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Miffy: duloxetine / Cymbalta

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Miffy

Topic title:  20 to 18mg duloxetine is harder than 30 to 20mg

 

Hi there

I spent most of last year on 30mg of duloxetine (20 years of depression generally pretty well managed by medication - lots of different ones). Having started meditating regularly in the summer which I've kept up along with regular exercise -  I was feeling pretty good so went down to 20mg around November. I had no problems at all. Even with christmas and an operation to deal with!

 

2 weeks ago, I started following the guidance on this site on tapering duloxetine and used ball counting and gelatine capsules to taper to 18mg. It's been very hard. Tears and irritability. I haven't been like this in a long time. Why would it be harder to go from 20mg to 18 that it was from 90 to 60 , 60 to 30 or 30 to 20?? It doesn't seem right.

 

I've booked to the see the psychiatrist next week because my family are a bit alarmed and worried. But he is very pro medication. I don't think he'll be happy about my plans. But now I know duloxetine is so hard to come off, I want off it more than ever! I would not be completely against starting something else additionally to see me through but I know Prozac is often preferred and it has a bad effect on me s isn't an option.

 

I so grateful if you've taken the time to read this!

 

Edited by ChessieCat
added topic title

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ChessieCat

Hi miffy and welcome to SA,

 

Going from 30mg to 20mg is a 33% reduction.  You might have experienced withdrawal symptoms which you didn't connect to reducing your drug too quickly, and it may have been during the lead up and recovery from the operation so you might have thought it was connected to that.  What you are now experiencing is most probably from reducing too much as well as the operation.  You might have experienced the same thing happen even if you didn't reduce to 18mg, ie it may have been coincidence, or it may have been that you reduced too soon.  We just don't know so it's no good worrying about it.

 

My suggestion would be to return to 20mg immediately and hold on that dose until you stabilise which might take 2-3 months.  You will need to keep daily symptoms notes to see how the increase is affecting you.  It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.  Please post your notes so that we can assess whether you might need to increase by a tiny bit more.  The idea of updosing is to bring your symptoms to a bearable level, not to get rid of the symptoms completely.

 

So that we know that you have the information:  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?

 

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

 

This topic is also relevant to updosing.  Please read Post #1 of this topic:   About reinstating and stabilizing to reduce withdrawal symptoms

 

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

 

Tapering Calculator - Online

  

 

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

 

 

I will provide some more information in the next post.  This is your own introductions topic where your can ask questions about your own situation and journal your progress. 

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ChessieCat
12 hours ago, Miffy said:

I've booked to the see the psychiatrist next week because my family are a bit alarmed and worried. But he is very pro medication. I don't think he'll be happy about my plans.

 

I don't think this will be at all helpful.  Very few medical professionals understand tapering and withdrawal of psychiatric drugs which is why this site exists.  From the experiences of other members here, your psychiatric would most likely suggest you returning to 30mg and/or adding/changing drug.

 

I think you would be much better updosing and then doing as I suggested and provide your symptom notes so that we can see whether 20mg is enough or you might need a bit more.

 

My suggestion would be to change the appointment to a later date which will give you a chance to see how the updose goes.  You can always cancel it if things improve.

 

Q:  What drugs were you given for the operation/recovery?  Are you still taking any of those drugs?

 

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


What should I expect from my doctor about withdrawal symptoms?

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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.  

 

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Miffy

Hello ChessieCat

Firstly thank you so much for your response. I've been reading through all the links and there is super useful info in there. I've also downloaded Dr Glenmullen's symptom list so I can start recording things. 

 

I will take your advice and go back to 20mg for the next few months. The operation I had in December was very minor -a bunion. It just gave me some time off work. I only took paracetamol and ibuprofen. 

 

I will also take your advice re postponing the psychiatrist appointment. Last time he told me duloxetine was repairing the neurotransmitters in my brain ie was actually positive medicine for my brain. I can only think  learned that from the drug company!

 

I will return to 20mg tomorrow (I took 18mg today) and will start recording my symptoms. So should I just summarise them every now and again and share here for feedback? 

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ChessieCat

The best thing to do would be to keep daily notes of your symptoms on paper, noting especially what improves or worsens.  You won't need to post them here unless you think you might need to updose, then you can post them and they can be assessed.  But it's okay if you want to post them straight away.

 

It's just that it is very hard to think back and try and work out what happened so it is better to keep notes for a little while whenever you make a change so you can be objective about your symptoms.  When we are experiencing withdrawal symptoms we feel at that time that they are bad, but looking at notes might help you to see that they aren't quite as bad as they had been.

 

Hopefully 20mg will be enough.  Please note, though, that if we suggest that you increase the dose it will only be by a very small amount.  And remember that it takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain so you are looking at about 1 week before you should even consider increasing.

 

Also, it is best if you don't make any other changes (eg starting a new supplement, or stopping taking something that you have been taking) over the next few days except for increasing your duloxetine.  The fewer variables makes it easier to see if the increase is helping.

 

21 hours ago, Miffy said:

Last time he told me duloxetine was repairing the neurotransmitters in my brain ie was actually positive medicine for my brain. I can only think  learned that from the drug company!

 

Yes!   again-chemical-imbalance-is-a-myth-stop-the-lies-please

 

Gwen Olsen was a pharmaceutical rep for 15 years:

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

 

Manipulating Doctors (10 minutes)

 

We are trained to misinform (6 minutes)

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Miffy

Hello

I've been back on 20mg of duloxetine (reinstating after trying to taper to 18m) since 21st March. It isn't going brilliantly. I have low mood and anxiety that I didn't before I started this process in December. How long should I give myself to stabilise before I give in and go up to a higher dose? So don't want to do that but it makes life difficult for colleagues and family. That's why I have been on ADs for so long.

Thanks.

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Miffy

Hello I'm currently on 18mg on cymbalta/duloxetine, about to go down to 17/16mg. I'm taking 3-4 weeks per taper. Looking ahead I wondered what is generally considered the dose at which you just stop taking Cymbalta? e.g 4mg? or lower?

 

Many thanks!

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ChessieCat

Many members find that the lower their dose gets the slower they need to go, reducing by less and/or holding for longer.  Why taper paper: dose-occupancy curves
 

I'm tapering Pristiq (original dose 100mg) and I plan to go down to at least 0.5mg or possibly lower before I stop.  I'd rather take is slow and go low and get off with minimal discomfort. 


When to end the taper and jump to zero?
 

You could look for members who have stopped Cymbalta/duloxetine in the Success Stories forum to see what dose they stopped at:  success-stories-recovery-from-withdrawal

 

These have been written by one of the moderators who has successfully got off Paxil and has been drug free for over 1 year.  It took him about 7 years to get off. 

 

Here's his success story:  tao-of-the-brassmonkey

 

How Long Is Withdrawal Going to Take?

 

How Long, the Bottom Line

 

CT and Fast Tapers

 

It doesn’t end at “0”

 

Things to do Along the Way

 

So, When Will We Get There?

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Miffy

Hello 

I'm still tapering - on 14mg of duloxetine now. It's tough - my business partner has cancer and we're constantly at risk of going bankrupt. 

 

Anyway I've just bought an Alpha Stim device - the NHS ran a successful study and it's getting positive coverage in the UK. It was £499 but frankly if it keep some going and able to earn money it's worth every penny! I'm keen to find other users and talk to them abut their experiences - how often do they change pads, how much conductor liquid do they use, do they find they can go to higher voltages over time.....lots to discuss!

 

but `i don't know where to post this topic. Any tips warmly received.

 

Thanks!

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Miffy

I don’t usually write about how I’m doing. I just generally come on with specific questions around medication etc.

But today inspired by  Determined Anna https://www.survivingantidepressants.org/profile/13181-determinedanna/ I’m going to share a bit.

 

Every morning I wake up with the cold hand of dread on my chest, like something is gripping hard. All my anxieties surface and the depression is there instantly.  I feel like I can’t cope, I’m going to fail, get everything wrong. I won’t be able to bear anything,

Obsession areas and triggers include:

- money (we’ll have none very shortly, will lose our home)

- work, (my small business is about to go bankrupt/that clients will fire me)

- People and family (I’ll have to spend time with people who aren’t my husband and children and it will be unbearable).

 

I’m writing this on a train, weeping my eyes out, with no tissues to hand… on the way back from a meeting with a new client. The meeting finished with them saying they wanted me to tell them how to manage the project, what to do next (it’s very complicated). I feel overwhelmed. Have no idea how to start. And unfortunately, I can’t afford professional support as our business is in dire straits.

 

I want to cry and scream and run far far away and escape. But I can’t because I have to earn money and have 2 vulnerable teenagers (one with diagnosed depression, one with what seems like the onset of depression).

 

I can’t cry at work – our business is tiny and very fragile and employees are very young and they couldn’t cope. Plus my biz partner is off long term sick – has his own troubles. 

 

I can’t cry at home – it terrifies my husband who thinks we will go bust and I will go mad. And it scares my children  -I’ve probably triggered my kids’ depression with my behaviours.

 

I display anger so much of the time, and so often against children and husband. It’s the biggest negative effect on them. They see it far more from me than sadness. I can be completely horrible. And it’s often. 

 

Last time I saw him (18 months ago or more) the psychiatrist said anger is a depressive symptom and put my dose up.

 

I was diagnosed clinically depressed in ’97 and have been on medication ever since. The anxiety and depression never went away, I just had some phases when I felt better than others.

 

Anyway I’m slowly tapering the duloxetine, counting beads. I’ve done 3 weeks on 14mg, will stay on 14mg for a few more weeks. 

 

I used to see medication as a prophylactic – I would always be on at as a bulwark against the depression and anxiety derailing my life and my ability to provide for my family.

 

The few times I do share my problems with people I just can’t bear the suggestions they make. I don’t have friends with mental health issues. I do have siblings who suffer but I can’t bear spending time with them even though they’d like too. One of them lives near so it’s hard avoiding it. I feel physically sick at the thought of it. I think my parents and siblings represent what I hate about myself and my life prior to meeting my husband.

 

I do think about suicide but I know I can’t do it to my children and husband.

 

I’m meditating twice a day – have been for a year. I cut out alcohol. I do yoga around 3 times a week and go for a jog at least twice. I’ve just bought an Alpha Stim and have used it for a week.

I feel like I’m working so hard at it – trying to do the right thing, not give up and collapse. But why doesn’t it work??

 

It’s at this point that I’m so vulnerable to being encouraged to go back on meds. I refuse to go back up on duloxetine – it’s too hellish hard to come off. I’m seeing the doctor in a week  - I’ll run out of meds soon. I expect they’ll want me to go back up dosage-wise or start something different. 

 

I think I’ll stop writing now. My overwhelming feeling right now is of despair, shame and self-loathing.

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Gridley

 

2 hours ago, Miffy said:

I’m going to share a bit.

 

Miffy, I'm very sorry you're feeling so terrible.

 

I'm wondering, given the symptoms you're experiencing and the stressors of your business, whether you might want to slow down your taper.  I noticed in one of your earlier posts that you're tapering 10% every 3-4 weeks.  We definitely recommend four weeks and for some that's too fast. Here are two alternatives that could lessen the difficulty of your taper, especially during this stressful time.

 
A micro-taper is the gentlest way to come off these drugs. 

 

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month.  Many members, myself included, have found this works well and minimizes withdrawal symptoms.
 
 
If you want to stay with the 10% method, I'd taper no faster than every four weeks and I'd work in some holds.
 
 
 
 
 
 
 
 
 
 

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Miffy

Thanks Gridley  appreciate your advice. I will try microtapering it sounds like wise advice and is possible as I'm on duloxetine so can count the beads (I actually have to get my daughter do it for me as I'm too clumsy *blush*).

Can i ask about 'updosing' does that mean going back to previous dose? That would mean back to 16mg from 14mg. I'd rather not but if people find that tiny re-addition lessons their symptoms maybe I should. It seems unlikely somehow.

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Gridley
53 minutes ago, Miffy said:

Can i ask about 'updosing'

 

Updosing means increasing your dose, not necessarily back to your previous dose, as a means to alleviate or minimize withdrawal symptoms.  

 

It's not clear from your signature when you were on 16mg, perhaps some time in June?   Could you update your signature to reflect this?  Here's the link:

Account Settings – Create or Edit a signature.

 

Updosing (or reinstating if you've gone to zero) is the only known way to help alleviate withdrawal symptoms.  It doesn't always work but it often does.  We recommend updosing by a very small amount, in your case perhaps 1mg  to avoid overwhelming your system.   Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic
 
 It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.  If you do updose, you would need to hold for several months to stabilize.  Then you can continue with a microtaper.
 
You're under an awful lot of stress, which exacerbates withdrawal.  What are your symptoms?  
 
If you don't updose, it might be a good idea to hold at 14mg for a few months to let your system rest.  Then you can continue tapering using to micro taper method.
 
 
 
 
 
 

 

 

 

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Miffy

I feel I can't cope at all. I' terrified I'm going to fall apart.

Is the best thing to go up from my current 14mg to 16mg which was the last dose i was on or throw in th towel and go back to 20mg...which the shrink would say was a completely insignificant dose of course.

I feel such a failure in life but I want to get off this stuff.

 

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ChessieCat

You reduced from 16mg to 14mg which was a 12.5% reduction.  SA recommends tapering by no more than 10% of the current dose with a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

A 10% reduction of 16mg would have been 14.4mg.  You might find that increasing by 0.25mg might be enough to reduce the withdrawal symptoms.  It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.  You could try 0.25mg for 1 week and if your symptoms are still unbearable then you could try increasing by a bit more.  I wouldn't increase more than a total of 0.5mg.

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Miffy

Hello Chessiecat I'm sorry my maths is terrible so I did those amounts because I could work it out.  As 2mg = 12 balls as far as I could work out.

 

I don't think I can work out 0.25 maybe that would be 2 balls.

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ChessieCat

If 12 balls = 2mg then 3 balls would = 0.5mg

 

Calculation:

2mg = 12 balls

1mg = 6 balls

0.5mg = 3 balls

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Miffy

I'm on 14.5mg of duloxetine now and will stay for the full 4 weeks before considering a 10% drop. 

During the bad wave my ability to sleep has gone downhill. I've listened to a great video that was shared on here - an 8 hour depression hypnosis sleep video -i don't go to sleep with it but after an hour r so I'm pretty relaxed and turn it off.

However I didn't get to sleep at all last night -this has happened a couple of times recently. I have a couple of potentially triggering events coming up and I'm wondering what else I can do (beyond yoga, meditation etc). I have 5mg melatonin but i hear that's too high to get myself a decent nights sleep. I'm in the UK so can't buy melatonin -a friend got it in the US. Is it possible to crush them up? There are no lines scored on any of the different brands I have.

Alternatively I have 2mg clonazepam. Not sure which is a better option -the slightly too high melatonin or or the benzo?

Thanks in advance.

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Gridley
2 hours ago, Miffy said:

Alternatively I have 2mg clonazepam. Not sure which is a better option -the slightly too high melatonin or or the benzo?

Get a pill cutter at the pharmacy and cut your melatonin into quarters.  Then cut them into eighths.  It doesn't have to be perfect.  That will give you .75mg, an acceptable starting dose. If you can only cut the melatonin into quarters, 1 1/4mg will also probably be okay.   Melatonin is infinitely preferable to the clonazepam, which is highly addictive.

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