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AJ 716: Cymbalta reduction - likely desperate


AJ716

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2011:

I was prescribed the following:
     Cymbalta 60 mg (arthritis).
     Zoloft 100 mg (anxiety).
     Buprenorphine 8 mg (off label for treatment resistant depression).  Over a couple of years the doctor increased it to 24 mg.

 

September 2018

Decided I wanted to try and reduce the meds. I began a rapid taper of the Bupe and was down to 12 mg by the end of November 2018.

 

Mid December 2018:  

Started having severe panic attacks daily.  Each morning they started at wake and lasted between 2-6 hrs.  Assuming it was because of my recent Bupe reduction I increased my dose for a while.  It didn’t help so I went back down again.

 

October 2020:  
I've been suffering horrid, daily panic attacks for 22 months.  They start each morning before I even open my eyes (severe nausea and strong sense of doom).  They quickly worsen from there and last for hours before slowly lessening.  Then I go through a 1-2 hour period extremely fatigued and lethargy.  My  doctors have been unable to diagnose me but they have treated my symptoms with various medications (listed below). They don't help much during an episode, however it does help with later anxiety and to sleep at night.


There is little fight left in me I'm so tired and losing hope.  I have fallen down from exhaustion and muscle deterioration many times (once I broke off two front teeth) and am too scared to leave the house (only go to the doctor each month).  I stopped eating more than fruit due to severe nausea and have lost 60 lbs.  In the last six months I've gotten worse with severe leg weakness and just lately started having pain up and down my left arm (spoke with doctor).  Other than that I endure horrible racing thoughts, a racing heart, heart palpitations, headaches; severe nausea, a sense of doom/worry, and a numbness and tingling of extremities.  


I believe that I may have finally figured out what is wrong:  Serotonin/Norepinephrine overload because of the Cymbalta and Zoloft mix (perhaps brought on by stress because of menopause or my quick Bupe reduction in late 2018....I recent read that opiates block re-uptake transport or something).   My doctor eliminated the cause of my illness as anti-Depressant related since I had been on them for such a long time without incident. There were many other tests to no avail.   So I've researched and am attempting to reduce the Cymbalta from 60 to 30 mg on my own.  I started three days ago.  As of now my withdrawal symptoms are tolerable (it's difficult to discern between panic and withdrawal, so I evaluate my symptoms after the daily attack).  I have headaches, nausea, cognitive difficulty, muscle weakness, and depression.  It is key for me that I have had some relief from my panic syndrome though.  My racing heart and palpitations were practically non existent.  Unfortunately yesterday I took additional Zoloft to take the edge off and it turned out to be a big mistake.  Although I still didn't panic this morning, along with some other general symptoms  I became extremely fatigued and lethargic (which normally doesn't happen until after the CNS attack). 

 

Side note:  I am unsure where I am headed with this Cymbalta reduction.  My first goal is to stop my panic attacks and stabilize myself.  However if my episodes worsen or if withdrawal becomes intolerable I will reinstate the 60 mg.  Something tells me that IF I am suffering panic attacks because of neurotransmitter overloads that my withdrawal symptoms might not be as serious. Is that possible?  

 

When do the symptoms of Cymbalta reduction generally peak and how long does it last?   Reminder: the 11th, 12th, and 13th I took the reduced dose.   

 

Lastly, it may be that some of the recent differing symptoms are due to a recent reduction of my Estrogen patch (I have no choice. The doctor is cutting me off). I could probably go back up but could only do so for about two weeks before I'd have to start a reduction again. 

 
Any advice or encouragement will be graciously accepted. 

 

Current Prescriptions
Cymbalta: 30 mg (on October 10, 2020 I reduced it from 60 mg)
Zoloft: 100 mg
Buprenorphine: 8 mg
Atenolol 25 mg (2 times daily).
Xanax:  .25 mg (take half doses of .125 mg; regularly only take about two per day).
Valium: 5 mg (occasional and rare; only in half doses).
HRT (out of necessity I am reducing my Estrogen patch slowly). I also take have a combo patch.

 

OTC
Mag Glycinate
Mag Citrate
Vit D3
Chia Seed Oil
 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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Posted October 16 (edited) Despite my discomfort, today has been the best day I’ve had since August 21st. Posted October 17 Hiya,  Today was also

  • Moderator

Welcome to SA, AJ716.  I'm sorry you're going through this.

 

To give members the best information, we ask them to summarize their medication history in a signature.  You can simply pick up your current prescriptions list in your post and use this link to create your signature.  Then press "save."

 

Account Settings – Create or Edit a signature.

 

You have three major drug interactions, between xanax and buprenorphine, between diazepam and buprenorphine (both pose a risk of central nervous system depression) and between zoloft and cymbalta (risk of serotonin syndrome), plus several moderate interactions.  You can use this link to check these for yourself.  

 

Drug Interactions Checker 

 

I'm concerned about your reduction of the Cymbalta.  Withdrawal symptoms can be delayed and, once incurred, long-lasting.  There is no way to predict how long they will last.  

 

What is withdrawal syndrome.

 

Your situation is complicated, and I'm going to bring it to the attention of the other staff.

 

 

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020 Begin 7-week Ativan-Valium crossover and change from 3 daily doses to one 18.75mgai dose (0.311mgpw). Jan. 11, 2021 begin hold at current bedtime 18.75mgai dose.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (0.44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Hello Gridley.  Thank you very much for the review and your response. 

 

I became aware of the Benzo/Bupe interaction within a couple months that the Benzo's were prescribed (my doctor told me not to worry because the Benzo doses are small and I was desperate to reduce the daily CNS spikes - still am). 

 

The  Zoloft/Cymbalta interaction or Serotonin Syndrome possibility has only recently come to my attention.  I'm startled as it's quite serious, especially since I have been suffering many of those symptoms in the form of daily panic attacks and lethargic episodes, etc for the last 22 months.   I'm appalled that my previous doctor prescribed me those medications simultaneously and without hesitation or warning.  Not to mention that my current doctor continued to prescribe them to me without mention of any interaction. 

 

There is also some question as to whether or not hormones fluctuations interact with Cymbalta.  Since my body was surely starting to change hrt was prescribed last year.  After a couple of months it seemed to lesson the symptoms of my daily episodes but that only lasted a couple of months.  Now it seems to be just another complication.  I will update the med list with my doses.

 

Wow. What a mess. 

Update:  Between my post last night and today my situation has changed.  1) My daily panic and lethargy episode was almost as strong this mornings as they were  before I started the Cymbalta reduction (a few days ago).   2) I've had a slight increase of withdrawal symptoms (mainly body aches - arm and neck pain significant; increased cognitive difficulty) although it is till tolerable at this point.  I haven't had any brain zaps yet or an increase in anxiety.   3) Your Cymbalta concern is now my own.  I don't understand why the episode severity would return back to how bad they were previously, but I see no point in suffering wd and risk incurring another syndrome on top of it.  However it seems a very slow Cymbalta taper likely won't hurt me and may help.  I'd appreciate any suggestions on where to go from here regarding the Cymbalta.


I look forward to educating myself with by way of the above link(s).  Again I thank you for responding and I look forward to more input and discussion from you and other staff.  Cheers!

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator
15 minutes ago, AJ716 said:

I'd appreciate any suggestions on where to go from here regarding the Cymbalta.

I would reinstate with your next dose back up to 60mg Cymbalta.  You were on the reduced dose for only three days, and very likely going back up should not present a problem.  

 

We'll be happy to help you to taper Cymbalta. First, I would wait a week after you go back up to 60mg to stabilize before beginning your taper.   For your taper, we recommend tapering by no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Cymbalta and gives instructions how to get the nonstandard doses you'll need for your taper, which basically is by counting beads and reducing the amount very slowly.

 

Tips for tapering off duloxetine (Cymbalta)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. I see you're already on magnesium.  After you've gone back up to 60mg and waited a few days, you could add the omega (we recommend making only one change at a time).  

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

 

 

 

 

 

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020 Begin 7-week Ativan-Valium crossover and change from 3 daily doses to one 18.75mgai dose (0.311mgpw). Jan. 11, 2021 begin hold at current bedtime 18.75mgai dose.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (0.44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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  • Moderator

@AJ716

 

One of the other moderators suggested a smaller updose than all the way back to 60mg.  She enclosed a link that showed the the neurotransmitter occupancy at 40mg was almost the same as at 60mg.  If you reinstated to 40mg instead of 60, that might help with the serotonin situation, plus you'd have less to taper off.  You'd use the bead-counting method to get a dose of 40mg, as described in the link I provided earlier.

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020 Begin 7-week Ativan-Valium crossover and change from 3 daily doses to one 18.75mgai dose (0.311mgpw). Jan. 11, 2021 begin hold at current bedtime 18.75mgai dose.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (0.44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Hello Gridley,

 

I'm still not caught up on the reading but am working on it. 

 

As you suggested I decided not to continue with the 50% reduction.  In between your above two messages I had changed my intake to 54 mg (from a 50% reduction to 10%).  I had not yet received the update about neurotransmitter occupancy rate so yesterday and today I took the 54 mg dose.  My son has set me up with a weeks supply of those using a sensitive scale.   Perhaps that can be my next change?   I still feel desperate regarding my daily episodes but I'm also very scared of getting worse.  It seems every change is ultimately negative for me so after deep thought I decided to take the slower route.  

 

What you said about Serotonin sparked my interest.  I am sincerely interested in continuing to educate myself and this group appears to be a very knowledgeable (more so than any doctor I have had) so any leads toward a trustworthy source of information is appreciated.  

 

 

 

 

 

 

 

 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator
8 minutes ago, AJ716 said:

I decided to take the slower route.  

Slower is better.

 

Please respond to Altostrata's questions.  It will be very helpful to us.

 

22 minutes ago, Altostrata said:

 

What type of doctor prescribed this cocktail for you?

 

Before you change anything, what is your current daily drug schedule? How do you feel before and after you take each dose?

 

You can use this format to list your current daily drug schedule and tell how you feel before and after each dose.

 

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

 

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020 Begin 7-week Ativan-Valium crossover and change from 3 daily doses to one 18.75mgai dose (0.311mgpw). Jan. 11, 2021 begin hold at current bedtime 18.75mgai dose.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (0.44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Hello Altostrata, 

 

It's an interesting cocktail indeed.  I have updated my signature with my current medications (I can see it and hope you can now too?).  

 

Short version:  In 2010 I developed PTSD and was a wreck.  My therapist recommended a psychiatrist who had me try every AD medication methodically from a long list, but nothing helped.  Since Zoloft had worked for me previously (in the 90's prior to two pregnancies) he decided to keep me on that in case it kicked in again.  When I tried Cymbalta it helped my arthritis, so he kept me on that as well.  My anxiety lessoned but the depression continued to cripple me so when we were done with every other medication on the list he suggested Buprenorphine as an off label AD.   It stabilized me for a long time.  Those three were initiated 9 years ago and I have been on them since. 

 

About 2 years ago that Dr decided he wasn't going to treat Bupe patients anymore and since it causes dependence I had to find a doctor that prescribed it.  I did and my new doctor continued with that cocktail. 

 

I don't feel anything when I take the AD meds although perhaps a little more perky after the Bupe (like more awake).  The Valium makes me crash but it seems to cause awful rebound anxiety (next day) and makes my panic episodes worse.  The Xanax helps when I have anxiety and racing thoughts but I work very hard to limit myself because I fear more addiction.  During my daily panic attack episodes, nothing helps. I've tried everything I could think of except for illegal drugs (honestly, I'd likely do some if I knew where to go and it helped me).  I have loads of supplements, etc (CBD; Kratom; everything) but don't bother with them anymore. I just have to wait it out.  PS.  I gave up coffee cold turkey after one of my very first panic attacks.  Also, I drink a lot of cocoa as it helps my mood. I do notice a difference with.  It appears Theobromine (found in coffee beans) can be a mood lifter and it's not as offensive as caffeine to the CNS.    

 

Thanks for asking! 

 

 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Administrator

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

It's possible some of your symptoms are from drug-drug interactions.

Edited by Altostrata

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata and Gridley,

 

Gotcha! I understand now and will provide a neater schedule in that more precise format by tomorrow.   Thanks!

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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Despite my discomfort, today has been the best day I’ve had since August 21st.  I have been keeping track of everything for about 20 months now.  My rating system:  0 is normal and 5 is the worst.  Today was a 1 regarding the severity of my waking episodes/panic attack.  Yay!

 

I think it’s important to stress that my daily episodes begin before I am even out of bed in the morning and I don't need to ingest any medication or food for them to start or continue.  When my episodes began in December of 2018 I was only taking Zoloft, Cymbalta, and Buprenorphine  (NO Benzo’s, OTC meds, or sleep aids; those were prescribed to help treat my symptoms).   I now wonder it all started because of hormonal spikes that happen when I sleep and cause an abundant release of “morning chemicals” when I wake up (cortisol, serotonin, norepinephrine, etc).   Literally, my eyes aren’t even open before the symptoms begin (usually the nausea wakes me and the other symptoms follow soon after).  As is the norm, when I went to sleep “last night” I was fine.

 

Since reading all of the posts and articles I’ve begun to believe that I am experiencing a kind of Serotonin overload that begins each “morning” when Serotonin release is at its peak.  Perhaps today was better due to the recent decreases in Cymbalta lately:

 

Cymbalta former daily dose 60 mg.  
Oct 10-Oct 13;  I took 30 mg. 
Oct 14-Oct 15;  I took 54 mg.


 

Edited by AJ716
dumb errors.

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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Below is from today.  Because of the nausea I tend to be unable to eat anything until mid-evening. That is when I take my prescription medications.


2:30 am.  Melatonin 2.5 mg. Simvastatin 5 mg.
                  Became very drowsy but didn’t fall sleep.
5:00.         Melatonin 2.5 mg. Xanax .125 mg.
6:00          Fell asleep.

11:45.      Woke hot and with ears ringing, a headache, nausea, feelings of doom.
11:47.      Anxiety and heart palpitations began.  Left arm and neck pain/stiffness.  Leg weakness.  Headache and nausea continued but the doom passed.
11:50.      200 mg Ibuprofen with water for headache.  25 mg Atenolol for palpitations.  Became very cold instead of hot.  Began to drink Cocoa slowly.
12:00.      Took my first 2 mg dose of Buprenorphine (I take four doses per day). 
                  As usual I waited for symptoms to pass and change, which they eventually did.
1:00.        Transitional period of fatigue began.
2:00.         Episode ceased. 

 

It is the norm for the nausea, leg weakness, arm/neck pain, and ringing ears to continue but with a lot less severity.  Anxiety and palpitations also continue but are sporadic and I experienced the least at night. 
 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator
7 minutes ago, AJ716 said:

Below is from today.

It would be better, if you can manage it, to post in 24-hours chunks so that each day is in one post.  Be sure to put the times for all four Bupe doses and your Zoloft and Cymbalta doses.

 

That's great that you had a good day yesterday.

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020 Begin 7-week Ativan-Valium crossover and change from 3 daily doses to one 18.75mgai dose (0.311mgpw). Jan. 11, 2021 begin hold at current bedtime 18.75mgai dose.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (0.44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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Hiya,

 

Today was also a better day!!  Again I'd rate my episode as a 1 (0 the best, 5 the worst).  Incidentally a couple of symptoms improved since yesterday (lessened nausea, headache, and palpitations but the arm and neck pain was about the same).  Three and four days ago I was at 3.5 and 4 respectfully while before that I had been regularly charting 5's and 4's for twenty months. This is a huge deal for me!!  Thanks for all of the information I'm very grateful.

 

After continual research yesterday I am even more convinced that I have indeed been suffering a reoccurrence of Serotonin Toxicity.  In particular I discovered that Serotonin is produced during deep sleep (all of my episodes begin when I wake up and lasted hours before slowly I improving throughout the day).  In the last 1.5 years I had also noted that on days following a restless night and poor sleep that I wasn't near as symptomatic (just really tired) which is another strong indicator.  In order to test the Serotonin Toxicity theory further, yesterday I took only 75 mg of Zoloft (instead of 100).  As noted I improved from yesterday.  Because of this I didn't think I should bother you both with the submission of my schedule and symptoms in depth.

 

I am so relieved and hopeful that I could scream out in celebration but (deep sigh)..... I know I have a journey ahead of me.  Obviously I have to continue taking these poison's or suffer from withdrawal but try to reduce them enough to get relief from the episodes. I need to find a balance.  As planned I will be  sticking with the Cymbalta reduction (10% for a few weeks) and I will stay on my current HRT dose which I had reduced about 10 days ago (I feel stable and don't think I'll need to make another reduction for at least four weeks).  Where to go regarding my Zoloft is a conundrum though.  Serotonin is obviously very bad for me at the current levels but at the same time if I reduce to quickly I will put myself at risk.  I'd like to continue with 75 mg for a while (instead of 100) and focusing on the slow Cymbalta taper.  I know it's not recommended to change two medications at the same time but I don't know what other options I have.  Thoughts? 

 

Thanks!

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

Link to post

Update on taper and symptoms.

 

I still have daily episodes every morning.  The severity did increase since my last post (I thought they might),  but they aren't as severe as they were.  Heart palpitations and racing heart have lessoned and that was most worrisome to me. The rest I have been fist clenching through.  Withdrawal symptoms come and go.  I decided to introduce a Zoloft taper of 12.5% (as close as I can get to 10% by breaking up the pills). 

 

Sometimes it's mind-bending trying to make distinctions between symptoms of Serotonin Excess and medication withdrawal but there are differences.  I'm currently fighting two evils.   

 I needed to try and determine which medication was the worst offender.  Besides the one day (last post) the Zoloft changes haven't affected me as much (good or bad) so I think Cymbalta is the bigger Serotonin culprit for me.  Still this leaves me with a decision.  Should I ditch the Zoloft taper completely?  I'm on the eighth consistent day of 10% less Cymbalta and my fourth day of less Zoloft.   As it stands currently my daily episodes are still worse than withdrawal symptoms.  I have been anxious to make my morning episodes more tolerable but have resisted the urge to make any more changes.   

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator Emeritus

Please post daily symptom notes for the next 3 consecutive days.  Please follow these instructions:

 

Keep Notes on Paper

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

REMINDER TO SELF:  I don't need the drug now, but my still brain does.

Current from 9 Jan 2021:  Pristiq 0.405 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

Link to post
On 10/24/2020 at 8:23 AM, ChessieCat said:

Please post daily symptom notes for the next 3 consecutive days.  Please follow these instructions:

 

 

Hi ChessieCat,  I haven't had any withdrawal symptoms for a few days so that's good. 

 

Regarding my horrible daily episodes of illness (lasts hours and have phases), they start when I wake up for seemingly no reason. 

I take absolutely nothing beforehand and virtually nothing until after they stop.   *Sips of water and an occasional Ibuprofen.  It's virtually the same every day.  Episodes begin directly when I wake up .  

 

October 23

11:00 am   Wake and had my episode/illness. See notes from today (below).

5:30 pm      Zoloft 87.5;  Cymbalta 54.

7pm-Midnight was fine except for some nausea.

8:00 pm      Banana.  Went down alright.

12:30 am. Toast with margarine.

1:30 am.   6.5 ounces of sugar free jello.

2:30 am.   1 oz of chocolate. *I'm addicted to chocolate it's the least I've had one day in a looong time.

3:30 am.  Melatonin 1.25 mg but couldn't sleep.

4:30 am.  Xanax .125

5:00 am.  Slept

 

October 24

11:30 am.              Woke with nausea, headache and sense of doom.  

11:35-11:45 am   Had some water, a couple of crackers, and laid on sofa hoping it would pass.  Only doom faded.

                                  Nausea and headache became worse (very bad). 

                                 Additional symptoms developed:

                                 Left arm, shoulder and neck muscles cramped and tensed up (very uncomfortable).

                                 Ears began ringing (a little less loud today).

                                 Legs became weak (bad).  Dizzy. Cognitively slow. 

                                 Heart began racing (medium). Palpitations (medium).  Anxiety/Racing thoughts (medium). Bad fear.

12:00 pm               Ibuprofen 200 mg.

12:00-5:00 pm     Symptoms persisted. Extreme fatigued started. Although I stayed awake was miserable.  I could hardly keep my eyes open and keep from nodding off.

5:00-6:00 pm       Nap.  Most symptoms had passed when I woke but was very tired.  Still had some nausea and slight headache

6:00                        Zoloft 87.5 mg.  Cymbalta 54 mg.

                                 After had 2 cups of caffeine free cocoa.

8:00 pm                 Banana (forced).

 

The rest of tonight will likely be like they were late last night. I'll drink water and have toast and jello later. Hoping to pass on chocolate though.

 

It's been this way for 22 months and I believe it's medication related as the doctors have found nothing else (so I've started to taper).   At the start I had a couple of better days regarding my episodes (had reduced the Cymbalta by 50%) but when the withdrawal symptoms peaked I went back up and started over with a 10% taper.  The episodes are tricky. I've had the occasional (rare) good days before, after adding or changing something but they always come back.  I worry that I'll just keep getting used to lower doses.  

 

Thank you.         

 

Edited by ChessieCat
added dates

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator Emeritus
1 hour ago, AJ716 said:

Yesterday.

 

1 hour ago, AJ716 said:

Today

 

Please use dates.  What were the dates for these two days.  I can edit the post for you.

 

Edited by ChessieCat

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

REMINDER TO SELF:  I don't need the drug now, but my still brain does.

Current from 9 Jan 2021:  Pristiq 0.405 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

Link to post

"Today" is October 24 and "Yesterday" is October 23.

 

I re-read my symptoms regarding my episode(s) and words don't do it justice.  They are horrid and debilitating. I should have included that, lol.  

 

Thank you.

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Administrator

How often do you take Xanax or Valium?

 

Why are you taking Zoloft and Cymbalta together at night?

 

When do you take buprenorphine and atenolol? Please include ALL your drugs in your daily notes.

 

Did one doctor prescribe all these drugs? Are you still seeing this doctor?

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi Altostrata, 

 

Thanks very much for asking!   I'm struggling badly, but I don't think it's from the medication reductions.  When I did have withdrawal symptoms I was able to tell the difference between those and my symptoms during daily my episodes (those haven't lessoned except for a few days around the 16th and 17th after initially reducing Cymbalta by 50%).  

 

 

33 minutes ago, Altostrata said:

How often do you take Xanax or Valium?

I rarely take Valium anymore. Last few times: 10/7/20 2.5 mg, 9/25/20 1.25 mg, 9/9/20 1.25 mg, and 8/5/20 2.5 mg. Prior to that I took it a couple of times of week. It seemed like it was making me worse the next day.

 

I take Xanax every day but have always waited until I really need it.  Usually .125 mg twice a day (once late afternoon or early evening and once close to sleep.  I don't take it during my episodes because it doesn't help.

 

33 minutes ago, Altostrata said:

Why are you taking Zoloft and Cymbalta together at night?

Been taking it together for as long as I can remember.  Should I be taking it separately or at specific times?  Any suggestions I'd soo appreciate it.

 

33 minutes ago, Altostrata said:

When do you take buprenorphine and atenolol? Please include ALL your drugs in your daily notes.

Yes, I forget to do that!  FYI I struggle cognitively and it takes me a looooong time to type/write because of that and extreme fatigue (1-2 hours).

25 mg Atenolol within first hour of wake and 25 mg Atenolol in the hour before sleep.

Same times for the Bupe but early 2mg and late 6 mg.

 

33 minutes ago, Altostrata said:

Did one doctor prescribe all these drugs? Are you still seeing this doctor?

No. One doctor prescribed the Cymbalta, Bupe, and Zoloft. 

After 8 years I got another doctor and he kept me on the same meds/doses.  Since my episodes started he prescribed me different medications on and off trying to help me.  The others are where I'm at now.

 

 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

Link to post

The Doc has called me in a prescription for Cyproheptadine (we finally got to speak on the phone about possible Serotonin Toxicity;  I won't see him next week).  4 mg  3x a day.  I am reluctant to take that high a dose (or that often) because my body is very sensitive to CNS meds and my episodes do not last 24 hours a day.  We didn't discuss the dosages on the phone, btw.  He just said that he'd call it in. 

 

I thinking that I should just take half a pill to start but don't know:  tonight before sleep or wait until the morning when I’m symptomatic.  Any advice?

 

PS. I'm working on my daily symptom list. I'd like to post the entire day so I'm waiting till tomorrow.   

 

Thanks!!!

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator Emeritus

From :  https://en.wikipedia.org/wiki/Cyproheptadine

Cyproheptadine is well-absorbed following oral ingestion, with peak plasma levels occurring after 1 to 3 hours. Its terminal half-life when taken orally is approximately 8 hours.
 
Please also see this which has tabs for different information about the drug:  https://www.drugs.com/cdi/cyproheptadine-tablets.html
 
Dosing information is 3 times per day, which would be because of the half life of the drug.  To find out more about what terminal half life is do an internet search for:  what is terminal half life drug
 
When starting anything new SA's suggestion is to start with a low dose to see how you react.  And only make one change at a time, otherwise if things improve/worsen you will not know what has cause the change.  Please note that I am not a medical professional and have no knowledge of cyproheptadine.  What I suggesting are just ideas that might work:  Can you cut a tablet in half and quarters easily enough?  Sometimes you can cut a tablet (or a 1/2 or 1/4) horizontally like you cut a cake to add filling to it.  If not you might be able to crush a tablet between 2 spoons and divide it into 3 and take 1/3 of a tablet 3 times a day for a few days.  Obviously the smaller the dose you can get (with as much consistency and accuracy as possible) to test to see how you react to the drug the better.  To start with you aren't taking it to see if the drug works, but to find out if you have a bad reaction to it.
 
 
I suggest that you check with your doctor about when you will need to stop the drug (and include how! ie can it cause withdrawal and/or what effect will it have on your psych drugs), eg is it short term regardless of whether you reduce the serotonin drugs, or will you have to reduce the cypro as your reduce your psych drugs, because serotonin syndrome is dose related, and if you reduce your psych drug/s would continuing to take the cypro cause issues.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

REMINDER TO SELF:  I don't need the drug now, but my still brain does.

Current from 9 Jan 2021:  Pristiq 0.405 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

Link to post

Thank you C-Cat!  it's very helpful to discuss my situation with people that have experience.  I have been reading your links. 

 

You're so right. I don't have a plan yet and haven't decided how low I want to go with Cymbalta, etc.  Ty for the tips as well it makes perfect sense.  Yes the Cyproheptadine comes in small tablet form and can be quartered. I will take your "non doctorial" suggestion (*wink) and try just 1 mg tonight.  I don't want to be too optimistic but I am hoping  (praying!) that it negates Serotonin production while I sleep.  Late is when I begin to get symptomatic (I can actually feel a "chemical" kind of running through me, as if I'm on an IV; it's weird;).  I theorize that as I wake in the morning a bundle gets dumped into my system. Perhaps I'm just delaying the inevitable but we shall see.  I will post an update.

I had two questions and you already answered one (about terminal half life) but I forgot the other already. I'm sure to remember after hitting the reply button though, lol.  Ty again.

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Administrator
20 hours ago, AJ716 said:

I take Xanax every day but have always waited until I really need it.  Usually .125 mg twice a day (once late afternoon or early evening and once close to sleep.  I don't take it during my episodes because it doesn't help.

 

It's very important you keep track of when you take Xanax. Include that in your daily symptom notes, at least 24 hours at a time, every day.

 

What are these "episodes"?

 

Zoloft and Cymbalta is a very dumb drug combination; taking both at the very same time is not a good idea. Please keep your entire drug schedule the same but move Cymbalta a half-hour earlier each day until you are taking it at noon. This will allow us to see what it's doing. Be sure to keep notes of your symptoms as you make this change.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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3 hours ago, Altostrata said:

 

It's very important you keep track of when you take Xanax. Include that in your daily symptom notes, at least 24 hours at a time, every day.

I understand.  I've tried to keep up with notes and the schedule each day but keep falling behind. I'm still working on yesterday so I think I'll start over again tomorrow. 

 

What are these "episodes"?

 

I tried to explain in my very first introduction post but think I have confused matters, so I apologize.

 

In December of 2018 I began having daily episodes that start when I woke up.  They are 95% debilitating.  At the time I was only taking Cymbalta, Zoloft, and Buprenorphine regularly.  The episodes have always been similarly horrible but over time have become more complexed.  They last between 2-8 hours. 

 

 Episode Symptoms below are in basic order of occurrence although they overlap.  The first three listed begin when I'm still in bed.   *Stars are the worst.  Bolds last almost the entire time.  Meds don't spark any of the symptoms. They just happen.

 

*Severe Nausea.

*Akathisia (or similar). Extreme agitation and discomfort.

Heart racing on and off.  

Muscle tension and cramping.  Mostly neck/shoulders, also upper back, arms. 
Muscle weakness; loss of control legs.

Anxiety. Racing thoughts.

Palpitations. 

Dizziness.
Temperature fluctuations. Get bitter cold. Occasionally hot.
Ears ringing.
Frequent urination, especially at night. 

*Extremely fatigued and lethargy  (lasts a couple hours and indeed extreme; cannot talk, hardly think, can't use a pen, and no walking)

 

Please keep your entire drug schedule the same but move Cymbalta a half-hour earlier each day until you are taking it at noon.

 

My schedule changes often depending on when I'm able to fall asleep. I've been working on getting it more normal but don't want to risk it.

Can I take one around dinner and one around midnight instead?  Then I can be sure to end up taking them at the same time each day. 

 

Thanks very much!

 

 

Edited by ChessieCat
extracted responses from quote box for easier reading

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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Cyproheptadine:

It seemed to help with a couple of symptoms but not most or enough to warrant the side effects.
I took occasional notes:

 

1:00 am- Cypro 1 mg.

1:25- Perhaps a little less tension in the shoulders.

1:40- Was a little nervous and scared. Small palpitations. Unsure I'd have experienced this anyway, as I sometimes do late at night.  

2:00- Still was a little nervous and had small palps.

2:15- Melatonin 1.25 mg for sleep.

           I found it difficult to determine if the Cypro was affecting me at all.  

3:00- Ears ringing. Felt a little nauseas was getting anxious.  Cypro didn't help that.

3:10- Xanax .125  For anxiety and to help me sleep (knew I'd not be able to fall asleep without it)

           began to notice tension starting in my right arm and shoulder.

3:50- Less nausea and anxiety.

4:25- Still right arm discomfort.  No palps or anxiety.   

5:30- Fell asleep.

 

12:00 pm- Cypro 2 mg.  I woke sick/episodic and completely wiped out.  Tried to go back to sleep but couldn't.   I was miserable.

12:30- Very bad. Leg weakness. Neck pain. Nausea. Akathasia. Couldn't walk.

1:00- Very bad.

 

Episode continued for hours as usual.  

 

 

 

 

 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Administrator
3 hours ago, Altostrata said:

Please keep your entire drug schedule the same but move Cymbalta a half-hour earlier each day until you are taking it at noon. This will allow us to see what it's doing. Be sure to keep notes of your symptoms as you make this change.

 

You're going to have to keep your drug schedule regular from day to day. If you take these drugs on an irregular schedule or make sudden changes in the way you take your drugs, your symptom pattern will also move around and be impossible to interpret. Do not suddenly take Cymbalta 6 hours earlier. There's a reason I asked you to move it gradually.

 

My guess is those nightly episodes you experience are serotonin toxicity from the combination of antidepressants and possibly other drugs.Moving the Cymbalta apart from Zoloft may reduce the intensity of these episodes.

 

What happened when you reduced Zoloft?

 

When you are past this rough patch, strongly recommend you file a complaint with your state medical board against the doctor who prescribed Zoloft, Cymbalta, and buprenorphine together, particularly the Zoloft and Cymbalta.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Moderator Emeritus
1 hour ago, AJ716 said:

Can I take one around dinner and one around midnight instead?  Then I can be sure to end up taking them at the same time each day. 

 

The goal is to get your two drugs separated AND to be taking them consistently at about the same time.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

REMINDER TO SELF:  I don't need the drug now, but my still brain does.

Current from 9 Jan 2021:  Pristiq 0.405 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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56 minutes ago, ChessieCat said:

 

The goal is to get your two drugs separated AND to be taking them consistently at about the same time.

 

 

1 hour ago, Altostrata said:

 

You're going to have to keep your drug schedule regular from day to day. If you take these drugs on an irregular schedule or make sudden changes in the way you take your drugs, your symptom pattern will also move around and be impossible to interpret. Do not suddenly take Cymbalta 6 hours earlier. There's a reason I asked you to move it gradually.

 

Thank you both. I appreciate this sooooo much. 

 

I understand completely.  I won't change the time abruptly but will slowly take them further apart until I'm at a set schedule.

    
I'd like to clarify.  Do you think it matters which medication I take at a certain time?  For example, Zoloft early and Cymbalta late.   If I have a preference, I don't know about it.   

 

1 hour ago, Altostrata said:

My guess is those nightly episodes you experience are serotonin toxicity from the combination of antidepressants and possibly other drugs.  Moving the Cymbalta apart from Zoloft may reduce the intensity of these episodes.

 

I really hope that you are right.  For a couple of months in the fall of 2019 the episodes were 50-75% less intense and only lasted between 15 minutes to an hour.  I have always kept records but not that in depth so I don't know what I was doing differently.  I could not find a pattern. 

 

What happened when you reduced Zoloft?

I only noticed being a little more depressed.  If you didn't see, I noted that my doctor said not to continue reducing that and go back to my regular dose.

 

When you are past this rough patch, strongly recommend you file a complaint with your state medical board against the doctor who prescribed Zoloft, Cymbalta, and buprenorphine together, particularly the Zoloft and Cymbalta
It makes me livid and am perplexed at why and how this could happen.  Really feels like patients are at war with the pharma industry and doctors are caught in the middle.  They obviously want to cover their azz but either way there were warnings back then, I remember discovering them later.  No doctor or pharmacist has ever mentioned a possible complication. 

 

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Moderator Emeritus
2 minutes ago, AJ716 said:

I'd like to clarify.  Do you think it matters which medication I take at a certain time?  For example, Zoloft early and Cymbalta late.   If I have a preference, I don't know about it. 

 

Have you ever only taken one of the drugs?  If you did and you took it at night, did it affect your sleep?

 

(If) The drug that affects your sleep would be better taken earlier in the day.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

REMINDER TO SELF:  I don't need the drug now, but my still brain does.

Current from 9 Jan 2021:  Pristiq 0.405 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

Link to post
  • Moderator Emeritus

Or the opposite, have you found that one drug makes you more sleepy?

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

REMINDER TO SELF:  I don't need the drug now, but my still brain does.

Current from 9 Jan 2021:  Pristiq 0.405 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

Link to post
  • Administrator
1 hour ago, AJ716 said:

What happened when you reduced Zoloft?

I only noticed being a little more depressed.  If you didn't see, I noted that my doctor said not to continue reducing that and go back to my regular dose.

 

How exactly did you feel a little more depressed? Why would "a little more depressed" mean you have to go back to 100mg Zoloft?

 

1 hour ago, AJ716 said:

....
I'd like to clarify.  Do you think it matters which medication I take at a certain time?  For example, Zoloft early and Cymbalta late.   If I have a preference, I don't know about it.  

 

If it doesn't matter to you, why are you even asking this question?

 

I need to know more about the Zoloft reduction and why you backed off from it. Rather than moving Cymbalta, I am thinking it might be best for you to go off Zoloft, rather quickly. You are taking an excessive amount of Zoloft as well as Cymbalta.

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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How exactly did you feel a little more depressed? Why would "a little more depressed" mean you have to go back to 100mg Zoloft?

When I spoke to the doctor about my recent start to taper and why, he told to focus on just one at a time and to reinstate the Zoloft.  I didn't even mention to him that less Zoloft was making me more depressed. 

 

If it doesn't matter to you, why are you even asking this question?

I don't have a preference physically or mentally. It has more to do with convenience.  My son helps me reduce the pellets and weigh the capsules, etc.  Since I started this he's already put it off until the day of and I was anticipating that it would happen again in the future. Just wanted to make it so I didn't have to wait and get thrown off my schedule later, if there wasn't a chemical reason to take one earlier rather than later that I didn't know about.

 

I need to know more about the Zoloft reduction and why you backed off from it. Rather than moving Cymbalta, I am thinking it might be best for you to go off Zoloft, rather quickly. You are taking an excessive amount of Zoloft as well as Cymbalta.


The doctor didn't explain why regarding the Zoloft.  We discussed several things on the phone and he just told me to go back up on Zoloft and that we'd resume the discussion at my appoint next week. 

I was a little more depressed around the time I had cut back on the Zoloft but I can't be sure that was why. I was guessing because previously the Zoloft worked better for my depression. 

 

 My plan was to try and stabilize myself and then re-evaluate if/when that happened.   Originally I assumed Cymbalta was the bigger culprit, but that I'd try to reduce both a little, rotating, and see how I felt down the line.  I feel you have a real good understanding of how these meds work, more than my doctor, so I'm open to suggestions and would very much appreciate advice with a plan.

I apologize that I'm not always clear but really am trying :)   

 

 

Edited by ChessieCat
extracted response from quote box

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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  • Administrator
On 10/13/2020 at 10:09 PM, AJ716 said:

Cymbalta: 30 mg (on October 10, 2020 I reduced it from 60 mg)

 

How did you feel after you reduced Cymbalta from 60mg to 30mg? Why does your signature say you're taking 54mg?

 

As you know, I'm not a doctor. But I believe those rather awful symptoms you describe as starting in the middle of the night and continuing into the first part of the day are a result of your taking Zoloft with Cymbalta, 2 drugs that should never be prescribed together. It appears you feel better in the evening after they both wear off a bit, then you start the cycle over again by taking them together at night.

 

The adverse inter-reaction of these 2 drugs is called serotonin toxicity, at the extreme it is called serotonin syndrome and is life-threatening. This adverse condition demands you go off one or both drugs in a fairly short amount of time. I am also concerned about the muscle weakness you are complaining about, which potentially is another very serious adverse effect.

 

The boatload of other drugs you're taking may also be involved. Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

In my amateur opinion, feeling a little more depressed sometimes is the least of your problems.

 

If you get Zoloft liquid to reduce Zoloft first, your son won't have to weigh anything. You would measure the liquid with an oral syringe.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi Altostrata,

 

I reduced the Cymbalta from 60/30 before I joined this forum.  I did so on a whim, thinking I may have Serotonin Toxicity and the cause was Cymbalta.  After I made my first post stating that I had reduced the Cymbalta by 50% it was suggested by others that I reinstate my original dose and start tapering again, but slowly.  There have been many so warnings about tapering too quickly and since I wasn't sure of my status and scared of what could happen, etc. I did as suggested.  In hindsight that was at least a good test.  For two days my episode symptoms had lessened (my withdrawal symptoms were starting to worsen though).  

 

I understand you aren't a doctor and don't feel comfortable telling me exactly what you think I should do, and I totally get it.  Also I really, really do appreciate the attention and knowledge you have shared with me!    With that, I'm trying to weigh my options and decide what to do now, at least until next week. 

 

I'm equally scared of the consequences of jumping off of these meds quickly and risking a continual, slow taper.   I really do not think my body or mind can handle going too quickly (especially since I don't have the option of checking myself into a hospital to be guided through it).  Unfortunately my doctor isn't really on the same page as us.  I cannot get him to understand how dire my situation is (perhaps because he only sees  me when I'm not episodic), and I think he's skeptical about my having Serotonin anything.  Doctors suck (this one is actually one of the better ones I've had, which isn't saying much).  Between the psychiatrist that prescribed the combination and my current doctor there were three others that I tried, but disposed of.   I am at the mercy of the system and local clinic. 

 

Since I won't see the Doc until next week (Friday) to discuss all of this and to try and get Zoloft liquid, for now I want to continue with the Cymbalta taper

and your other suggestions (getting on a strict med schedule and slowly changing the time I take the Zoloft and Cymbalta, extending the time in between taking them).  I think I'm also ready to start another reduction of the Cymbalta?   It's been two weeks.

Two updates:  

Yesterday (Oct 27th) I took the Zoloft and Cymbalta an hour apart.  Today (Oct 28th) I am moving them each another half hour.   

                           
My episode symptoms were noticeably not as bad today and did not last as long.  It was still very, very uncomfortable and for about a half an hour it seemed to teeter, as if it was going to worsen.... but it did not.  Maybe I got a little lucky, but perhaps it was taking the meds at differing times?  It has  given me hope!

Cymbalta:  Currently 48.5 mg.  Previously 60 mg, 2011-Oct 2020.  

Taper Oct 11-13 (three day reduction of 30 mg relieved many Serotonin Toxicity symptoms but WD became too harsh). Oct 14- 24 (eleven day reduction of 10%, 54 mg).  Oct 25  (began second reduction of 10%, 48.5 mg; holding to stabilize and work on schedule).  

Zoloft  100 mg. 1993-2000 Stopped CT for pregnancy twice, then it pooped out.  Reinstated 2011-2020.    

Taper attempt:  Oct 17-24 (seven days at 87.5 mg was discontinued; reinstated to 100 mg). 

 

Buprenorphine: 8 mg (4 mg 2x day @ 4pm and 1am)  Atenolol: 25 mg (max 2x day; prn).  Xanax: .125 mg (max 3x day; prn; average 2x).  HRT: Transdermal weekly patch.  Melatonin OTC:  2.5 mg, sleep.  Magnesium Citrate OTC: 125 mg, dinner.

Oct-Nov 2020:  Discontinued Simvastatin 20 mg, Magnesium Glycinate, Vitamin D, and Chia Seed Extract. Growing sensitivities.

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