SonSetFree: starting my journey of healing (Wellbutrin, Cymbalta, Trazodone)

[Colonial]

2 minutes ago, SonSetFree said:

 Note: I stopped seeing the anxiety and crying spells at that particular time of the day with the doses.  But I still have these episodes 2-3 times a day (sometimes more) at random times.  I believe this is the general discontinuation of the original Wellbutrin/Cymbalta.

 

Yes, it could be cymbalta wellbutrin wd together.

You did jump from rather high dosages of both ( in relation to last stable dose)

 

I still would not reinstate more than 0.6mgs on the cymbalta to start, since even the 2nd dose of the Wellbutrin was enough to trigger some episodes.

This is the  tricky part, "we" may get worse before better, since some side effects can hit before the wd stabilizes.

 

Also, you have an severe interaction there with the trazadone and Remeron, so let's call the Brassmonkey in to look it over.

 

Interactions between your drugs

Major

traZODone  mirtazapine

Applies to: trazodone and Remeron (mirtazapine)

 

Using traZODone together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

 

@brassmonkey It's a bit out since July 5th so I wouldnt go further than 0.60mgs of cymbalta reinstatement to start.

Last reliable estimate was 3.3mgs cymbalta down to about 0.6 July 5th when we jumped off.

 

Any thoughts on the Remeron added in giving the stomach pain issues?

 

[brassmonkey]

In a simple list form what are you currently taking and when?

 

If I have picked out the right numbers your current doses are low enough that the interactions shouldn't be a problem. What you are seeing is the lack of stability causes by a large number of dose changes to multiple drugs over a short period of time. The CTs and large changes, the changes in timing etc. have totally confused your body. What seems to have started as a simple adverse reaction to one of the mediations has turned into a major case of instability that is going to take some time to sort out. Once we find out exactly where you are at we can come up with a plan to get things stable. 

[Colonial]

@brassmonkey Thanks for checking in.

 

Son has the signature line pretty much up to date on what they are taking right now since July

Basically there were, in essence, 2 cold turkey's - rushed tapers that both ended July 5th.

 

The Wellbutrin was reinstated to  22mgs but Son was looking for advice on reinstating the Cymbalta this far out.

I said considering 9 months ago Son was down to 3.3mgs I wouldn't start any higher than 0.30mgs 2 times per day.

 

Son did a great job working with me to get the last 4 months listed in fair order.

I think your right the biggest issues has been the on and off again, and time changes.

Which is why if they are going to reinstate the Cymbalta, I thought it best to get all the changes done close together so avoid the yo yo affect.

 

I'll let Son come in and add anything else they feel and then they can tag you in their reply as well.

Thanks! 🙂

 

2021 May Trazodone Dose drop from 75 to 50 - Started Muscle Cramping and Spasms
2021 July 5th Stopped Cymbalta After 3 YR Taper (No method, I removed flakes based on how I was feeling.  Got down to 4 flakes, or 0.6mg before stopping)
2021 July 5th Stopped Wellbutrin cold turkey (was taking 75mg.  Over last week on Wellbutrin, I skipped days taking 100mg SR every other day) 
2021 Aug 3rd:  Start Remeron 7.5mg at Night 

2021 Aug 23rd: Reinstated Wellbutrin 10mg AM / 10 mg PM, Stopped Remeron

2021 Aug 30th: Changed WB Dosing to 10mg AM / 5mg Mid Day / 8mg Early Evening

2021 Sept 1st: Reinstated Remeron 7.5mg for sleep

2021 Sept 14th: Changed WB Dosing to 10mg AM / 6mg Mid day / 6mg Early Evening
Currently on Trazodone 50mg and Remeron 7.5mg and Wellbutrin 10mg AM / 6mg Mid day / 6mg Early Evening

[SonSetFree]

Hi Colonial and @brassmonkey,

 

Sorry, correction on my Cymbalta taper.   I was basing my Cymbalta dose based on an assumption that there are 120 beads per capsule.  There are 205-207 per capsule.  I just counted two capsules.  So my estimated dose drop for Cymbalta toward the end of my taper as I was removing 2-3 beads every 4 weeks or so;

 

January:  20 Beads = (20/205)*20mg = 1.95mg  to July:  4 Beads = (4/205)*20mg = 0.39mg

 

So my jumping off point for Cymbalta was 4 beads = 0.39mg.  So do you think 2 beads twice a day to start?  That's 0.39mg a day.

 

Son

[Colonial]

19 hours ago, Colonial said:

Since these beads are not the same weight, you would need a scale to weigh a bunch out, crush them and then make up dosages, I assume like your doing now with the Wellbutrin. 

 

I'm unaware of Cymbalta beads all weighing the same amount, so they will not have the same amount of active ingredient in them.

Hence the need to weigh them to decipher how much active ingredient is in each bead.

 

So, as stated, you would need to weigh the entire contents of a capsule, then a certain amount of them as a stock pile, crush them up together and then weigh out the individual dosages. This may seem excessive but taking any 2 beads will vary dose to dose and inconsistent dosing can be worse than just staying off of it

 

While it still was too fast of a taper, of about 75% in 6 months, you have not had any since July 5th.

Reinstating what you think you were taking at the time may now be too high.

 

Half of what you were on would now be 0.10mgs 2 times a day for a total of 0.20mgs.

The question is, if you jumped off from that much lower of a dose than you thought is reinstatement wise at this point if getting exact consistent dosing is going to be problematic if your planning on just taking beads and not weighing them.

 

I would be hesitant to recommend returning to just consuming random beads now that you are so destabilized.

[ChessieCat]

16 minutes ago, Colonial said:

crush them up together and then weigh out the individual dosages.

 

@SonSetFree

 

 

DO NOT crush them.  From Post #1 of the tips-for-tapering-off-duloxetine-cymbalta which has a lot of information about how to get the dose you need.

 

 

 

On 5/7/2011 at 5:26 AM, Altostrata said:

You cannot crush the beads (see http://survivingantidepressants.org/index.php?/topic/275-do-not-crush-list/page__view__findpost__p__3021 ) or dissolve them in a solution -- the drug would never get into your system, it would be destroyed in your stomach and you would have immediate cold-turkey withdrawal.

 

[Colonial]

@ChessieCat

 

Thank you! 💗

Got my meds mixed up, thanks for the link.

[SonSetFree]

Thanks @ChessieCat @brassmonkeyall for chiming in to help!

 

@Colonial Ok, so I am looking at one Cymbalta bead which is about 0.10 mg 2X a day.  It’s such a small amount I wonder if it will even break the blood brain barrier.  Has anyone heard of such a small amount knocking out withdrawal?  In @Altostratareinstatement guidelines, I’ve heard reintroducing at 0.5 to 1 mg.  
 

Despite my destabilized state, given it is such a small dose, it seems worth trying before the 3 month window.  What would you all do in my shoes?  Like a lot of folks on here I am really struggling.  I sound exactly like the guy from Kentucky (Huff) in this article who WD from Cymbalta:

 

https://www.drugwatch.com/cymbalta/side-effects/

 

If I do reinstate, how long would I give it at that dosage?
 

Also, If I am on such a small dose, how would I taper off of it down the road?

Thank you all!  
 

(20mg/205beads=0.098mg)

[Altostrata]

Yes, 2 beads might be a good way to start. Why do you want to take your dose twice a day?

[SonSetFree]

Hi @AltostrataColonial suggested 2X a day because of shorter half life.  

[Altostrata]

Maybe. But it's only 2 beads. How about taking them 6 hours apart?

[Colonial]

 

Hi, your very welcome.

Most stabilizations take some months.

I felt somewhat normal again after 6 and I waited 9 months to begin tapering again

 

As to how to taper off, that's a good question, which is why I wanted to tag Brassmonkey or someone else in who know this med better before the discussion went too far along because if you only have different beads to work with to reinstate,  how to get correct dosages as close as possible for dosing up or down is important.

 

I suppose you can attempt to weigh the beads and just take out the ones that do not fall very close in weight to each other.

Then if your only taking the ones that are most alike your dose is stable.  If you start taking two, and it is enough, when you are ready to drop, you would just drop a bead at a time total if there is no liquid prescription available.

 

As for whether your brain will register that dose, again each med is different, but I felt the drop in my paxil from 0.24 to 0.22, and for some meds it is good to get down to as close as 0.01 as you can before dropping, so I think your brain will register it.  If it will be enough or if you will need to go up 1 to 0.30 a day you can't tell ahead of time.  And if it does work, and you stabilize on it long enough than going off the same way, one bead at a time is the best you can do. 

 

 

[brassmonkey]

One of the biggest problems of tapering Cymbalta is working with the beads. They can not be crushed or turned into liquid because that will render them useless. The only way is to gradate the beads by size, large, medium, and small. Then mix and match the different sized to slowly reduce the dose. Ending with the smallest bead possible, using that as long as you can and then making the jump.

[SonSetFree]

Ok, I started reinstatement of Cymbalta yesterday.  One tiny bead (~0.1mg) at 10:00 AM and 4:00 PM.

 

the Good:

I got the best sleep last night that I have had since this all started over 2 months ago!  Slept 7 hrs, not straight through the night but previously I got 2-4 hrs.

 

the Bad:

I feel agitated which is a new symptom, like I have to do something.  

I feel like a different person...very surreal.  This was in a depressed bad kind of way, like I'm underwater.

Today I feel still the above symptoms plus nausea

 

@Colonial and all, any thoughts on whether this kind of stuff is to be expected with reinstatement and will settle, or would this be considered an adverse reaction and stop?

 

Son

 

 

 

 

 

[Colonial]

Did the new symptoms start yesterday after the first dose or not until after the second dose?

Why are you only taking them 6 hours apart? We discussed the 12 hour half life.

 

When you are taking them this close together,  it looks something like this: from 10 am 4pm you have 1 pill in your system.

Once you take that second one at 4pm to 10pm, 6 hours, you have the full dose in your system until 10pm.

 at 10pm to about 4am your at about only  75%,

and then from 4 am until 10 am, you are about 25%.

 

Your going from full dose for 6 hours from 4pm until about 10pm,

and then only about around 25% dose for 6 hours from 4am until about 10am again.

 

Granted, that's an average, but the further apart your dosages are,  you don't have that drop towards the end. 

It may not sound like a big deal, but something as simple as the levels coming up and down more than necessary can make you symptomatic. 

Being symptomatic from levels being up and down can be misinterpreted as needing more to stabilize or side effects or adverse reaction.

 

You seemed to have an uptick of symptoms from going back to the Wellbutrin for a bit.

This is always the question is in a temporary side effect or adverse reaction, or interdose wd from taking both dosages too close together,

 

At what times of day yesterday and day did each symptom come?

Can you pin point them down better to your med timing?

Did you ever have any of those before.?

 

Also, you have to keep in mind this is your 3rd reinstatement in about 2 weeks.

It could be a totality, a systemic reply to of all the meds , 2 of which you have been off since July, coming back into your system very close together.

And you were not o both the cymbalta and the wellbutrin with the remeron, so there may be some interplay there.

 

 

 

Edited September 22, 2021 by Colonial

[SonSetFree]

The symptoms were more pronounced after the second dose and also this morning before the morning dose.  So yes consistent with the ups and down inter dose you are stating.  I will switch to 12 hours apart like you initially suggested.  
 

On your second question, I have felt the underwater surreal feeling before, especially at the beginning of initial discontinuation of WB and Cymbalta, then subsided when I reinstated Wellbutrin.  I felt agitation before but only when I first reinstated Wellbutrin, but then settled down after.  

[Colonial]

As long as nothing is brand new and everything did resolve before in time it looks like the unfortunately normal response to activation and dose changing.

I would continue to keep good symptom notes for 2 weeks and see how things even out as the days go by.

As long as your getting more sleep back and the other symptoms start to recede over a week or so, it seems like a good plan.

Sleep is everything.

 

This is one of those catch-22's where too much tweaking of dosages every week is just as detrimental to stabilization as getting the dose right but the good news is the amount is enough to register in your system, so you may need some time to see if this is really a good amount.

 

Taking as close to every 12 hours as you can ( don't be obsessive) you should stay within 60-75% of the total dose in your system throughout the day, it being a little lower in the few hours before the dose and higher after.

 

Also, if you take a dose closer to bed time, you may sleep through the wort of any symptoms, if it helps sleeping again that would be wonderful.

Sleep coming back is so important for the nervous system to heal.

 

[SonSetFree]

Yes I am so fortunate to have sleep last night!  Thanks for your continued support.  You are truly worth your weight in gold for what you are doing on here.

 

Ok, will stay the course and keep a good journal.  Staying positive that these symptoms will start falling off!!

 

Question for @Go2zero or @brassmonkey I read the tapering tips for Wellbutrin, but still not sure.  If I am cutting my Wellbutrin 75mg IR down to about 1/8 pie slice pieces or less, do you think I need to grind up the pill down to a powder and mix prior to weighing out my dosing, or do you think the distribution is uniform enough to take in small pieces?

 

 

 

 

[SonSetFree]

Also, @ChessieCat @brassmonkey I read in link below that I am supposed to take the Cymbalta beads with an enteric capsule to pass through stomach intact.  Can you confirm this?

 

https://www.cymbaltawithdrawal.com/topic/9701-weaning-off-my-last-2mg/page-3#entry81374

[brassmonkey]

The beads can be taken by themselves, they do not need a capsule. But they can not be crushed or cut.

[SonSetFree]

Hi @Colonial

 

Please help.  I am on day 8 since reinstatement of Cymbalta at one bead morning, one bead evening.  

 

The first 3 days, saw improvements in sleep and appetite.  Since then the insomnia is back and the depression and anxiety have not improved and maybe have gotten worse.  Today I am feeling the worst I've felt in a while, haven't left the bed accept once and had a major meltdown...first of its kind since WB started.  Not sure if this is still getting adjusted to Cymbalta or if I am on the wrong path with reinstating Cymbalta this late.  Thoughts?

 

Alto Strata's write up on reinstatement advises most drugs take a week to reach steady state and to give it till then and if no adverse reaction, you can consider going up.  I read Cymbalta reaches steady state in only 3 days.  Maybe I need to try a higher dose of Cymbalta before quitting?

 

Also, I continue to have bad stomach pain, it's stinging and constantly gurgling and hurts all the time.  It was there but worse since Wellbutrin reinstatement.  Have you seen this symptom on WD?  I mostly just see nausea and diarrhea.  Should I consider the stomach issue an adverse reaction?

 

Thank you so much for all your support,

 

Sonsetfree

[Colonial]

If your feeling worse, the last thing to do would be to take more.

 

It could be the Cymbalta alone, or it could be that you reinstated so many things at once and started the Remeron,  a synergistic effect.

This is why making more than one change a month is problematic, it may go well but if it doesn't you don't know what's to blame.

You may likely settle down in another week, I don't see anything that screams out adverse reaction but more of total system upset.

 

It could be your body is rejecting it, OR IT could be the dose is not the same each time your taking it.

Are you weighing them to see if your taking ones that are all close?

Being even 10% off in your dose every 12 hours will make you symptomatic.

 

I lived that for the past year with the liquid Paxil, not being able to get correct dosages from the tiny syringe.

I finally had to get it compounded exact.

 

If you had the stomach issue from the wd, it's not an adverse reaction per se, it's your body trying to adjust to the on again off again med cycles.

Sometimes people get worse before they get better after a reinstatement but you know that's a possibility going in.

 

I think you need to investigate just how different per dose the weight (and therefore the dose) of these beads are.

 

 

Edited September 28, 2021 by Colonial

[SonSetFree]

Thanks @ColonialThese beads are too tiny to register on a 0.001 mg Gem scale.  Can't discern different sizes by the naked eye either.  I would need a microscope or maybe a magnifying glass would work.  So you think it's too soon to give up on the Cymbalta assuming we can level out the doses?  What if there is no way to get the beads more precise? 

 

I was thinking it could also be that it is such a small dose that it doesn't always register into the bloodstream some days.  

[Colonial]

2 minutes ago, SonSetFree said:

These beads are too tiny to register on a 0.001 mg Gem scale.  Can't discern different sizes by the naked eye either.

 

It never ceases to amaze me how powerful any single minute molecule can be on the human body.

It really is something, isn't it?

 

IF there is no way to get it precise, which outside of a pharmacy compounding for you may not be if they don't register on a scale, than you have to decide to either wait it out for another week or 2 and see if it's a temporary upset (possible, I got much worse for about THREE weeks before I got better), or to cancel the reinstatement. 

 

If it's making you symptomatic, than its likely it is registering each time you take it.

But again, it may be the cumulative effect of everything, and not just the beads alone.

 

Tough call.

I don't even know who to tag on this for their 2 cents worth.

 

 

[SonSetFree]

it is amazing and scary!  I was so hopeful when I got sleep the first night...and the third night.  Seems like enough hope to keep going a little longer.  Did you suffer much from insomnia?  How long can anyone deal with 1-3 hrs a night for months?

[Colonial]

I went on 2 hours a night for 5 weeks.

I suppose whatever your body can do for a month it can adapt to do for 90 days without too much difficulty.

Hard to say.

[SonSetFree]

Hi @Colonial

 

Checking in, been a little over 2 weeks since I reinstated Cymbalta (1 bead morning, 1 bead night). 

 

The Good:

I got 3 nights in the last 2 weeks where I slept more than 3 hrs.  That was unprecedented before.  On the nights I slept, the following day was less symptomatic and I was able to go to my son's football game and to the store once.

Less Stomach Pain Overall.

Appetite Back

 

The Bad:

Sleep and Appetite was improving in week 1, BUT week 2 pretty much back to no sleep and no appetite

Anxiety level has overall increased, especially days with no sleep where it becomes unbearable (panic attacks/breakdowns)

Depression level overall higher (also unbearable on days without sleep)

 

It's perplexing, seems the Cymbalta was helping in week 1.  Then Week 2 not as much.  I am coming off of my menstrual cycle (I am in day 6 of my period).  Maybe that is why Week 2 was so bad?

 

Not sure whether I hold a bit longer or go up on Cymbalta 1 Bead.  Despite the period might be the cause for the bad week, given it's been 2 weeks and 2 days I feel like increasing Cymbalta 1 bead is worth a shot, to see if I get my sleep again.  To you point, sleep is everything.  What do you think?  

 

Keep in mind I am also in my reinstatement of Wellbutrin.  I am still at 22mg a day.  Thinking an updose there is also in the discussion at the appropriate time.  Two reinstatements is tricky...what do you do?  

 

-Son

 

[Colonial]

1 hour ago, SonSetFree said:

t's perplexing, seems the Cymbalta was helping in week 1.  Then Week 2 not as much.  I am coming off of my menstrual cycle (I am in day 6 of my period).  Maybe that is why Week 2 was so bad?

 

Yes, hormones are problematic.

How long after the first day of your cycle did you notice symptoms?

I was a day 4 person, IF it was going to be problematic for me, and if so, 5-7 days of worsening symptoms.

If it's day 6, you may want to hold for another week for everything to settle.

I wouldnt be against raising to a 3rd bead in theory in the future, but I think it's still very soon considering all the changes involved.

 

Since you did see improvement before the cycle, the 2 MAY be enough, and adding a 3rd may "Reset" the amount of time before stabilization again.

That would mean next month your period could send you for a tailspin again.

Periods are a bad indicator of if we need a med adjustment.

 

16 days is not all that long, you could be JUST around the corner to feeling better.

When I changed formulas of my paxil, I got worse before better, and it was 38 days before I smoothed out.

The worst of it was 22 days from the time I registeredd the formulary change to I woke up one day feeling human again.

[SonSetFree]

2 hours ago, Colonial said:

How long after the first day of your cycle did you notice symptoms?

I was a day 4 person,

I started on 10/2 and symptoms intensified 10/6, so day 5.  That’s interesting.  And it would last 5-7 days…  Ok will hold steady and see if this clears up.  Thank you and all my best 🙏 

[Colonial]

Well, my symptoms always started on day 4, for a percentage of us we become symptomatic later than others who would start a wave with the regular PMS 2 days before or starting the day of. And my worsening was that long, hopefully you will settle that fast, but it is relative to how destabilized you are and all the med changes.  Hopefully it will not last too much longer than a week or 10 days and be less or non existent next cycle.

 

Have a great night

Edited October 8, 2021 by Colonial

[SonSetFree]

Got it that makes sense. Thanks and good night.  

[SonSetFree]

Hi @Colonial

 

Was starting to see some relief, things began to ease up.  Was sleeping again past 3 nights...less anxiety and depression during the day.  Then, randomly last night, no sleep and today the anxiety and depression, along with feeling sick has been unbearable.  So discouraging, I haven't changed anything.  Feeling hopeless.  Any encouragement appreciated.  

 

I really hope you are doing well and appreciate you so much.

 

Son

[Colonial]

3 good nights sleep is a great sign, especially so soon after your cycle on top of all the reinstatements!

1 day or even 1 week of symptoms is all part of the window-wave pattern.

It took me 38 days to stabilize after changing med formulations and it made me extremely seriously ill during that period.

3 nights straight I thought I was dying, couldn't inhale, couldn't swallow, paralysis, all really life threatening issues.

 

That's not to down play your symptoms, which I've had too and they are horrid in their own way,

but they are to be expected and not all that serious.

It's just when you start to feel better, and a wave hit you don't know how long and how bad, right?

It turns into a guessing game in your head what your possibly in for and how long it will last.

 

But you actually started feeling better about a week after it started so that's pretty normal for a hormonal induced uptick.

Best advice is, knowing your reacting pretty much normal, try to avoid thinking about the symptoms while you have them.

The more you think about them, the your body thinks they actually legitimate and gives them more energy.

 

It's been less than a month for the cymbalta and remeron and less than 2 for the wellbutrin,

hopefully at the 2 month mark for the last reinstatment (Oct. 21st) You will start having longer windows and less powerful waves.

Hopefully the next cycle won't be as bad either!

 

 

Edited October 11, 2021 by Colonial

[SonSetFree]

@Colonial

 

Hi Colonial, still hanging in there.  Tomorrow will be 1 month since reinstatement of Cymbalta, and about 2 months since Wellbutrin.  

 

As a whole I can say the Cymbalta reinstatement has helped my sleep and appetite and stomach problems, but the Anxiety and Depression is still overall worse than before Cymbalta reinstatement.  I am having regular anxiety attacks/meltdowns 3-4 times a week on average.  This is new and didn't happen before Cymbalta.  The meltdowns have been anxiety fear, wringing of hands and pacing, then to anger/rage/frustration (punching the wall, etc.).  This is what I grew up with and why I was put on meds in the first place.  I also still have on again off again physical symptoms as well, muscle cramping, frequent urination, ringing in ear, fatigue and shortness of breath.  

 

Overall I am still not functional and quality of life is very poor.  I am unable to watch tv, surf internet or construct an email (my husband is typing this for me).  I would have expected the reinstatement to address more and hasn't and want to discuss an updose.  Right now, I'm leaning on the Wellbutrin on the next round, trying an increase from 22mg daily dose (broken into 3 doses a day).  The reason I am thinking Wellbutrin is I'm hoping it acts on the anxiety and depression symptoms which the Cymbalta seemed to only aggravate.  On the other hand, Cymbalta seems to have had the biggest overall improvement effect and maybe I am just not at the right dose yet to knock out the other symptoms.  I am unsure which of the two would be the best option.  Please let me know what you think and if you could solicit any advice from others you think might have insight.  

 

All my best to you,

Son

[Colonial]

This is difficult because it's good that your improving, but it's hard to tell at this point if the negative symptoms are a temporary issue , like I had changing over to a new formula that lasted almost 40 days, or if they are a sign your now have adverse affects to the Cymbalta.

 

The sleep  improving is always the best first sign that the system will settle down and the negative symptoms may just be temporary.

 

I do NOT think raising the Wellbutrin is a good Idea, more of one drug will not help an adverse reaction to another.

 

 

Let's see what some of the moderators more knowledgeable with the adverse issues with Cymbalta think, but I would either wait another few weeks or lower the Cymbalta if you think it's more problematic than a help, and see if one of them can discuss which they think this is, adverse reaction or temporary issues.

@Shep @Altostrata

 

 

[Colonial]

This is difficult because it's good that your improving, but it's hard to tell at this point if the negative symptoms are a temporary issue , like I had changing over to a new formula that lasted almost 40 days, or if they are a sign your now have adverse affects to the Cymbalta.

 

The sleep  improving is always the best first sign that the system will settle down and the negative symptoms may just be temporary.

 

I do NOT think raising the Wellbutrin is a good Idea, more of one drug will not help an adverse reaction to another.

 

 

Let's see what some of the moderators more knowledgeable with the adverse issues with Cymbalta think, but I would either wait another few weeks or lower the Cymbalta if you think it's more problematic than a help.

 

Unfortunately, I can't tag for some reason right now on the connection I'm on.

Tag in both shep and alto and see if one of them can discuss which they think this is, adverse reaction or temporary issues.