Nanda: Reinstating Duloxetine - Help-me!

[Nanda]

hello, I'm Brazilian, please ignore grammatical errors, because I'm using the translator.  I need your help.  I spent 3 years taking duloxetine 60mg and a few weeks ago I started to funnel the drug on my own.  I removed the equivalent of 1mg a day from the capsule, I was doing well, but when I reached the equivalent of 25mg, I started to have severe withdrawal symptoms.  I contacted my doctor and he ordered 50mg trazodone and stopped duloxetine altogether.  That was when hell started, zaps, nausea, vomiting, shaking, pressure on the head among others.  I spent 4 days without duloxetine, I couldn't continue and drank a 60mg capsule. After that 60mg capsule, I started taking 30mg a day, but I'm having bad symptoms, lots of gas, chest tightness, extreme anxiety.  I think I did the reintegration with the wrong dosage.  Please help me!  I can't stand this shortness of breath, a lot of belching and extreme anxiety.  What has helped me is aprazolan 0.5mg, but I don't want to be dependent on it.

[Nanda]

hello, I'm Brazilian, please ignore grammatical errors, because I'm using the translator.  I need your help.  I spent 3 years taking duloxetine 60mg and a few weeks ago I started to funnel the drug on my own.  I removed the equivalent of 1mg a day from the capsule, I was doing well, but when I reached the equivalent of 25mg, I started to have severe withdrawal symptoms.  I contacted my doctor and he ordered 50mg trazodone and stopped duloxetine altogether.  That was when hell started, zaps, nausea, vomiting, shaking, pressure on the head among others.  I spent 4 days without duloxetine, I couldn't continue and drank a 60mg capsule. After that 60mg capsule, I started taking 30mg a day, but I'm having bad symptoms, lots of gas, chest tightness, extreme anxiety.  I think I did the reintegration with the wrong dosage.  Please help me!  I can't stand this shortness of breath, a lot of belching and extreme anxiety.  What has helped me is aprazolan 0.5mg, but I don't want to be dependent on it. 

Updated:

 After 3 days of taking 30mg (reintegration), the withdrawal symptoms passed (nausea, zaps, vomiting, tremor), but now I feel strong tightness in the chest and throat, constant burping and anxiety, today I decided to take only 10mg (I counted the balls)  .  I continued to experience the same symptoms, with a little less intensity.  Should I lower the dose even more tomorrow, like 5 mg to see if the pressure in the chest and the burps decrease)?  What do you think? 
 

[Altostrata]

Welcome, @Nanda

 

When did you start taking the 30mg capsule? How many times have you taken it? How do you feel now?

 

How often are you taking alprazolam? Were you taking it before?

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

 

 

[Nanda]

Thank you so much for responding.  I am desperate for these symptoms to heal.  After the single dose of 60mg (after a withdrawal crisis), I started taking 30mg of duloxetine in the morning + 10mg of fluoxetine (by doctor's recommendation), the doc wanted to start fluoxetine (7 days with 10mg and then with 20mg) and after  15 days to stop the 30mg of duloxetine totally and keep 20mg of fluoxetine to gradually taper. 

[Nanda]

47 minutos atrás, Altostrata disse:

Bem-vindo(a),@Nanda

 

Quando você começou a tomar a cápsula de 30mg? Quantas vezes você já tomou? Como você se sente agora?

 

Com que frequência você está tomando alprazolam? Você estava tomando antes?

 

Para nos ajudar, siga estas instruções Por favor, coloque seu histórico de drogas e retiradas em sua assinatura Você pode precisar usar um computador para fazer isso.

 

 

I will do the chronology: may/14 last dose of 25mg of duloxetine before stopping completely.  May/15, May/16, May/17, May/18 I used only 50mg trazodone, I stopped completely on may/18 when I took the 60mg dose of duloxetine at night.  On may/19 I went back to 30mg of duloxetine in the morning and 10mg of fluoxetine after lunch (indication from a second doctor).  I completely stopped fluoxetine on may/21 and I was only on duloxetine 30mg on may/22.  Today, may/23 I took only 10mg of duloxetine in the morning, but in addition to the extreme anxiety, pressure in the chest and throat and many burps, I started to have a slight tremor, so I took another 10mg after lunch and 1mg of aprazolan.  I have been taking 0.5mg once a day since May/14, only today I took 1mg.  Tomorrow what should I do?  I don't want to aprazolan anymore for fear of addiction.  In the past (about 5 years ago) I spent about 6 months taking clonazepan to sleep and to stop was hell, so I am afraid to continue taking it aprazolan. Help me, please.

[Altostrata]

2 hours ago, Nanda said:

30mg of duloxetine in the morning + 10mg of fluoxetine

 

Are you taking only 30mg duloxetine now? How long have you been taking only 30mg duloxetine? Do you feel better or worse today than yesterday?

 

What are the symptoms that cause you to take alprazolam? How often have you taken it in the last week? Please keep daily notes of what times of day you take your drugs and their dosages.

[Nanda]

8 horas atrás, Altostrata disse:

 

Você está tomando apenas 30mg de duloxetina agora? Há quanto tempo você está tomando apenas 30mg de duloxetina? Você se sente melhor ou pior hoje do que ontem?

 

Quais são os sintomas que fazem você tomar alprazolam? Com que frequência você o tomou na última semana? Por favor, observe diariamente a que horas do dia você toma seus medicamentos e suas dosagens.

I have had 30mg of duloxetine since May 19, that is, 4 days.  Only yesterday, May 22, I only took 20mg, but I didn't feel well.  What makes me take alprazolan is extreme anxiety, pressure in the chest and throat and a lot of gas (belching).  I have been taking 0.5mg of alprazolan, but it doesn’t have the right time, usually when I can’t stand the symptoms I listed above.  I have been taking aprazolan for 7 days.  

[Altostrata]

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 what the 30mg duloxetine is doing.

 

 

We need this: Please put your drug and withdrawal history in your signature 

[Nanda]

53 minutes ago, Altostrata said:

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 what the 30mg duloxetine is doing.

 

 

We need this: Please put your drug and withdrawal history in your signature 

Today 08:00 I drank 30mg of duloxetine with breakfast
 Between 08:00 and 12:00 I felt a little discomfort, drowsiness and mild anxiety
 Around 3:00 pm I had a strong tightness in the throat and chest and a lot of belching (eructation)
 Now at 20:00 I have a lot of burps, a lot of discomfort with gases. should i take duloxetine at another time?

[Altostrata]

24 hours at a time, please. Include any alprazolam doses as well.

[Nanda]

today I did not use aprazolan, nor do I intend to use

[Nanda]

I wasn't using aprazolan at the right time, yesterday I used it at 15:00

[Nanda]

tomorrow i will try to use duloxetine during lunch and i will come back here to tell you how i got

[Nanda]

I woke up at 7 am with a lot of anxiety, belching and chest pain.  My doctor is considering changing his medication.  would that be a good idea?

[Nanda]

I just talked to my doctor and he thinks I'm having a reaction to duloxetine, he asked me to start fluoxetine 10mg and do a 15-day bridge to leave duloxetine and be on fluoxetine alone.  could someone give me an opinion on this?

[Altostrata]

You have been switching your drugs around, taking alprazolam at different times, and you still haven't posted 24 hours of notes. Taking any of these drugs inconsistently can cause symptoms. If you prefer to take your doctor's advice, please do. Good luck.

[Nanda]

thanks for responding.  I will not follow my doctor's advice and bridge the gap for fluoxetine now, I will try to stabilize.  yesterday was a bad thing, I took 30mg of duloxetine in the morning and spent the whole day with anxiety, chest tightness and shortness of breath and belching.  I had to take aprazolan 0.5 twice yesterday (morning 9 am and afternoon 7 pm).  today may / 26 (my birthday) i took the usual dose of duloxetine at 08:00, i started having the same symptoms, then i drank another 10mg about an hour later, now (12:48) i feel a little better about the anguish and  shortness of breathe.  For today I will try not to take aprazolan and write everything down to send it to you tomorrow.  Thank you. Thank you very much!

[Altostrata]

I am sorry you are feeling so poorly on your birthday.

 

Please note that I have asked for daily notes several times. I ask for them because I need them to understand your symptom pattern. In these notes, I need: Times of day (o'clock) you take each drug, their dosages, and how you feel before and after taking each drug, 24 hours at a time.

 

 

[Nanda]

Thank you so much for responding.  Come on, on the 25th of May I had an acute anxiety crisis in the late afternoon and it only got better when I took pleasure.  Yesterday, May 26, I spoke to my doctor and he told me to use apraz regularly until I managed to get out of this crisis and the 30mg of duloxetine started working again.  He prescribed: 0.5mg of pleasure 3x a day for one week, in the second week 2x a day and in the third week 1x a day.  I thought it was sensible, although I am very afraid of being addicted to another medication 😭.  So I'm going to make the schedule of how it was today, May 27th.  What do you think of my doctor's prescription?  It makes sense?

[Nanda]

Thank you so much for responding.  Come on, on May 25th I had an acute anxiety crisis in the late afternoon and it only got better when I drank aprazolan.  Yesterday, May 26, I spoke to my doctor and he told me to use aprazolan regularly until I managed to get out of this crisis and the 30mg of duloxetine started working again.  He prescribed: 0.5mg of aprazolan 3x a day for one week, in the second week 2x a day and in the third week 1x a day.  I thought it was sensible, although I am very afraid of being addicted to another medication 😭.  So I'm going to make the schedule of how it was today, May 27th.  What do you think of my doctor's prescription?  It makes sense?

[Nanda]

With me it was like this: I took 60mg for 3 years for anxiety, that's when I decided to reduce the dose little by little, I started taking 1mg a day (which is very fast).  When I got to 25mg I had a withdrawal crisis, I went to my doctor and he ordered me to stop duloxetine completely that day, that was the worst decision I made, with 4 days without the medication I was about to die, that's when I resumed the dose of  30mg.  In the first days the main symptoms of withdrawal disappeared, such as nausea, pressure in the head, zaps, difficulty thinking, but then I started to have strong anxiety attacks that caused me strong discomfort in my chest and throat, a lot of belching and restlessness, I thought I was  having some reaction to the return to duloxetine.  I looked for another doctor and this one, much more sensible, said that he is having acute attacks of anxiety, he ordered to continue the dose of 30mg of duloxetine and to take 0.5 xanax 3x a day, but I continued without improvement, that's when he decided to change the benzo to  clonazepan: 4 drops in the morning, 4 in the afternoon and 8 at night, when I started this treatment I started to feel significantly better in the symptoms.  my benzo treatment will be tapered 2 likes weekly.  I believe that when I finish these 2 months of benzo, the 30mg of duloxetine is already able to handle anxiety well, then I will wait a while to stabilize and I will continue to taper, but this time decreasing 10% of the dose each month.  Altostrata, what do you think of this plan?  Will I be able to be stable with only 30mg of duloxetine at the end of the two months of the benzo?

[Shep]

@nanda I moved your latest posts off of tapererer's thread and placed them here in your own thread. Several of them are hidden because you posted multiple times with the same information. Please continue to use your Intro thread here to ask questions about your taper. 

 

We need a signature to know what your drug history is before offering advice. Please see:

 

How to List Drug History in Signature

 

A direct link to your signature is here:

 

Create Your Signature in "Account Settings". 

 

You can become dependent on a benzo in 2 - 4 weeks and some people become dependent in just a few days. So knowing your drug history, especially how long you've been taking these drugs and if you have a history of taking benzos in the past, is very important. 

[Nanda]

@Altostrata @sapo

 

hello friends, i did my medication history.  It's been about 6 weeks and I still have symptoms of WD, even though I'm taking clonazepan.  I have pressure in the head, ear and throat.  Is this normal even taking clonazepan?  My doctor made a plan for the use of clonazepam.  I started with 1.6mg divided into 3 daily doses and I'm decreasing 0.2mg per week, I improved considerably with the use of benzo, as I was having strong anxiety and panic attacks.  I'm very scared that I'm already dependent on clonazepam, but I wouldn't have been able to survive these last 6 weeks without it. 
 

@sapo could you tell me if this is a good plan to lower the benzo?

[Nanda]

my doctor tried to introduce 5.5mg of mirtazapine to aid sleep and help me get off clonazepan faster, but it didn't work well, I was sleepy and airy for most of the day, so I decided not to take any more.  I only used it for 3 days.  Now I have only 30mg of duloxetine and 1mg clonazepan divided into 3 daily doses, 0.3 in the morning, 0.3 in the afternoon and 0.4 in the evening.  Next Wednesday I should lower it to 0.8mg a day, but I'm afraid of this fast taperer, as I still have withdrawal symptoms and there's a risk that I'm already dependent on it.  What guide me?  I'm having trouble sleeping too, I've been using melatonin, but I don't have very restful sleep.  can you please give me some guidance?

[Altostrata]

Why are you reducing clonazepam rather than duloxetine?

 

Reducing clonazepam can cause sleep disruption.

[Nanda]

@Altostrata

Because I'm not stabilized yet.  I thought about taperer when it's stabilized.  I was cutting down on duloxetine when I had WD, I reinstated 30mg but I still had terrible symptoms of acute anxiety and panic, which is why the doctor introduced clonazepan last month to help with the symptoms.  What do you guide me?  What's your advice?

[Shep]

1 hour ago, Nanda said:

@Altostrata

Because I'm not stabilized yet.  I thought about taperer when it's stabilized.  I was cutting down on duloxetine when I had WD, I reinstated 30mg but I still had terrible symptoms of acute anxiety and panic, which is why the doctor introduced clonazepan last month to help with the symptoms.  What do you guide me?  What's your advice?

 

Nanda, please note you can develop dependency on clonazepam in 2 - 4 weeks time, so you may be dependent on this drug. 

 

We advise coming off stimulating drugs such as most antidepressants first and then sedating drugs such as clonazepam last in order to preserve sleep. 

 

Please see:

Taking multiple psych drugs? Which drug to taper first?

 

In your signature, you have "I am no longer using zolpiden."  When did you stop taking Zolpidem?

[Nanda]

5 horas atrás, Shep disse:

 

Nanda, observe que você pode desenvolver dependência do clonazepam dentro de 2 a 4 semanas, portanto, você pode ser dependente deste medicamento.

 

Aconselhamos primeiro sair de drogas estimulantes, como a maioria dos antidepressivos, e depois sedar drogas como o clonazepam por último, a fim de preservar o sono.

 

Por favor, veja:

Tomando vários psicofármacos? Qual droga diminuir primeiro?

 

Em sua assinatura, você tem "Eu não estou mais usando zolpiden". Quando você parou de tomar Zolpidem?

I stopped zolpidem when I started clonazepan, that is, about 1 month ago.  But about 2 times during these last 4 weeks I needed to ingest it to get to sleep.

[Nanda]

@sapo @Altostrata @Shep

so it would be better for me to stick with a dose of clonazepam that stabilizes me and starts lowering duloxetine first?  Would making a bridge to fluoxetine, which is better to reduce, as it has drops, be a good option? 
 

if it were you, what would you do?

 

 

[Altostrata]

Please stop tapering clonazepam. We need to figure out what's going on. Most likely you are physiologically dependent on it and your tapering may be causing withdrawal symptoms or an exacerbation of your underlying duloxetine withdrawal.

 

What are the current symptoms you attribute to withdrawal syndrome? How have they changed in the last few weeks, while you have been taking clonazepam? What is your sleep pattern?

 

What is your drug schedule? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. 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.

[Nanda]

1 hora atrás, Altostrata disse:

Por favor, pare de afilar o clonazepam. Precisamos descobrir o que está acontecendo. Muito provavelmente você é fisiologicamente dependente disso e sua redução pode estar causando sintomas de abstinência ou uma exacerbação de sua abstinência subjacente da duloxetina.

 

Quais são os sintomas atuais que você atribui à síndrome de abstinência? Como eles mudaram nas últimas semanas, enquanto você estava tomando clonazepam? Qual é o seu padrão de sono?

 

current symptoms: very strong pressure on the head that the eardrums even hurt.  My sleep is not regular, I have difficulty falling asleep and I spend the whole night waking up.

[Altostrata]

Has the clonazepam helped you sleep?

[Nanda]

8 horas atrás, Altostrata disse:

O clonazepam o ajudou a dormir?

When I was on the 1.6mg dosage, yes it helped my sleep, so much so that I stopped zolpidem.  But when the doses were decreasing the bell got much worse, that's when the doctor wanted to introduce mirtazapine 5.5mg, which even made me sleep, but made me sleepy and off all day.  That's when the doctor ordered him to stop the nightly doses of clonazepan and just stay with the mirtazapine at night, that's when the hell of the pressures on the head started.  I only did this for two days and I couldn't stand it, I completely stopped the mirtazapine and kept it on the nightly dose of clonazepan.

[Nanda]

6/25

 06:30 awake
 7:30 am Clonazepam 0.4mg
 08:00 Duloxetine 30mg
 09:00 - 11:00 Light pressure on head and ears
 12:00 Strong pressure in the head and ears
 1:30 pm Clonazepam 0.4mg
 14:00 - 18:00 light pressure on the head
 18:00 strong pressure on the head, eardrums aching
 7:30 pm Clonazepam 0.4
 20:00 light pressure on the head
 10:00 pm bed, but I can't fall asleep
 23:00 5.0mg of zolpiden and slept

 Note 1: the dose of clonazepam was increased on this day to 1.2mg, as the pressures on the head and ear were unbearable.

 Note 2: I wasn't taking zolpiden, but that day I could only sleep with it.

[Shep]

@NandaThanks for starting your daily drug and symptoms journal.

 

 

1 hour ago, Nanda said:

7:30 am Clonazepam 0.4mg
 08:00 Duloxetine 30mg

 

Please note the "moderate" drug interaction between these two drugs:

 

Drug Interaction Report

 

Questions:

 

• Have you always split the clonazepam dose out 4 times a day?
• Do you take it every day at these same times of the day?
• Do you wake up with head pressure and find that taking the 7:30 am dose of .4 mg clonazepam stops the pressure? 

 

[Nanda]

6/25

 7:20 am awake, pressure in the head and ears moderate, mild anxiety (with pressure in the throat)
 7:30 am Clonazepam 0.4mg
 08:00 Duloxetine 30mg

tomorrow post the rest of today