thenextguy: Trying to come off Cymbalta, trying bridge to Prozac - struggling

[Altostrata]

@Go2zero has been giving you excellent advice.

 

The way I interpret your recent symptoms are that when you got hungry during that long drive, your blood sugar was low. When your blood sugar drops, your body releases adrenaline to compensate. As you are in a drug withdrawal state, you are hypersensitive to adrenaline release, this caused waves of anxiety.

 

I am somewhat doubtful you had withdrawal symptoms from Prozac. Rather, you had a nasty wave. Also, were you careful to take 20mg Cymbalta at the same time each day? Irregular dosing can cause bad withdrawal symptoms.

 

I agree with @Go2zero that you have been taking too much of everything. Although you did the crossover to Prozac correctly, it probably was not necessary to take 20mg Prozac. Combining 20mg Prozac with 20mg Cymbalta risks serotonin syndrome as the Prozac ramps up.

However, you say your waves of anxiety stopped after taking Prozac. This could have been a coincidence, but in case you were having withdrawal symptoms from Prozac, I'd immediately cut back to 5mg Prozac per day. Yes, it's filled with powder. This topic explains how to take a small dose Tips for tapering off fluoxetine (Prozac)

 

Still, the 5mg Prozac will ramp up, with full effect in about 2 weeks. Over this time, please let us know how you're doing with the combination of 20mg Cymbalta and 5mg Prozac. I suspect you will be gradually reducing Prozac to zero within 2 weeks.

 

If you had asked here first, we would never have recommended a switch to Prozac to go off 20mg Cymbalta. The way you taper Cymbalta is by counting beads, see Tips for tapering off duloxetine (Cymbalta) We suggest bridging with Prozac or another drug only when a direct taper proves to be too difficult, as drug switches sometimes do not go well, not even with diazepam substitution for other benzos.

 

As @Nanda said, please stop changing your drugs. This vastly complicates your situation. Simpler is better.

[thenextguy]

Thank you everyone for your advice and support. I do think it's possible that Sunday was just a bad wave and not prozac withdrawals, but I don't know. I took 10mg today and my pharmacy is ordering me tablets, so I'll be taking 5mg tomorrow. I'll keep you posted.

[thenextguy]

20mg Cymbalta, 5mg prozac

 

A whole lot of nausea and reduced appetite the past two days. That’s about all.

[Altostrata]

9 minutes ago, thenextguy said:

A whole lot of nausea and reduced appetite the past two days. That’s about all.

 

Are these new symptoms, or different from your symptoms prior to taking 20mg Cymbalta with 5mg Prozac?

 

Be sure to keep those Prozac capsules with the powder in them, they could come in handy.

[thenextguy]

1 minute ago, Altostrata said:

 

Are these new symptoms, or different from your symptoms prior to taking 20mg Cymbalta with 5mg Prozac?

 

Be sure to keep those Prozac capsules with the powder in them, they could come in handy.

The nausea started yesterday morning. So after 3 days of 20mg Prozac. Could be related to that. I don’t know.

[Altostrata]

Yes, that was probably the 20mg Prozac ramping up. This should subside, as you've reduced the Prozac dose.

[thenextguy]

1 hour ago, Altostrata said:

Yes, that was probably the 20mg Prozac ramping up. This should subside, as you've reduced the Prozac dose.

 

I've also had a really bad sore throat the last few days. I don't know if it's related to withdrawals or if it's just a coincidence that I got strep throat right now. If it is strep throat, the nausea could be related to that. I saw a doctor today and he gave me some antibiotics for it. We'll see. 

[Altostrata]

Did the doctor take a swab first to make sure you needed the antibiotic?

 

Please be aware that taking an antibiotic can exacerbate antidepressant-related symptoms, as well as cause unpleasant gut symptoms. Do not take antibiotics unnecessarily. They are another type of drug that is overprescribed.

 

Each time you add or change a drug will alter your symptom pattern and make it more difficult to interpret any antidepressant-related symptoms you may have.

[thenextguy]

2 hours ago, Altostrata said:

Did the doctor take a swab first to make sure you needed the antibiotic?

 

Please be aware that taking an antibiotic can exacerbate antidepressant-related symptoms, as well as cause unpleasant gut symptoms. Do not take antibiotics unnecessarily. They are another type of drug that is overprescribed.

 

Each time you add or change a drug will alter your symptom pattern and make it more difficult to interpret any antidepressant-related symptoms you may have.

 

The doctor did not do a swab. It was a telemed appointment. He gave me a 5 day course of azithromycin. I was supposed to take 250mg twice today. I took one so far. I know you're supposed to finish a course of antibiotics, but I only took one pill so far. I'm thinking of giving the sore throat a few more days to resolve before I go to antibiotics. Or maybe go get it checked out in person.

 

So here's something that just happened. I was lying down watching tv. Very relaxed. And I noticed that I was feeling agitated for no real reason. I checked my Apple Watch and it said my heart rate was 110 bpm. I'm also feeling warm.

 

To recap, prozac was reinstated for 3 days at 20mg starting on Sunday. 10mg yesterday and 5mg today. 

 

I know prozac has a long half life and it's unusual to experience withdrawals so quickly. But is it possible I kindled myself with reinstating cymbalta last week. Maybe I'm more sensitive to changes in meds than normal. 

 

I wish I didn't take the azithromycin today. I didn't realize that could be related.

[thenextguy]

I should add that what I'm feeling right now is pretty similar to what happened on Sunday. It's not as bad as it was on Sunday, but it just started. 

[thenextguy]

I wonder if instead of a plan of going from 20mg to 5mg, I should go to 10mg. I took 10mg yesterday and 5mg so far today. I could still take another 5mg today. I don't think that counts as changing doses since it's the same day. 

[Go2zero]

2 minutes ago, thenextguy said:

I wonder if instead of a plan of going from 20mg to 5mg, I should go to 10mg. I took 10mg yesterday and 5mg so far today. I could still take another 5mg today. I don't think that counts as changing doses since it's the same day.

 

As we said before you need to stabilize after the bridge to prozac and bridge back to cymbalta you made. 

 

The longer you stay on Prozac the more problems you may have to get off it. We suggested several times to stop it asap by tapering to 5 mg and further to zero in maximum 2 weeks. When you keep messing around with dosage changes this may make things worse. 

 

 

[thenextguy]

Just now, Go2zero said:

 

As we said before you need to stabilize after the bridge to prozac and bridge back to cymbalta you made. 

 

The longer you stay on Prozac the more problems you may have to get off it. We suggested several times to stop it asap by tapering to 5 mg and further to zero in maximum 2 weeks. When you keep messing around with dosage changes this may make things worse. 

 

 

I haven’t done it yet. I’m just wondering if going to 5mg is too big of a jump.

[Go2zero]

5 minutes ago, thenextguy said:

I haven’t done it yet. I’m just wondering if going to 5mg is too big of a jump.

 

As we discussed before, it is choosing between being too long on Prozac and creating more problems or stopping asap since you have been not very long on it.... The bridging twice may take time to settle. This can be a bumpy ride....  You will have to sit this out..... Do not expect wonders within a couple of days.

 

If I were you I would get off the prozac rather sooner than later.... 

[Altostrata]

A word of advice: Never take an antibiotic unless its an emergency or a swab has confirmed you have an infection (bacterial) that can be treated with antibiotics. A doctor that does not do this is a slob.

 

We cannot interpret your symptom pattern because the antibiotic may have influenced it. Do not change drugs unless you absolutely have to, or we will continue to be unable to interpret your symptom pattern.

 

Please continue to report significant new symptoms.

[Nanda]

Honey, I know how scared you must be about all this.  It's really scary, I'm going through the same process and it's not been easy.  About the sore throat, I also had this week and was put on azithromycin, whether or not my WD symptoms got worse I don't know, but at least I don't have the terrible sore throat and debilitating body aches anymore.  About Prozac, in my case, I stopped completely as soon as I started having crises, it was only 7 days taking 10mg, 4 days after I stopped, I had nausea, severe headaches and lack of appetite.  I'm not a moderator here in the group, I'm just giving my report, as I might be able to help you understand some of your symptoms.  I know it's hard to stay calm when we're going through something this bad, but our bodies are perfect and will find a way to heal.  Everything you're feeling passes away.  Have you ever thought about finding a good psychiatrist to talk about what you're feeling and try to hear their opinion?  Count on me for what you need.  I will be praying for you and sending good energy here in Brazil.

[Altostrata]

Thanks, @Nanda!

[Nanda]

@Altostrata ♥️ 

[thenextguy]

Just thought I'd throw in an update. 

 

Still on 20mg cymbalta and 5mg prozac.

 

My sore throat is finally getting better. I was also given azithromycin for it. I have two more days and then I'm done with that. I went and got a covid test, but I haven't gotten the results back yet. I haven't had a fever or a cough, so I don't think it was that.

 

Overall I'm feeling pretty good. A lot of the cymbalta withdrawals that I was experiencing are starting to go away finally. The sharp pain in my shoulder is only occasionally popping up and it's pretty mild when it does. I'm still not eating much, but I'm sure that will come back, too.

 

I'm pretty hopeful that I will be able to stabilize and do a proper taper from the cymbalta. Thank you all for your help! I'll keep you posted. 

 

 

[thenextguy]

On 9/3/2021 at 3:45 PM, Nanda said:

@Altostrata ♥️ 

 

Oh, and can someone tell me how you included a screenname in your post so the person sees it? Like this here?

[thenextguy]

New symptom today. Woke up feeling depressed. No appetite (although that's not new). 

 

Not sure which med might be causing it. Today is my last day of azithromycin, so hopefully any symptoms that was causing will go away soon. 

 

But I can manage this.

[Go2zero]

38 minutes ago, thenextguy said:

New symptom today. Woke up feeling depressed. No appetite (although that's not new). 

 

Not sure which med might be causing it. Today is my last day of azithromycin, so hopefully any symptoms that was causing will go away soon. 

 

Very hard to say. While in withdrawal we have to deal with waves and windows. Symptoms come and go during the healing process. New symptoms come, other ones go. Better just see it and accept it. Analyzing every symptom may result in ruminating and stress, which both can make WD worse.

 

And as Altostrata said, taking an antibiotic can have mean effects on withdrawal. Just as lots of other meds and supplements.

 

If you really want or need to take as a med or supplement better check here before you start. We see a lot of things go wrong because of that. By checking you can prevent such...

[Camille]

On 8/25/2021 at 2:51 AM, thenextguy said:

In the last year I had decided that I haven't had a depressive episode in a long time and wanted to try to come off it

Hello @thenextguy, this forum really shows how dangerous it can be to come off ADs. Whether you are ideologically against ADs or not, maybe a pragmatic decision if you feel good enough on them, think you're at risk for Withdrawal and were put on them for a legit reason, would be to stay on them. Or at least take your decision knowing the horrors of AD Withdrawal and that tapering does not necessarily avoid these horrors. + we all know that ADs does not "cure" depression, so if you had legit depression before, there's a very good chance it will come back once you stop your meds (maybe even worse because of AD use). I am not a defendant of Antidepressant but I just think withdrawal is not worth coming off of them.

[Altostrata]

Another inappropriate post, Camille. When people are already suffering in the midst of withdrawal syndrome, it is inappropriate to harangue them about having made a mistake. Nobody can replay the past and make those decisions over again, and it is unnecessary and cruel to remind them of that.

 

You can, of course, take any psychiatric drug you choose, and I urge you to see a doctor for that rather than trolling members here.

[thenextguy]

I have considered staying on cymbalta forever. Luckily I didn't experience any side effects when I got down to 20mg a day. So I guess technically a could have stayed there. But I truly don't think I need it anymore. And just because there aren't any visible side effects, it doesn't necessarily mean it's a good idea to stay on forever. There could be long term issues that we don't even know about with SSRI/SNRIs. Medicine is great, but it should be a last resort, IMO.

 

 

[Nanda]

Hello, How are you? 

[thenextguy]

40 minutes ago, Nanda said:

Hello, How are you? 

 

I'm doing well. I think I was having a lot of side effects from the azithromycin, but now that I stopped taking it I expect those will go away in the coming weeks. 

 

Still experiencing windows & waves, but everything is heading in the right direction. 

[Nanda]

♥️ 

[thenextguy]

Feeling great. Probably 85-90% normal. It's been a week since my last 20mg of prozac and no sign of withdrawals worsening. In fact, things continue to get better. It probably was just a wave I experienced last Sunday and it was just a coincidence that the 20gm of prozac made me feel better. 

 

Still on 20mg Cymbalta, 5mg prozac. One more week until I dump the prozac.

[Go2zero]

18 minutes ago, thenextguy said:

Feeling great. Probably 85-90% normal. It's been a week since my last 20mg of prozac and no sign of withdrawals worsening. In fact, things continue to get better. It probably was just a wave I experienced last Sunday and it was just a coincidence that the 20gm of prozac made me feel better. 

 

 

So happy to read this! You are doing great. Yes waves and windows can give signals that are not signals, but just part of WD. Keep going! I am so happy for you!

Edited September 7, 2021 by Go2zero

[Nanda]

Happy for you ♥️♥️♥️♥️♥️

[thenextguy]

1 hour ago, Nanda said:

Happy for you ♥️♥️♥️♥️♥️

 

Thank you, @Nanda. I hope you get relief soon, too.

[thenextguy]

Little bit of a setback. The last couple of days haven't been as good, but nothing I can't handle. Some depression and insomnia mostly. 

 

I do have a question though. @Go2zero @Altostrata Next Tuesday I have an appointment with my psychiatrist.  I know the plan is to stop taking the 5mg prozac next Wednesday, but should I ask my doctor to prescribe liquid prozac in case I need it? I'd much rather do than than try to make my own with older capsules.

[Altostrata]

Have you told your psychiatrist of all your drug-related problems and your very recent antibiotic treatment? What is your psychiatrist's opinion about making another drug change so soon?

 

You took your last antibiotic on Sunday, after lots of adverse effects from it. We advise people not to keep changing their drugs to allow their nervous systems to settle down. Do you think next Tuesday is a good time to stop Prozac, after taking it in various dosages since August 2?

 

Please be aware that we do not treat "depression" here, that's what doctors get paid to do. The tapering and withdrawal process can be very distressing, emotional ups and downs are a natural part of it. Taking antibiotics or switching or discontinuing drugs can cause "depression". It's not a disease that suddenly pops up.

[thenextguy]

15 minutes ago, Altostrata said:

Have you told your psychiatrist of all your drug-related problems and your very recent antibiotic treatment? What is your psychiatrist's opinion about making another drug change so soon?

 

You took your last antibiotic on Sunday, after lots of adverse effects from it. We advise people not to keep changing their drugs to allow their nervous systems to settle down. Do you think next Tuesday is a good time to stop Prozac, after taking it in various dosages since August 2?

 

Please be aware that we do not treat "depression" here, that's what doctors get paid to do. The tapering and withdrawal process can be very distressing, emotional ups and downs are a natural part of it. Taking antibiotics or switching or discontinuing drugs can cause "depression". It's not a disease that suddenly pops up.

 

I haven't had an appointment yet with him since all this started. I'm going to discuss with him on Tuesday.

 

As for whether or not I'll be ready to discontinue the prozac next Thursday, I guess it will depend on how I'm feeling then.

 

However, I'm pretty confident that the depression I'm feeling is just related to the withdrawals, as it comes in waves and then I'm fine after a bit.

 

One other thing to point out, I stopped the antibiotics because the course was basically done. I did skip the final day, but I would have stopped it the following day regardless because it was only a 5 day course.

[Altostrata]

53 minutes ago, thenextguy said:

However, I'm pretty confident that the depression I'm feeling is just related to the withdrawals, as it comes in waves and then I'm fine after a bit.

 

That is possible. It's likely your psychiatrist will call this relapse.

 

53 minutes ago, thenextguy said:

One other thing to point out, I stopped the antibiotics because the course was basically done. I did skip the final day, but I would have stopped it the following day regardless because it was only a 5 day course.

 

Understood. Yet you were having adverse effects from the antibiotic. We have seen that antibiotics can rock the boat quite a bit when people are sensitized by psychiatric drug withdrawal.