Mimi65: Can I just stop duloxetine now?

[Mimi65]

I have been on duloxetine since middle of January, first 20mg for three weeks, then 30mg for a few days and then back to 20mg.  Doc said continue for one week than stop but after seeing some of the issues people are having I was afraid to just stop.  I have been opening the 20mg capsule and am now down to 55 beads, can I simple stop.

Edited March 1, 2021 by manymoretodays
name to title, tags

[Mimi65]

I probably should have added that my 20mg had 110 beads in it, so the 55 beads would be 10mg.

[Gridley]

Welcome to SA, Mimi65.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  A person is at risk of withdrawal symptoms after one month on a psychiatric drug, and you are right at that point.  

 

Account Settings – Create or Edit a signature.

 

10mg is a very high dose to stop at.  (Suggestion about recimmended jump-off dose follows later in this post).Doctors invariably taper their patients too fast, putting them at risk of withdrawal symptoms.  You are wise to be concerned.

 

We recommend tapering no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering duloxetine.

 

Tips for tapering off duloxetine (Cymbalta)

 

How are you feeling now? Are you feeling stable (about the same from day to day with no big swings in symptoms)?  If so, you could begin a 10% taper by counting beads, with a 10% reduction in number of beads every four weeks.  If your current dose is 10mg or 55 beads, your first reduction would be down to 50 beads for four weeks.

 

In terms of milligrams we recommend jumping to zero at a very low dose, which would mean less than 1mg.

 

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. 

 

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. Get supplements that ae single ingredient (not mixed with other types of supplements).

 

This is your Introduction topic, where you can complete your drug signature, ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

Edited March 1, 2021 by Gridley

[Mimi65]

I am down to taking 50 beads from a 20mg capsule and what I am finding is that about and hour or two after I take the dose I get tinnitus, headache, nausea and some anxiety.  It all starts to fade away by 8 or so hours later and stays that way until I take my next dose the following morning then starts all over again.  Anyone else have this?  Is it withdrawal or is it the duloxetine causing it.  Feels almost like start up side effects all over again.

Edited March 3, 2021 by getofflex
merged from tapering forum

[Mimi65]

I have been on 20mg duloxetine since Jan 21, so close to six weeks.  There were more side effects than benefit so doc said to just stop taking it.  I was fearful seeing everyone’s withdrawal issues so instead for the past 2 weeks have been opening capsule and removing beads.  Current dose is 45 beads which equals a dose of about 8mg.  Should I stop now since it’s just 6 weeks or do I need to keep removing beads?

[getofflex]

Hello Mimi, I do not suggest you stop the drug or change your dose at this time.  These drugs are sneaky, and oftentimes we don't get hit with the withdrawal effects until a week or 2 after we change the dose.  Gridley gave you a link "why taper at 10% of my dosage".  Did you read this?  

 

Also, can you please edit your drug signature and be more specific with dates?  For example, list the specific date of each change in the dose, and what the dose was and is.  You can see my own signature as an example. I'm wondering, based on context, if you meant Dec 2020 instead of 2019?  It is less confusing for us moderators than having your drug information spread across several posts.   This way each time you post, all your drug history will automatically be included.  A list format would be easier for us to read.  That way we can better help you.  This explains more: Drug History in Signature

 

From what you describe, your symptoms sound like side effects. 

 

Here is some more information on withdrawal from psychiatric drugs.  

 

What is Withdrawal Syndrome?

 

Recovery Occurs in Windows and Waves

 

Withdrawal Symptoms and Self Care

 

I'm sorry you are having to deal with this.  This forum is run by others like you who have been through and survived, or are surviving, withdrawal from psych meds.  Hang in there.   

 

 

Edited May 6, 2021 by getofflex

[RusTW]

How are u?

[Mimi65]

I am ok so far, thanks for asking.  Mild withdrawal effects, so far tolerable.

[getofflex]

Hello Mimi, I'm glad to hear that you are doing alright today.  

 

It is suggested to stay at precisely the same dose for 4 weeks when we are tapering any psychiatric drug, before reducing further.  This will allow your nervous system to stabilize and you will feel better this way.  I see you are reducing your dose each day.  This can feel OK for a while, but then it may sneak up on you in the future.  Please refer to the link Gridley posted about tapering 10% of my dose in his previous post.  

 

This will give you a clear picture of why it's so important to taper very slowly: 

How Psych Drugs Remodel the Brain

 

This tells you what happens with a too fast taper or cold turkey: 

Cold Turkey and Fast Taper

 

 

Edited March 12, 2021 by getofflex
soften wording

[Mimi65]

I have been taking 7.5mg mirtazapine for insomnia for about 2 months now.  The first 6 weeks I took it every night.  For the first 3 weeks I was sleeping fairly well on it but then i started getting less and less sleep with each week. Then in week 7 I fell asleep one night before I took it and actually slept better and felt better the next day than I did when I took it.  However the next night I could not fall asleep at all so I took the 7.5 and slept ok but not good and the next day I felt off, tinnitus, fatigued and a little jittery.  It seemed like for the next 2 weeks I was falling asleep on my own every other night but the following night I could not fall asleep so I had to take the 7.5 dose.  The nights I fall asleep on my own I sleep better, maybe 6 hours and I feel good the following day.  The alternating nights when I have to take it to fall asleep I only get 3 or 4 hours of broken sleep and feel pretty bad the following day, jitters, tinnitus, nausea, headache, no energy, fatigued.  I am unsure as to why this is happening as well as why I can only seem to fall asleep on my own every other night.  I don’t know if I need to get off mirtazapine completely and try using something else, like trazodone, for sleep or if I need to take the 7.5 every night making sure to take it before I fall asleep on my own even though sleep was getting less and less.  And if I need to take it every night and it only gives me 3 or 4 hours of sleep if I should increase dose to 15.  Any thoughts would be greatly appreciated as the last 2 weeks have been pretty miserable every other day for me.

[Mimi65]

Wow, no replies.  There isn’t anyone out there who can shed some light and offer advice.  

[Altostrata]

@Mimi65 please do NOT start new topics in the Introductions forum. There's only one Introductions topic per member.

 

Put any questions about your situation here, in your Introductions topic.

 

Did you see @getofflex's March 4 response in this topic?

 

On 5/3/2021 at 10:41 AM, Mimi65 said:

The alternating nights when I have to take it to fall asleep I only get 3 or 4 hours of broken sleep and feel pretty bad the following day, jitters, tinnitus, nausea, headache, no energy, fatigued.  I am unsure as to why this is happening as well as why I can only seem to fall asleep on my own every other night.

 

This is happening because when you skip doses of mirtazapine, it takes about 48 hours for your body to realize it's missing, and you get rebound insomnia. 

 

It appears 7.5mg is too strong for you now. We advise slowly lowering the dosage, as explained to your earlier. See Tips for tapering off mirtazapine (Remeron)

 

You are lucky that mirtazapine helps with the withdrawal insomnia from your going off Cymbalta too fast.

 

This is a site for going off drugs. We're not in a position to recommend another drug to counter the effects of your going off drugs too fast -- you'll have to taper from anything that might be prescribed. We want to make less traffic for this site, not more.

[Mimi65]

I was going to try to do the water titration method for the mirtazapine but I was told that mirtazapine is not water soluble so that would not be a viable option for tapering mirtazapine.  Apparently it has to be crushed, weighed and placed in empty capsules. Have you had success with water titrations mirtazapine 

[Mimi65]

After some health issues in December I developed severe insomnia.  After a month with no improvement and getting no more than 3 hours sleep a night I saw my pcp.  He first put me on Zoloft but I had adverse side effects immediately so he had me stop it after a few days and replaced it with cymbalta.  I was on the cymbalta which only made the insomnia even worse so doc suggested I get off cymbalta and try mirtazapine.  I started 7.5 mirtazapine while I quick tapered off cymbalta.  I have been on only mirtazapine 7.5 since early March.  I saw my doc in early June and told him while I was sleeping okay the next day fatigue and brain fog were getting to me.  He said we could try a 15mg dose to see if that improved things or get off.  I was told to take 3/4 of a pill for one week, then 1/2 a pill for one week, then 1/4 pill for another week and then stop.  I wound up,doing each step 10 days each.  There were no real issues during the taper or for the first 3 days off, in fact, I felt really good those first 3 days.  On day 4 all sorts of things started, tinnitus,headache, nausea, sweats and worst of all sleep started deteriorating, fell to about 5 hours a night.  After about 3 weeks most side effects were starting to abate except for the insomnia which was getting worse each day.  A few days ago sleep had gotten down to 90 minutes a night which was what it was when I went to doc originally for help. I thought that it was a return of the insomnia and maybe not so much withdrawal since the other withdrawal effects were showing much improvement, but one way or another I simply could not go on like that anymore.  Three nights ago I reinstated the 7.5 mirtazapine.  I tried 3.75 first but when I still hadn’t fallen asleep by midnight I took another 3.75 and slept from 12.30 to 6 am.  The past 2 nights I have taken 7.5 and sleep has improved.  I have been experiencing some daytime anxiety and nausea and was thinking maybe that was just getting used to drug again.  I’m thinking perhaps I should just stay on the 7.5 for a while to stabilize.  Before reinstating I tried a few different things to try to deal with the insomnia, melatonin, calm aid, and trazodone but none of them helped.  If I fell asleep about 10 I would be up at 1130 and no more sleep.  I have been unable to sleep during the day since chemo so no naps no matter how exhausted I was.  At midnight if I tried the trazodone it would help me get back to sleep but only for about another hour and then I would simply lie in bed til 630, exhausted but not able to sleep.  I was unable to do anything during the day due to the unrelenting tiredness, simple sat zombified on the couch til night when the whole thing would repeat.  Any thoughts anyone would care to share with me.  

Edited July 26, 2021 by Mimi65
Additional info added

[Mimi65]

Since I failed at the mirtazapine taper could someone tell me how to bridge to another drug that may be easier to taper off of.  I have been on 7.5 mirtazapine since early March with the exception of being off of it for three weeks before side effects, primarily insomnia, became too much and I reinstated at 7.5 and have been on that for about a week now.  I see my pcp on Tuesday and would like info on bridging so that I could bring that up with him, and what would the equivalent dose be for 7.5 miratzipine.  I would greatly appreciate if anyone could shed some light on this for me.  Thanks.

[Mimi65]

I have ordered a scale and capsules from Amazon which will be delivered Saturday.  I would like to attempt another mirtazapine withdrawal.  I am on a dose of 7.5 and have been since early March with the exception of a 6 week period of time tapering and 3 weeks off before the insomnia went to how it was when my doc put me on mirtazapine for sleep.  I went back on mirtazapine at that time and have been 7.5 for the last month.  The past 2 nights I have shaved off a little bit of the mirtazapine so perhaps the dose for the past 2 nights has been 7.  I am going to continue that until the scale arrives on Saturday.  I plan on weighing the pill and going to try to make a dose equal to 7 and stay on that before lowering the dose a slight bit more.  I may have questions as to the math and if I am doing it correctly and I hope someone will come forward to assist.

[Mimi65]

Scale arrived early so I calibrated scale and weighed the 7.5 pills and it seems the average weight is .83.  I filed pills down until they weighed .75 and that is what I am going to take for a few weeks to see how things go.  I would guess that if things go okay after the next several weeks I should file the next pills down to .68.  I hope that’s right.  Last time most withdrawal effects were uncomfortable with the exception of the insomnia which became unbearable so my doc had me go back on 7.5 and was of the opinion since other effects were abating that the insomnia was a return of  the original reason I went on.  I guess perhaps I should use sleep as a guide to judge stability after a few weeks.  Anyone?

[Mimi65]

Scale is driving me crazy, after my last post I went back and recalibrated the scale again and it seems that my 7.5 pills actually weigh .75.  I reweighed a weeks worth of pills and made them .68 or a ten percent cut, I have been taking that dose for about 10 days now.  So far withdrawal has been headache, tinnitus, nausea, a little anxiety and broken sleep but has been tolerable to this point.  It’s odd to me that the withdrawal symptoms are worse in the morning and have virtually disappeared by early afternoon.  I am thinking I should stay on this dose for at least another week and see what happens.  If there is anyone available who can share their thoughts with me on this I would most appreciate it.   I am considering possibly doing a 5 percent cut every two weeks instead of 10 percent every four.  Does that seem too aggressive of a reduction?  I’m looking for a little feedback here or possible a bit of encouragement.  I was put on mirtazapine for insomnia and other than sleep it has not really done anything for me other than to make me tired during the day and foggy headed which I already deal with enough of with my post chemotherapy brain.  Any help would be so very much appreciated.

[Mimi65]

Last night sleep was bad, only about 4 hours of broken sleep.  Hoping sleep will settle down during the hold.  Other effects seem to be getting a bit better.  Hope someone will come in and help me out please.

[Altostrata]

Hello, @Mimi65

 

Are you taking the same amount of mirtazapine at the same time every night? What time o'clock? How long have you been doing this?

 

How much mirtazpine are you taking now?

 

We have many people using a liquid to taper, as explained here Tips for tapering off mirtazapine (Remeron)

 

The drug does not have to be soluble to make a suspension.

[Mimi65]

Thank you so much for getting back to me.  I am currently taking .57 mirtazapine and I take it every evening between 9 and 930.  I have been doing this dose for about 10 days.  
I was put on the 7.5 dose for insomnia in early March and remained on that dose until June 1st when I tried tapering per doc by cutting a quarter pill every 10 days.  Stopped end of June but insomnia had gotten so bad by three weeks off, 90 minutes of sleep a night which was why I went on mirtazapine, I had to reinstate 7.5.  I stabilized on that dose and decided to try tapering again smaller and slower and began filing the pills down by eye. I purchased a scale in order to help with the reduction. 
any help would be much appreciated.

[Mimi65]

The dose I am taking is .57 weight, the actual dose is 5.7mg.  Sorry about that.

[Mimi65]

Monday night sleep was not good but for the rest of the week it was ok.  I take mirtazapine between 9 and 930 in the evening and normally fall asleep about 20 minutes later but I keep waking up about 3 every morning and can’t get back to sleep.  I then experience some morning anxiety around 9am which lasts until early afternoon.  I don’t know if this is withdrawal or the mirtazapine itself.  Any ideas?

[Mimi65]

About two weeks since dose reduction, as of yesterday it seemed like things were improving but no sleep last night.  Took mirtazapine at 9, fell asleep about 930, woke up at 10 and could not get back to sleep after.  Finally fell back asleep from exhaustion about 4 but woke up for good 430.  Sleep was the issue that got me put on mirtazapine.  I guess I will try to hold some more and see if things even back out again or I guess I’ll have no choice and have to go back to the 7.5 so I can sleep.  Any ideas, any help?

[Altostrata]

@Mimi65, overall, your taper was too fast. Your nervous system needed more time to recover from the taper you started in June.

 

You might go back to 6mg to see if that's enough, and stay there for a while, let your nervous system accommodate.

 

You might find using a liquid to be less frustrating. See Tips for tapering off mirtazapine (Remeron)

 

To switch to the liquid, I would add 0.3mg in liquid to the 5.7mg you're taking now, then gradually increase the liquid part until you're taking half in solid and half in liquid. You'd taper from the liquid part.

 

Please let us know how you're doing.

 

 

 

[Mimi65]

Alto,

I realized that the night I slept so badly that for the 2 previous nights I had somehow not taken my medical marijuana.  I restarted it 2 nights ago along with the 5.7 dose of mirtazapine and sleep has been ok the past 2 nights.  I’m going to try to continue at the 5.7 dose and see if things remain somewhat stable.  I read the article on making a liquid and will keep that in mind as doses get lower and if I have trouble weighing.  Thanks for your help most appreciated.

[Mimi65]

After 3 weeks things seemed to be okay, sleep was ok so I reduced my dose to 5.0mg.  Guess I’ll see how this goes.

[Mimi65]

I have now been at 5.0 dose of mirtazapine for about 10 days, things got rocky again on day 3 after cut with the usual headache, tinnitus, nausea, restlessness and the worst of all insomnia.  Things may be starting to settle back down so thinking I should hold at this dose at least another week to see if things can become stable.

[Mimi65]

Things have settled down, I’ve been at the 5.0 dose for a little over 2 weeks now.  I take the mirtazapine about 9 and usually fall asleep by 10 but always seem to wake up around 4.  About 7 or 8 is when the withdrawal effects seem to start and they usually dissipate by early afternoon.  I feel bad for those few hours each day and am wondering if it is still withdrawal or if it is the mirtazapine itself causing the issues.  I still have a long way to go with my taper so I’m hoping it’s not the drug itself.  If things continue to remain the same for the next few days I will try to reduce to 4.5 dose.  

[Gigi68]

Hi Mimi, I am also tapering Mirtazapine. I make my own liquid and am currently at 3.84ml. I have had bouts of insomnia too. Hate it! I’ve been listening to yoga nidra by Jason Stevenson or Melissa West on YouTube. I think they are helping me sleep better. I’m currently having some new WD symptoms to go with the insomnia and diarrhea I’ve had off and on. I think it may have something to do with food. I had a pork chop one night and didn’t sleep at all so pork is out. I’ve noticed I sleep best after chicken and not quite as well after beef. At least that’s my theory. I am still testing. 

[Mimi65]

Hello Gigi, sorry to hear we both find ourselves trying to get off this drug.  You seem to be doing well so far with your taper and are at a lower dose than I am.  I just reduced my dose to 4.5 and will now try to stabilize on that dose.  I’m weighing for now, may have to go to liquid at some point but am very unsure of making my own liquid, may have to beg my doc to have my pharmacist make a liquid for me.  

[Mimi65]

I am using 7.5 mirtazapine tablets, hard pills with a plastic feeling coating, is it okay to cut or crush these tablets, as that is what I have been doing.  Also will putting the powder or crumbled bits into a gel capsule to take be okay?

[Gigi68]

Hi Mimi, it’s fine to crush the pills. I crush them but make a liquid out of them. I don’t know anything about putting the powder in a capsule. 

[Mimi65]

Alto,

It seems that I take my dose of mirtazapine around 9 or 930 at night, always wake up by 4.  Usually get out of bed about 6 and it seems each day what I thought were withdrawal symptoms, nausea, tinnitus, light jitteriness, sometimes headache start up about 9 am and continue for a few hours and usually settle down by around 2.  Things stay pretty normal and I take the mirt again near bedtime and things repeat again.  Is this withdrawal I am getting or is this all side effects from the mirtazapine itself.  Anyone experiencing the same thing or could shed some light on what is occurring.

[Mimi65]

@altostrata, can you help me with my question in above post

[Mimi65]

How do you get responses or help in this forum, what am I doing incorrectly?