stop the Prozac withdrawal symptoms when you were taking it in 2015, it sounds like it helped and you were doing ok until your 4 month taper earlier this year.

 

You have been tapering too fast. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?  (The general philosophy of gradual tapering)

 

Its good you have felt some relief in a week, that indicates that something is helping. What are you taking now? How are you feeling? Its important to take the same dose at the same time every day, this will help your nervous system to stabilize, if you keep jumping around with different drugs and doses, you wont be able to stabilize. Please read more about this here:

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Stabilization after reinstatement can take a while. You need to think in terms of weeks and months rather than days.  Here is our reinstatement topic so you will know what to expect:

 

 About reinstating and stabilizing to stop withdrawal symptoms

 

Please would you add a few more details to your signature, the last 2 years are most important. We need to see dates of changes, drugs taken and dosages. 

 

If I were you, I would give the Cymbalta a chance to work, because that's what you are currently on, I think.

 

If you keep making changes, your nervous system wont be able to stabilize and your symptoms may get worse. Please carefully read through the links I've posted.

 

You will need this when you are are ready to taper off Cymbalta:

 

Tips for tapering off Cymbalta (duloxetine)

 

But please give yourself enough time to stabilize before you begin tapering again.

 

Its a good idea to rate your symptoms daily to help you keep track of how you are doing. Withdrawal symptoms can distort our memory and make it difficult to accurately recall how we felt days and weeks ago. Here are some tips on how do do this:  

 

Rate symptoms daily to track patterns and progress

 

Keep notes on paper

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again.

 

Petunia.

 

 

[Esha]

Thank you so much for the thorough response, Petunia. To answer your questions:

- I went on Effexor first for the Prozac withdrawal symptoms, and it did indeed help. I only switched to Cymbalta because I was having a lot of tinnitus and the doctor said to try it in case it was any different. The switch was unproblematic and I get the sense the two medications are quite similar. Still, I see what you mean about sticking to one thing in order to stabilize.

- Now I'm taking 15 mg of Cymbalta at bedtime. I took 30 mg for six days, then reduced it to 15 three days ago because I was feeling jittery with fidgety legs. I still feel slightly jittery but haven't had any problems lowering the dose by this much. It is helping, though this time around I feel sad, spacy, and easily stressed (I imagine these are from the destabilization). I have a doctor's appointment in four days to discuss dosage levels and do blood tests.

 

Now one more question from me: When the doctor switched me from Effexor to Cymbalta in 2015, she said Cymbalta is known for its discontinuation syndrome but she thought we could "manage the symptoms" (at that point, I didn't ask for specifics and now she's left the practice I was with, plus I'm living elsewhere for now). In 2017, I wanted to switch back to Effexor because of this, but only recently I've read that Effexor has the same problem. I understand that everyone's response is different, but is it known that one is clearly more problematic to go off of than the other? Or are they similar? I'll stay on the Cymbalta as you suggest, but would still like to know about this for the long term.

 

Also, a housekeeping note: When I was trying to sign in just now, I had slightly misremembered the password I used. After two tries, the system said I'd tried three times unsuccessfully and blocked me. How do I let someone know it's cutting off after two tries instead of three?

 

Thanks for any thoughts.

[Esha]

Also, is there a way to edit the tags on my first post? I misspelled duloxetine, so it doesn't work as a tag. Apologies.

[Carmie]

Hi Esha, 

 

How are you doing?💚