Riccardo: duloxetine sexual problems / withdrawal symptoms heart

[Riccardo]

Hi Everyone,

 

First of all, thank you for having me in this community and for the time you will dedicate to support. It's already a relief to be able to speak about certain problems here. 

 

I have been trying to get off Cymbalta 60 mg (which I have been taking for almost 15 years); I never really had problems with it, if not for the fact that it personally makes it quite difficult to climax during sex. As I would like to become a father, I tried (regretfully) to stop and go cold turkey. For the first 2 weeks, except some brain zaps and general irritability, I have to admit that things were not so bad. After that phase, I was feeling pretty ok.

Then real hell started: after something like 6-7 weeks I started feeling chest pain and left arm numbness, associated with, anyway, a constant feeling of tiredness. Some sleeping problems but not impossible to cope with. 

As I got really scared about the physical pain (something related to the heart?) I got back on the medication, but this time with half dose, 30 mg, at least to cope with the symptoms (which are definitely reduced, if not almost disappearing) and it seems to be doing the trick. Anyway, in few days I am going to a psychiatrist to discuss about all of the above, as I still consider professional help advisable and I admit it was reckless to stop abruptly (at least, for me).

 

My questions are: 

1. Does anyone have problems ejaculating while on Duloxtine? If so, is there any way to cope with it / improve it? 

2. About withdrawal symptoms, has anyone ever felt this pain that seems to be heart related? I have to assume it's a withdrawal sign, since once I took back the medication, pain basically went away.

 

Thank you to anyone who will reply, I really appreciate it.

I want to send all of you positive feelings, good energy and strength. Do not EVER give up. 

 

[Frogie]

@Riccardo

 

Welcome to SA. We are a volunteer run site with members such as yourself tapering off or have tapered off antidepressants.

 

This is your introduction page. This is where you can receive information, ask questions and meet other members. We ask that each member only have one page so we can keep all you information in one place.

 

First, can you please create a signature. That helps us see your medication and dates in one place. Thank you.

 

Instructions:  Withdrawal History Signature

 

I would stay on the 30 mg Cymbalta for a while before tapering off. You have a very sensitive nervous system from going on and off and it needs time to heal.

 

 

Why taper by 10% of my dosage?

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

What is Withdrawal Syndrome?

 

Brain Remodelling

 

Anhedonia, apathy, demotivation, emotional numbness

 

Asthenia / Muscle Weakness

 

Brain Zaps

 

Post-SSRI Sexual Dysfunction PSSD

 

We don't suggest supplements on here except 2 that are calming the the nervous system to some members. If you want to try one, try a small amount, wait a few days before introducing the other.

 

Magnesium

Omega-3 Fish Oil

 

Here is some information on talking with your dr.

 

How do you talk to a doctor about tapering and withdrawal?
What should I expect from my doctor about withdrawal symptoms?

 

I hope you will reach out to us with any questions you may have.

[Riccardo]

 

Hi Frogie, 

 

Thank you so much for your tips and info. 

I would have a question about Cymbalta withdrawal: I got really scared after abruptly stopping the medication (after some weeks) when I started feeling chest pain and in my left arm (only the left one). 

As it got better once I reinstated duloxetine (this time half dose) already after few days, I assume it is a withdrawal symptom. My question to you (and anyone who would read this) is: is it common? Can it be life - threatening (like leading to a heart attack)?

 

 

[Frogie]

@Riccardo

 

No, I would think it is not life threatening, but if you feel like you should see a dr then you might want to so you are reassured. 

 

It is just wd symptoms, unfortunately.

 

One Theory of Antidepressant Withdrawal Syndrome
What is Withdrawal Syndrome?
Is it withdrawal or relapse?  Or something else?

[Riccardo]

Thank you so much for your reply. The fact that most likely it is not life threatening helps to cope with it.

 

You know, when you hear about chest pain, left arm numbness / tingling and for the first time in your life you start seeing your left wrist pulse (which was never visible before) it can get pretty scary.

If you are also dealing with some anxiety and tiredness, it's easy to assume the worse, that's why I asked.

Of course I will mention this to my doctor as well, but your reply is already something that makes me feel better. 

[Riccardo]

Hi @Frogie 

 

You mentioned "I would stay on the 30 mg Cymbalta for a while before tapering off. You have a very sensitive nervous system from going on and off and it needs time to heal.".

I know that every person is different and reacts differently, but I was wondering how long (average) you intend "for a while". Would you consider weeks, months?

I am not in a rush, I want to do things right, I just want to know more or less what to expect also in terms of timing, if there is any chance to predict something.

 

Thank you so much

[Frogie]

@Riccardo

 

I unfortunately can’t give you a timeframe as to how long you might have to to stay on it before you can start tapering, but I would think a couple of months and you should be in much better shape by then. But there is no predicting because everyone is different.

[Riccardo]

@Frogie

 

Thank you for your reply. Yes, as I was mentioning, it can be quite different from person to person. 

A couple of months on 30 mg before tapering anyway, sounds already good as a generic indication. I am determined on this and surely I will listen to my body and its reactions. 

[Riccardo]

Hi @Frogie I wanted to ask you if, in your knowledge, there is a correlation between eating and having enhanced withdrawal symptoms. 

I was mentioning the heart racing and chest / left arm pain. I forgot to mention that this happens, mostly and more intensely after eating. 

Do you know if this WD symptom is common and what it can be related to? Is there any wat to cope with it? 

I was reading that it could be connected to abnormal histamine levels. 

 

Thank you

[Riccardo]

Hi Everyone,

 

So I went to my doctor last Friday and we spoke about a tapering plan. She agreed about the 30mg dose, mentioning that in my case this should be able to keep me in good shape without significant risks.

In the meantime, WD symptoms became less and less intense. The pain in my left arm is not so strong now (still a bit, but way less), I just experience some dizziness, which anyway is manageable.

 

I was advised to stay on 30mg for like a year, then evaluate the possibility to taper further and eventually get off the medication.

 

Now, this seems to me a bit much, but I don't want to overdo it either; As one moderator in this forum had advised me, anyway I should stay some months on 30mg and see how it goes, before considering any further action. Maybe it won't be a full year, but I see that both experienced people in this community and my doctor agree that I should stay on 30mg for some time, so I will. 

 

 

 

[Hangingin]

Hi Riccardo,

After I had (mistakenly) gone "cold turkey" 3 months in 2014-2015 (with horrendous side-effects), I went back on the Cymbalta again for at least 1.5 years.  That worked for me as there was a lot going on for me personally (deaths in the family) and didn't want to complicate things.  However, I believe each person's chemistry is different so as you stated, you should see for yourself what makes sense - based on how you actuallyl feel - in terms of stabilzation before attempting to taper.

[Riccardo]

Hi Hangingin,

 

Yeah I totally can relate with the horrendous side-effects after going cold turkey. Really bad idea. I am sorry you had to go to the hospital for that. 

I can see that now you are down to 10 mg (after taking - I assume 60? mg) for 14 years. How are you handling with 10 mg currently? 

[Hangingin]

Hi Riccardo, actually, originally I was only on 20 mg/daily (then up to 30 mg for about 1 month) and back to the 20 (there wasn't much taper needed b/c I had only been on the higher dose a month).  Regarding my taper since then, I know it seems that going from 20 to 10 is not a huge leap, however, if I've tried going faster, I've had significant issues.  I recently read an excerpt from a published study that even at 5 mg, there ~44% bioavailabililty of the drug in one's cells (apparently, this "saturation level" so to speak is a key factor).  So, it makes sense there's a problem with going too fast.

[Riccardo]

Hi Hangingin, I can imagine that from 20 to 10 still is a huge step; after all, it's about cutting 50%, even if we are talking about "just" 20 mg compared to 60.

I am quite interested about the excerpt you mentioned, but I did not really understand this part 

 

"even at 5 mg, there ~44% bioavailabililty of the drug in one's cells (apparently, this "saturation level" so to speak is a key factor)"

 

Could you please clarify for me? Sorry for my ignorance, I am trying to gather some knowledge on the matter - I think that the more I know, the better I can approach any issue related to tapering and WD in general.

 

 

 

[ChessieCat]

Why taper paper: dose-occupancy curves

[Hangingin]

Hi Riccardo...regarding my quote about bioavailability (the scientific term is SERT occupancy) here is some content from a post in another Cymbalta-related forum.  It's a summary of the article and then a link to the actual research paper.  

 

Meanwhile, you had asked how I'm doing on the 10 mg.  Quite well - but only if I continue to go slowly - 5% drop every 2-3 weeks or so.  I did try faster once but withdrawal symptoms came back with a vengeance.  The following gave me the answers regarding this phenomenon:
 

There is a scientific evidenced based rationale for why the last 30mg of Cym can be more difficult to taper off for some people.

It is due to the hyperbolic effect of how Cymbalta blocks the serotonin receptors. One would think that the lower you go in mg dose of Cym the less serotonin receptors are blocked but this is not the case.

Please read over the below summation of this current research.

One of our members recently did his PhD research on antidepressants withdrawals…. There is a pinned post from Oct 22 which explain the need to slow taper and the link to his research. The below is just his summation from his post….

****************

So, I did my Ph.D. on psychiatric drug withdrawal recently. One project was to determine the relationship between antidepressant dose and serotonin transporter occupancy, which is the primary biological effect of antidepressants.

They occupy the serotonin transporter which in turn increases serotonin levels in the brain.

The reason this is relevant for tapering is that withdrawal symptoms arise when the biological effects decrease upon dose reduction - not when the dose per se is reduced.

Therefore, you want to taper according to occupancy.

SERT occupancy of duloxetine is:

5 mg: 44±9%

20 mg: 74±7%

40 mg: 81±5%

60 mg: 85±3%

These data explain why duloxetine must be tapered so extremely slow and with such extremely small dose reductions, as you’re all aware in this fantastic group that it must. To gradually reduce occupancy, and thus minimize withdrawal symptoms, all the way down to cessation, multiple dose reductions even below 5 mg are necessary. 5 mg is not a low dose! 20 mg is not a low dose!

In essence, these data show how potent a drug duloxetine is even at one sixth of the smallest standard available dose, and that hyperbolic tapering is necessary (that is, performing smaller and smaller dose reductions as the tapering progresses).

However! These data do not mean that larger dose reductions are possible in the higher dose-range, even though the dose/occupancy-relationship plateaus. The reason is that duloxetine, like all drugs, have other biological effects than occupying the serotonin transporter, which can also cause withdrawal symptoms when unblocked.

I just wanted to share these findings with you in case it could help .

So, keep micro-tapering my friends – you’ll make it through!

- Anders Sørensen (See more at my page Psykolog Anders Sørensen )

https://www.nature.com/articles/s41380-021-01285-w...

[Riccardo]

Hi Hangingin, glad to know you are coping well. And of course thank you so much for the article and excerpt, it's really elightnening.

 

I see now why it is always important to decrease at small rates (and based on the current dosage, not the starting one). If I understand well, then decreasing from 10 to 0 mg can be more difficult (or, at least, take a longer time) than from 60 to 50. 

This is all good to know, not to put my brain and body under unnecessary stress and embrace a bit of patience while tapering.

 

What gives me hope is the fact that, while tapering and re adapting to a lower dosage, the body actually heals. It might seem crazy, but I think that it is also up to us to feel whether we are ready to decrease further or wait a bit more.

[ChessieCat]

I wrote this to another member earlier this evening:

 

Some members find that as their dose gets lower they need to reduce less and/or hold for longer.  There is no rule about when this might happen (if it does); it can be different for different people/drugs/doses/situations.  The 10%/4 week taper protocol is only a guide.  The important thing is to listen to your body/symptoms and not make another reduction unless you are stable.  If you are experiencing an illness or additional stress it is generally better to hold.  Generally it is better to hold for longer than to reduce too soon.

 

Even if you are stable you might get up with tapering and decide to have a "tapering holiday" and just have some time when you can enjoy some form of "normality".

 

The goal is to get off the drug with minimal discomfort and live your life as normally as possible.

 

Non-drug techniques

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

[Hangingin]

Hi - so glad you found this article helpful.  It helped me too - as a person who needs to know "why" 🙂  I hear you and agree that it is an individual decision as to the tapering schedule - each of us has a different "chemistry" that affects how we absorb/metabolize these drugs and as well, as psychological state - these and other variables like physical health, and so on play into how we each feel at various stages.

 

For me, it's good know "what's happening" at a biological level - its reassuring to know the withdrawal symptoms are "normal" and make sense. 

[Ariel]

On 3/17/2022 at 11:02 AM, Hangingin said:

Anders Sørensen (See more at my page Psykolog Anders Sørensen )

 

https://psykologanders.dk

[Riccardo]

Hi 
Is it possible that also the time of the day when you take a dose while tapering can make a difference? 

 

Usually I take it in the morning as soon as I wake up, but once I took it later (in the afternoon) and once I even forgot and just skipped it accidentally. I noticed that in both cases I developed mild withdrawal symptoms (which anyway lasted only a couple of days).

 

[ChessieCat]

@Riccardo

 

When taking a psychiatric drug, it is best to take it every day at about the same time.  If you take it later or miss a dose you may experience withdrawal symptoms.

 

Cymbalta has a short half life, and some people need split their dose and take it twice a day.

[modelarz71]

It is good that the restoration helps with your digestion. 
 I have restored but I don't think anything helps because the amount is too small.
I try to drink mint leaf for this digestion and yesterday I tried digestive enzyme