Kulfi: 20 mg duloxetine / Cymbalta withdrawal

[Kulfi]

Hi. I'm a new member and after many years on and off various meds I have only recently made the breakthrough about how bad my withdrawls have been and how I and medics have mistaken for returning symptoms.  Recently tried alternate days for a few weeks on 20mg duloxetine, but awful on days off.  Started 10% reduction 2 weeks ago, but feeling worse.  Should I go back up to 20mg for approx 1 month and then start taper?  As I am super sensitive should I start my taper at 5%?  Grateful for any advice.  Seeing my GP tmrw, who is a good guy but his withdrawl advice has not been helpful.

[ChessieCat]

Hi Kulfi and welcome to SA,

 

Tapering by skipping days is not recommended.  You might find that increasing you dose by a small amount might help to bring the withdrawal symptoms to a bearable level.  We can suggest a dose increase once we have more details about your reductions.

 

 

Please create your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  Why taper by 10% of my dosage?

 

Tapering Calculator - Online

 

When the drug is taken away too quickly we can get withdrawal symptoms:  Dr Joseph Glenmullen's Withdrawal Symptoms

 

This topic explains how to get the dose you need:  Tips for tapering off Cymbalta (duloxetine)

 

I will provided some additional information in the next 2 posts.  This is your own introductions topic where your can ask questions about your own situation and journal your progress.

[ChessieCat]

Here's some additional information which might help you to understand what is happening:

 

Recovery isn't linear it happens in a Windows and Waves Pattern

 

Withdrawal Normal Description

When we take a psychiatric drug, we are adding chemical/s to the brain.  The brain then has to change to adapt to getting the chemical/s.  It might have to change something to do with A and then once that change has been made it affects B so another change has to be made and so on down the line.  It is a chain reaction, a domino effect.

 

The same thing happens when we take the drug away.  That's why it's possible to experience such a vast array of withdrawal symptoms, and they can change, and be of different intensity.

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

 

On 12/4/2015 at 2:41 AM, apace41 said:

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

[ChessieCat]

During any taper, there will be times of discomfort.  We strongly encourage members to learn and use non drug coping techniques to help get through tough times.

 

Understanding what is happening helps us to not get caught up with the second fear, or fear of the fear.  This happens when we experience sensations in our body and because we don't understand them we are scared of them and then start to panic.

 

This document has a diagram of the body explaining what happens in the body when we become anxious:

 

https://www.getselfhelp.co.uk/docs/AnxietySelfHelp.pdf

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio FEMALE VOICE:  First Aid for Panic (4 minutes)

 

Audio MALE VOICE:  First Aid for Panic (4 minutes)

 

Non-drug techniques to cope

 

dealing-with-emotional-spirals

 

Dr Claire Weekes suffered from anxiety and learned and taught ways of coping.  There are videos available on YouTube.

 

Claire Weekes' Method of Recovering from a Sensitized Nervous System

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy

 

Resources:  Centre for Clinical Interventions (PDF modules that you can work through, eg:  Depression, Distress Intolerance, Health Anxiety, Low Self-Esteem, Panic Attacks, Perfectionism, Procrastination, Social Anxiety, Worrying)

 

On 4/28/2017 at 4:03 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

[ChessieCat]

Simplified drug history:

 

Feb to July 2017                                no drugs   

 

July to Sept                                         60mg                     duloxetine     

                                                        

Oct to Dec                                           30mg

 

Jan to April 2018                               15mg                     30mg alternate days

 

May to Dec                                         20mg

 

Dec 6th to Dec 10th                         10mg                     20mg alternate days

 

Dec 11th to Jan 1st 2019                20mg

 

Jan 2nd to Jan 13th                          10mg                     20mg alternate days

 

Jan 20th to Feb 5th                           18mg                    

 

Feb 6th                                                 20mg

 

Edited February 8, 2019 by ChessieCat
italicised average dose for alternate day dosing

[ChessieCat]

Thank you for completing your drug signature and for providing the clear information about the dates and doses.  That is very helpful.

 

On 2/6/2019 at 3:29 AM, Kulfi said:

Should I go back up to 20mg for approx 1 month and then start taper? 

 

I can see from your drug signature that you have already increased your dose back to 20mg.

 

As previously mentioned SA recommends tapering by no more than 10% of the current dose approximately every 4 weeks.  Also skipping days to taper is not recommended.

 

It can be clearly seen from the simplified drug history in the above post that in the past you have made reductions of 50%, also alternated days as well as made several updoses in the last 18 months.  This upsets the nervous system and it can become sensitised.  The brain likes consistency.

 

Most probably the best thing for you to do now it to stay on the dose you are currently taking, 20mg, and allow things to stabilise.  Please keep daily symptom notes on paper so that you can see how the latest increase is affecting your symptoms.

 

Once you stabilise, which could take 3 to 6 months, you will be able to start tapering.  When you make the first reduction after stabilising it might be best to make a small test reduction to see how it affects you.  If you find that you feel okay, then you could try a larger reduction after that.

 

When tapering it is important to throw out the calendar and listen to our body.  It is also better to hold for longer than to risk reducing too soon.  It can be a frustrating and slow process and we can feel like we need to do or take something, but the best things for the brain are consistency and time.  It will be important for you to stay as calm and stress free as possible and not to panic.  When we panic we can make bad decisions.  We have members here who have panicked and updosed, reduced, taken additional supplements etc and ended up making things worse.

 

Getting off psychiatric drugs has nothing to do with how strong or disciplined we are as people.  As explained above, the drugs introduce chemicals into the brain and the brain adapts to getting those chemicals.  And it has to adapt as we take them away.  I have found that learning about psychiatric drugs has helped me to understand what is happening and has helped me to be patient.

[Carmie]

Hi Kulfi, 

 

How are you doing?💚

[thecowisback]

i wonder if they've stabilised yet?

[Kulfi]

Hi,

 

Thanks for getting in touch.  Appreciated.  After an unsuccessful attempt to taper in jan, I reinstated duloxetine back to 20mg.  Since being back on 20mg, I feel no better, but guess my brain is better off.  My plan is in April to cut down by 10% every month.  I know I have some tough times ahead, but I know that taking antidepressants is a dead end and I will just have to ride out.  The truth is I feel pretty rubbish on antidepressants, so knowing that makes withdrawal easier as I am not giving up something that makes me feel better.  I used to get some benefit, but after many years no more.  I am doing the right things; exercise, eat well, no booze or caffeine, relaxation and see supportive people.  Even started dancing again!  Helps that Spring arrived so get outside more.  Been a period of transition.  The shock of discovering how entrenched my dependancy has been and anger with myself (should have done more research into withdrawal) medics (not once been given correct withdrawal advice) and big pharma (bury negative evidence)  Am slowly accepting it more and getting on with life as best as I can.  Every part of me wants to be off pills now, but the receptors need to be listened to.  Patience and courage.  Hope things progressing for you.

 

best wishes

 

Stuart x

[thecowisback]

good luck with your taper 👌

[Kulfi]

Thx thecowisback.  Good luck with yours to👌

[Carmie]

Hi Stuart, 

 

I’m glad you’re taking care of yourself, eating well, and staying away from coffee and alcohol. 

 

Please don’t set a date when you are going to start your taper, because it’s best to listen to your body. If you don’t allow it to stabilise first, and you start tapering, you will probably end up worse than you’re feeling now. Been there, done that! You have made so many changes, it might take quite a while for you to stabilise. If it does, please allow the time needed for you to stabilise. 

 

I know it’s easy to angry about what has happened to us, but getting angry doesn’t change the past. We have to grieve the fact that we are in this predicament, and then move forward. I’ve gone through so much, and still have many years of tapering to go, as I can only taper by small amounts. I’m tapering by just over 3% now. 

 

Take care, sending hugs🤗

[Kulfi]

Hi Carmie,

 

Thx for reply and kind words.  I know what you mean by listening to your body and stabilising first b4 withdrawal.  However, I don't see how I can stabilise by taking the drug.  I have taken pills on and off for so many years it feels like the negatives far outweigh the positives and my mind, body, spirit etc has had enough of the dead end chemical cure.  Maybe setting April withdrawal is 2 early or artificial, but I sense that I could be waiting forever for the stability and 'right' time to withdraw.  Getting a bit worse is horrible, but part of the withdrawal process for many isn't it?  

 

stuart x

[Carmie]

Hi again Stuart, 

 

Yes, Going through windows and waves certainly is part of the withdrawal process. If I go too quick though I get severe akathisia, it’s like I’m being tortured. There are no words to describe it, only people who have gone through it will understand. 

 

What are your symptoms like at the moment? You sound like you’re in fairly good spirits, even dancing.💃😁

[Kulfi]

Hi Carmie,

 

Up n down.  akathisia can kick in; generally a vice like feeling around jaw, chest n stomach.  Had a few good experiences in past 10 days when felt pretty good.  Exhaustion is around still when I crashed a year ago when i tapered too quick. Often feel cut off and joyless. Try and exercise every day which helps.  Not just drug related as part of why I crashed last year; was also me straining and searching for answers to life and getting desperate to work it all out.  Last year was a series of dead ends; searching for the answer, psychotherapy and now antidepressants.  negative emotions can be addictive to brain and body.  Did an acceptance and commitment therapy course a while ago which helped.

 

kulfi x

[Carmie]

Hi Stuart, 

 

How have you been doing?💚

[Kulfi]

Hi Carmie,

 

Thanks for getting in touch.  Appreciated.  I started 10% taper 10 days ago and feel a bit worse.  I had gone back to 20mg for three months and generally felt worse going back on, which was unpleasant but the silver lining is that it is telling me that getting off the pills has to happen.  I joined cymbalta hurts worse facebook group which has been helpful.  Advised to taper at 5% to start with, so going to do that.  Plan to reduce every 3 weeks. Sounds like you are doing well.

 

Kulfi ❤️