Scotteves: need advice for Cymbalta withdrawal

[Scotteves]

So what happens if I went back up from 22.5mg to 30mg? Does anyone know? I'm going to kill myself if I don't figure out something soon. I'm not dealing with this hell anymore and getting no support. I can't live in this hell for several more years.  No one seems to know anything. 

 

I'm not stabilizing so I can't stay where I am.

I can't go back up. 

I can't wean off because I'm too sick. So what now? There's no hope or options left. 

[ChessieCat]

It's better to increase by small amounts than to risk taking too much.

 

Much of the information about reinstating is relevant to updosing.  About reinstating and stabilizing to reduce withdrawal symptoms

 

If you can provide 3 days of symptoms notes then they can be assessed.  Without them it is difficult for us to offer suggestions.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

[ChessieCat]

You might want to reconsider this.  I think it would be worth trying.

 

On 1/4/2019 at 11:37 AM, ChessieCat said:

 

Cymbalta has a short half life of about 12 hours.  From your notes it looks like you may be experiencing interdose withdrawal.  I've alerted the other mods to this.

 

Because of this you might find that taking your dose 12 hours apart will help.

 

It is generally better to move 1/2 of the dose by 1 hour each day.  Because you are taking it at 1pm on the first day you could take 1/2 dose half an hour earlier (12.30pm) and the other 1/2 half an hour later (1.30pm) and keep doing that until they are 12 hours apart.

 

 

 

[ChessieCat]

From Scallywag's Intro topic for CYMBALTA:

 

Another day, another chart. This one shows how the metabolizing doses stack up to reach steady state. Again this is for Cymbalta or another drug with a 12-hour half-life.

 

 

Notice that what gets steady is the daily transition from maximum and minimum, 133% and 33%, the same cycle every day.

 

steady state chart - scallywag - 24 hour intervals.xlsx

 

 

 

[Altostrata]

36 minutes ago, Scotteves said:

So what happens if I went back up from 22.5mg to 30mg? Does anyone know? I'm going to kill myself if I don't figure out something soon. I'm not dealing with this hell anymore and getting no support. I can't live in this hell for several more years.  No one seems to know anything. 

 

I'm not stabilizing so I can't stay where I am.

I can't go back up. 

I can't wean off because I'm too sick. So what now? There's no hope or options left. 

 

Hi, Scott. Are your symptoms worse at any particular time of day? When do you take Cymbalta? How do you feel in the hours after you take it?

 

Do your symptoms follow any daily pattern?  Please keep daily notes on paper with times of day for when you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. Post your notes here in your Intro topic.

 

If you think more Cymbalta would help, you might go up to 25mg and see the effect. You won't want to make any big jumps in either direction. But first, look at your daily symptom pattern to see what it's doing now.

 

I don't know if Effexor would be an effective substitute for Cymbalta. Some doctors would substitute Prozac as a bridge, but that's unpredictable, too.

[Scotteves]

Hey Alostrata so I'll outline my symptoms for you guys below. Do you think now that it's been 5 months since my last taper that it's too late to go up? How long should I try going back to up 25mg for? Could I damage myself permanently if I go back up? What do I do if it doesn't work? Also, compound pharmacies are terribly unreliable so even if I go back up to 25mg the dosage will bounce around a lot. There's just no winning it seems. 

 

1. I usually wake up and feel ok first thing in the morning. When I wake up I can usually tell if I'm going to have a bad day if my vision is messed up. 

2. I try to eat something light like eggs or one piece of rye bread with almond butter in the morning within an hour of waking. I can't handle much carbs or anything. I'm wasting away because I can't eat much without it setting me off. 

3. I usually start feeling like hell a couple of hours after I wake up - blurred vision, heart pounding, dizzy, head pressure, headaches, insane anxiety, panic, horror, doom. 

4. I take my pill at 1PM. 

5. I feel at my worst from about 2 hours after I wake up until around 7 or 8PM with it peaking mid-afternoon. Then I'll start feeling better until we do this all over again the next day. This is the pattern I usually followed in benzo withdrawal except in benzo withdrawal I'd get windows for several days and the symptoms weren't as severe. 

 

This is pretty much how it goes every day. 

 

 

 

[Altostrata]

2 hours ago, Scotteves said:

I can't eat much without it setting me off. 

 

What does eating set off?

 

From that outline, it looks to me like you might be having a reaction to the foods you eat for breakfast. By coincidence, the whites of eggs, almond butter, and rye bread are all high in histamines. See Histamine food intolerance

 

Histamine food intolerance can cause these symptoms

 

2 hours ago, Scotteves said:

blurred vision, heart pounding, dizzy, head pressure, headaches, insane anxiety, panic, horror, doom. 

 

You might want to try  Elimination or exclusion diets for reactions to food (food intolerance) to see if this reduces your symptoms.

 

It does not look like Cymbalta is causing your symptoms. But it is possible that you are a fast metabolizer and it is wearing off in the morning, causing withdrawal symptoms until after you take it at 1 p.m. But that seems unlikely, because you did not have this symptom pattern when you were taking 30mg, correct?

 

Why do you take Cymbalta at 1 p.m.?

[Scotteves]

No I didn't. I was fine taking my regular dose at 30mg. I'm not sure why 1PM... I suppose because that's the easiest time for me to take it - right around lunch. 

 

My doctor wrote me a prescription to jump up from 22.5mg to 25mg and see if I feel better. What do you think? Try that out for 30 days and see what happens? I haven't been at 25mg for 7 months. 

[Altostrata]

If I were you, I'd try the exclusion diet first. If that helps, you know Cymbalta is not involved in your symptoms -- you're having food reactions. Playing with the Cymbalta dosage is not going to fix them.

 

An exclusion diet is not that hard. Concentrate on those foods that are low in histamine. Oatmeal for breakfast, chicken and rice for dinner is good.

[Scotteves]

I have tried it in the past. It's either cymbalta, benzo wd or both. I'm supposed to go up from 22.5mg to 25mg starting tomorrow. Do you think a 10% jump can set me back really bad if it goes the wrong way? I can't even take vitamin d without feeling like crap. 

[Altostrata]

What kind of exclusion diet did you try, and for how long? Have you read up on histamine intolerance?

 

I don't know what increasing your dosage will do. You'll have to keep daily notes of your symptoms.

 

It could be that increasing your Cymbalta dosage helps, but you'll have that much more to taper if you want to quit.

[Scotteves]

Topic title:  Went back up a bit. Way worse now

 

I was at 22.5mg for 6 months and was struggling. I went back up to 25mg to try it out and I feel like I'm back in acute withdrawal now. I'm way worse than ever. Should I go back down again right away or stay where I am for years until i stabilize? Please someone just tell me what I should do. I need real advice. 

 

Edited March 16, 2019 by ChessieCat
added topic title

[ChessieCat]

How long ago did you increase?

[Scotteves]

17 days ago. 

[ChessieCat]

On 3/1/2019 at 2:45 PM, Altostrata said:

 

I don't know what increasing your dosage will do. You'll have to keep daily notes of your symptoms.

 

17 days is probably too long for you to drop back down now.

 

Q:  Have you kept daily symptoms notes?  If yes, please post them here in your topic.

 

If not, please keep them for 3 days and post them so your situation can be assessed.

[Scotteves]

Yes I have. I should note that the last 5 days I feel like my change in dose has really affected me negatively. I am not getting any relief like I used to except a little bit later at night. I feel depressed, scared and miserable most of the day which might not be reflected in my notes.

 

Thursday

7am waking up. Feel ok but tired and heart pounding which I haven't had in a while. Bad nightmare.

9am got out of bed. Feeling woozy when standing. Light sensitivity. Shaking.

915am Ate two eggs and a piece of rye bread

1115am had a paleo bar

1pm cymbalta

130pm chicken salad

330 Apple peanut butter

5pm Feeling really dizzy and out of it. Shaking is bad .

630pm Steak and asparagus 

8pm Symptoms starting to calm down. A little dizzy and anxious but not terrible.

830pm Had some leftover chicken and quinoa 

11pm Took 10mg of cbd for first time  and bed

 

Friday

5am woke up in terror. Crazy nightmare and a feeling of being trapped in this hell. Went back to sleep after an hour.

745am wake up. Feeling better. Can't notice any crazy symptoms yet.

9am shower

915am feeling woozy. Vision distorted but minor.

925am breakfast. Bacon and eggs

1130am feeling shaky. Can feel heart pounding when lying down. Had a paleo protein bar. 

1pm cymbalta

3pm feel like hell. Tired. Shaking. Heart pounding. Anxious.

330pm tuna on a rice cake 

415pm took cbd. 

5pm Feeling more calm from cbd but shaky and dizzy.

6pm Salmon salad and quinoa

830pm Half a croissant and an apple with almond butter. Dizzy and tired but symptoms are manageable.

10pm bed. Heart pounding is pretty bad.

 

Saturday morning 

530am woke up in panic. Nightmare.

7am went back to sleep

830am woke up. Terrible derealization, vision, anxiety. The heart pounding oddly seems better despite feeling so bad. Feeling very defeated and scared.

 

 

 

 

[Scotteves]

Do you guys think i permanently screwed myself up by going back up from 22.5mg to 25mg after 6 months?

[Altostrata]

Scott, from your symptom pattern it looks like 25mg Cymbalta is too much. If I were you, I'd go down to 23mg right off. Please continue to keep notes.