gannet: tapering duloxetine, also on divalproex sodium

[gannet]

Hi all,

 

I've been on and off psychiatric medications for over a decade now, starting with Lexapro in 2008. That led to a suicide attempt, which led to me being switched to Zoloft and then quickly to Wellbutrin. I was on Wellbutrin until September 2010 when I had a grand mal seizure and had to discontinue it immediately. No one ever discussed withdrawal issues with me at the time, now looking back I know I had serious mood issues but it was just considered part of my ongoing depression.

 

Fast forward to 2014 and I went on Prozac. I didn't feel like it was helping me, so I quit cold turkey after a few months. Again, no one had ever discussed the possibility of withdrawal issues with me. Now looking back, I remember how I had sudden unexplained dizziness to the point of feeling like I was going to pass out, nausea, and constant forgetfulness and brain fog. Multiple trips to the doctor never brought up the possibility of withdrawal symptoms.

 

In the spring of 2016 I started taking citalopram, and after having a complex partial seizure I was also prescribed divalproex sodium, twice a day 250mg pills, which I am still taking. EEGs and follow ups with neurologists have led to the general conclusion that psychiatric medications raise my "seizure threshold" high enough that I might have seizures; no medication, no seizures.

 

Around October or November of 2017 I was switched to Lexapro because it's a more "modern" form of citalopram. After gaining 20-25 lbs I asked for a different medication and was put on 30mg of duloxetine, which I was taking until I started my tapering process.

 

I read about this community and antidepressant withdrawal in a New Yorker article, which led me down a research rabbit hole, which led me to wanting off these drugs. I talked with my psychiatrist and he is supportive. He wanted me to drop down to 20mg for two weeks, starting April 11. I had read about the 10% per month rule but thought I'd try it the doctor's way at least one day. Well, I had dizziness, an inability to concentrate, and friends commented that I looked pale. So the next day I switched the the tapering methods recommended here. I counted all the little beads in the capsules and got an average of 180- took out 18 from each one and put the rest in new capsules. It's been going pretty well. I have been having some dizziness and nausea, and I think I'm reacting poorly to caffeine, but I'm going to try to keep an eye on it. Fortunately I never drink anything stronger than black tea anyway.

 

I'm a little discouraged at how long the taper process will take, but I'm trying to think about how bad the cold turkey experience was with Prozac and remind myself that it will be worth it.

 

I'm also not sure what I'll end up doing about the divalproex, my psychiatrist said he wanted me to stay on it for now so that we can control the variables. I do think he'll be supportive, he was happy that I was doing research on my own and was in favor of a conservative taper, but of course that's a conservative taper in the medical context which I think most people here would consider much too fast.

Edited April 21, 2019 by Carmie
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[Carmie]

Hi gannet, 

 

Welcome to SA. I’m glad you found this site, and have decided to taper slowly. Yes, jumping down to 20mg was way too quick. I’m glad you rectified that quickly. 

 

A lot of people have problems with caffeine when going through withdrawals. It affects our CNS and it is best avoided. If you decide to go off it, don’t just stop it abruptly, go off it gradually. 

 

As regards the divalproex, I wouldn’t think about tapering that as yet if you decided to do so. It’s best to only taper one medication at a time. Our brain can’t cope with too many changes at a time, these medications are really potent. 

 

The good old tapering process does take a long time, as you said. I’ve been tapering the Seroquel for many years, and have got many more to go. I’ve been on and off so many medications that I’m totally sensitised now. It all started with chronic pain. I’ve gotten down to 7mg from 300mg, but the lower the dose the tinier the drop. I won’t be jumping off until I’m down to 0.0something which is still ages away. I feel every drop. Any forward movement makes me happy though. I will get there one day!

 

Cold turkeying is definitely not a good idea, so I really am glad you are tapering sensibly. Some people who have cold turkeyed have gone through years of withdrawals afterwards, that’s why Alto started this site. She was one of these people.

 

Feel free to ask any questions on your thread here, and use it to journal your journey. 

 

Take care, sending hugs🤗

[gannet]

Hi Carmie,

 

Thanks for the note! Yeah, my current caffeine intake is two cups of black tea on weekdays, one in the morning and one in the afternoon. I really drink it for the taste, not the caffeine content, so I'm going to miss it a bit. But I also really haven't appreciate the dizziness that I've experienced recently after drinking it. My psychiatrist said the same thing about the divalproex, that I only want to change one medication at a time so that I know where any symptoms are coming from. I am definitely good with that! And thanks for sharing your story, it's good to think about any forward movement as progress.

[Carmie]

Hi gannet, 

 

It doesn’t look like you’re drinking a lot of caffeine, but it can still affect the CNS. Maybe you can go down to one cup a day for a little while, and then go off it if you want to. If you’re just drinking it for the taste you can get de-caffeinated teas. 

 

I’m so glad you’re only going to change one thing at a time. These medications are really powerful, and our brains can’t handle tapering two of them at once. 

 

Keep us updated as to how you’re doing, sending hugs🤗

 

Edited April 23, 2019 by Carmie
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[gannet]

Talked with the psychiatrist today. He's supportive of my tapering plan and really curious to see how it turns out, although he's very skeptical that it's necessary. Anyway, I feel that it can't hurt to be cautious so I'm going to stick with the 10% per month taper as suggested here. Last time I had given him permission to discuss my case with colleagues (he's a resident) and he said it's sparked a lot of interesting discussions. When one colleague heard I was only on 30mg, they said I could just quit cold turkey on a dose like that! Which my psychiatrist doesn't agree with but says it represents the "variety of viewpoints in the field" which I think is a generous way of saying no one knows for sure. But overall I think it's a positive experience for both me and my psychiatrist.

 

I haven't really had any emotional withdrawal symptoms so far; my mood has been pretty stable and good. Any changes have been from a recognizable event that would upset me, and I was able to allow myself to be upset and then move on. Nothing major, though. Still having some dizziness and nausea, and gastrointestinal irregularity.

[Carmie]

Hi gannet, 

 

Glad to hear you haven’t had any of the emotional effects of withdrawals. Yay!

 

It’s amazing that doctors can think that 30mg is a small dose, it’s “only” 30mgs. Some people have jumped off at 1mg and have still gone through bad withdrawals.

 

Wishing you all the best with your tapering.💚

[gannet]

Today is my second decrease- down to about 24.3 mg. Still haven't really had any issues besides the caffeine sensitivity but will try to add updates here if I have any.

[laydefish]

Hi @gannet & Welcome to the group! Congratulations on deciding to taper off these drugs- glad to read you have a supportive Doc- very helpful!  Anyhow glad you found this forum, its a great place for support & info. Stay Strong! - Laydefish