hermitical deep into Cymbalta - duloxetine tapering

[hermitical]

Hi folks

 

I guess I'm looking after a little advice.

 

Been on a/d for 10 years now, intially Fluoxetine, then a year later Venlafaxine / Effexor 225mg. As I was later diagnosed with fibromyalgia I was put on Cymbalta - duloxetine 60mg and amitriptyline of which I take 10mg a night (this was after giving up on Lyrica - Pregablin).

 

I've been tapering off Cymbalta - duloxetine for the last 2 months or so. I started on 60mg, initially reducing by 6 beads a day, I soon upped that to 20 beads a day as things seemed ok. I counted them to start and made it 580 beads, though I've seen 560 elsewhere?

 

Things seem to have gone pretty well apart from my pain levels have increased a lot, and I am worn out a lot more than before (and I thought it was bad then!). There has been no major emotional dip, I'm quite irritable but we are also in the middle of a heat wave!

 

I am now down to 100 beads, with Tuesday 23rd July being the first day of zero beads at this rate. I must admit I am now more than a little scared and wondering if I should slow the taper for the last period or just bite the bullet and go for it. I was also wondering about boosting with 5-htp and l-tyrosine now that I am down to low levels of Duloxetine so SSRI syndrome won't be a danger.

 

Any thoughts or advice?

 

edited to add:

 

I should say that I am not clear of symtpoms, before and after the withdrawal I have fuzzy/foggy head, very tired, pain, nausea/hunger, dizziness and slowness, poor heat control etc etc

Edited July 19, 2013 by hermitical

[Altostrata]

Welcome, hermitical.

 

By our standards, you are tapering rapidly.

 

If I were you, I would not reduce from 100 beads, I would hold for a good time, maybe a month, to see if your withdrawal symptoms get better.

 

See our topic on tapering Cymbalta http://survivingantidepressants.org/index.php?/topic/283-tips-for-tapering-off-cymbalta-duloxetine/

[hermitical]

thanks for the reply and link...

 

I don't think the pain will improve at all. I will need to look at other avenues to work on that problem, possibly the fatigue as well as these are part of fibromyalgia.

 

In fact as I said I had all those symptoms whilst taking duloxetine, not since reducing...

[Narcissus]

 

 

I don't think the pain will improve at all. 

 

If your symptoms have worsened since tapering than they should improve by holding for a bit.  It sounds like you're suffering enough as it is, you don''t need to be throwing withdrawal symptoms into the mix.

[hermitical]

Regarding the pain, as I understand it duloxetine is now more widely used for pain than depression in the US, as such the pain is not a symptom of withdrawal it is the fibromyalgia pain becoming unmasked.

 

I wish it wasn't so hot! It isn't helping matters!

[cymbaltawithdrawal5600]

I am starting to develop some drug company cynicism. I don't know how widely it is being prescribed for pain when I thought it was clearly an AD. The commercials for it on my USA tv stations certainly warn about 'the risk factors for depression' or some such at the end of them. It may be an off-label use and would certainly be alarmed of patients decided to suddenly stop using it because they didn't think they needed it and found themselves in a full blown withdrawal unawares. You are certainly in the right place for help here as you withdraw from it and please take care. You can see from my sig my abrupt stopping of Cymbalta AND Lamictal were bad. Please go slow! It may be some time beore you can figure which is withdrawal and which is the fibromyalgia vexing you.

[WhoAmI]

Hi hermitical,

I have a similar history of AD's. I have just started tapering and am VERY tired. I just feel "wiped out". I have only reduced my dose by 10%, though (20 beads) and I'm still in the 1st week.

 

I've found a lot of help on this site and I've taken a lot of their advice, too. The gist of that advice being take it slow. I'm afraid in the next few days you may experience worsening withdrawal symptoms. I tried tapering from Effexor XR by removing one bead/day a few years back and I was fine until I got to the end. It was terrible. I wish I had known then what I know now!

 

Good luck and keep us posted how you're doing.

Anna

[Narcissus]

Sorry, I was a bit confused with your use of the word pain.  I see now that you were referring to your fibromyalgia and not the other symptoms you're experiencing.  You mention that  you've had these  other symptoms prior to tapering, have they gotten worse any worse while tapering?  

None of this is really known for certain, but I'm not sure that taking 5-htp and l-tyrosine will necessarily help prevent withdrawal syndrome.  Slow tapering seems to be the only sure bet for minimizing the risk of withdrawal.

[hermitical]

I'm maybe a little more spaced out sometimes, apart from increase in pain levels the only other change is increased tiredness, but we have had what constitutes a heatwave for the UK in the last few weeks...

[Jemima]

Hermitcal,

 

Here is our topic on 5-HTP:

 

http://survivingantidepressants.org/index.php?/topic/656-5-htp-5-hydroxytryptophan-and-tryptophan/?hl=tryptophan

 

It is fairly certain the 5-HTP won't prevent withdrawal symptoms and may even complicate the situation.  In withdrawal it seems that the fewer drugs in our systems, the better.  The only things that seem to help consistently are high quality fish oil, magnesium, and sometimes B-12, although some very sensitive people have had uncomfortable side effects even from these.

 

I agree with Alto that you should hold for at least a month.  Cymbalta is such a new drug that I'm not sure anyone knows a lot about withdrawal from it, but some drugs, such as Effexor, have a nasty way of delaying withdrawal symptoms for four or five months and then hitting a person hard (after a too-fast taper).  Best to be careful.

 

I had quite a lot of pain when I was in withdrawal from Lexapro, so withdrawal may be aggravating your fibromyalgia.

 

Welcome to the forum.  You'll find lots of good information and friendly support here.

[hermitical]

thanks I'll hold off the 5-Htp. I know there is the whole serotonin syndrome thing but have also heard some medical professionals saying it can help with fibromyalgia even if you are on SSRI/SNRIs

 

I am taking a vegan Omega 3, Vit D and B complex as well, haven't taken magnesium for a few months but will look at getting some more.

 

I am still tapering though, but have slowed it down. Maybe I will pay in the longer run and I do appreciate all the advice. I guess I am maybe feeling too cocky that I haven't felt completely dreadful so I must be able to handle it... we'll see....

[Rhiannon]

Not to be a downer, but the fact that you haven't felt terrible so far doesn't necessarily mean that all is well and you should keep going at the same pace.  Unfortunately there is a lag time with psych drug withdrawal, and the withdrawal symptoms appear and unfold out over time, usually many months.  Which means that cuts you have already made haven't fully made their effects felt yet. 

 

Your taper is faster than what we find usually works for people. Some people do okay with a fast taper, though, it's true.  However it seems that almost everyone needs to slow down when they get to the lower doses, regardless.

 

I think probably the best thing for you to do right now would be to just hold for at least a month and see if you continue to feel well. If you do, if things don't get worse, then probably the pace you've been going has been okay for you.  But I'd still recommend slowing down now that you're getting to the lower doses.

 

If you find that you become more symptomatic while holding, then that's a sign you've been tapering too fast, and you may want to increase your dose somewhat (not all the way back, just a partial reinstatement) and then stabilize, and then begin a slower taper.

 

Also, pain is a typical withdrawal symptom from ADs.  For me, it's the most noticeable, consistent withdrawal symptom that I get when I'm reducing my AD too fast.  I believe it's often described as "flu-like aches and pains." My pain usually feels like muscle and joint pain and achiness.

 

There seem to be some associations between glutamate levels and fibromyalgia, and there are definite associations between glutamate and ADs.  Just something to keep in mind.

[hermitical]

thank you

That pain is typical for fibro as well so it may well be down to both...

 

Could you explain any further about the glutamate and a/d link, I apologise if it is well known...

[hermitical]

actually a very quick google search led me stragith back here so I will take a look in the next few days!