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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by PhoenixGirl on January 13, 2013, at 18:03:25
I'm having nausea, dizziness, headaches, and those surging "brain zaps". My doc had me go from 60mg to 30mg for four days, and then stop completely as of this past Friday. I'm going off of it so I can try an MAOI (Emsam). How long does Cymbalta withdrawal usually take? I have to go to work next week, and I don't know how I will function. My doc gave me Phenergan to help with the nausea, but it knocks me out for hours. Today is a little better than yesterday, but damn, this withdrawal is hardcore.
Do you think my doc took me off Cymbalta too rapidly? A few months ago, she had me stop taking Adderall cold turkey, and I became suicidal. In a few days, she is going to have me stop taking Wellbutrin XL with only a few days of tapering.
Any thoughts/insights/hugs would be appreciated.
Posted by jono_in_adelaide on January 13, 2013, at 19:10:58
In reply to Cymbalta withdrawal HELL!, posted by PhoenixGirl on January 13, 2013, at 18:03:25
I'd say that the withdrawl was way too fast, I'd have said 45mg for 4 days, 30mg for 4 days, 15mg for 4 days at a minimum.
For nausea you could buy some OTC Bonnine, it is much less sedating than Phenergan
Taking a benzo (Ativan, Valium, Xanax) for a week or two can help with the withdrawl syndrome from SSRI's/SNRI's if you have some on hand or if your doc can prescribe you some.
Posted by alchemy on January 13, 2013, at 20:24:32
In reply to Cymbalta withdrawal HELL!, posted by PhoenixGirl on January 13, 2013, at 18:03:25
Ya, too fast for me. I hate it when psychiatrists think withdrawals aren't that big of a deal.
Going off Wellbutrin in only a few days? My body would freak. Especially when you are still in the withdrawals of Cymbalta. It might not be too bad for you, but I personally would go slower.
Posted by SLS on January 13, 2013, at 20:50:53
In reply to Cymbalta withdrawal HELL!, posted by PhoenixGirl on January 13, 2013, at 18:03:25
Hello PhoenixGirl.
It is nice to see your name reappear, but I wish it could have been under more pleasant circumstances. As with most things involving psychopharmacology, people react differently to drug withdrawal as they do with therapeutic effects or side effects. I can only speak from experience. I use a more gradual taper schedule than what your doctor recommended. I opened up the capsules and divided their contents. I pretty much discontinue drugs by "feel". Perhaps you could ride it out but apprise your doctor of your reactions and have him reconsider the rate at which he plans to taper the Wellbutrin.
I hope you feel better tomorrow. Why did you choose to go with Emsam instead of Parnate?
- Scott
Posted by SLS on January 13, 2013, at 20:53:48
In reply to Re: Cymbalta withdrawal HELL!, posted by jono_in_adelaide on January 13, 2013, at 19:10:58
> Taking a benzo (Ativan, Valium, Xanax) for a week or two can help with the withdrawl syndrome from SSRI's/SNRI's if you have some on hand or if your doc can prescribe you some.
That's a good idea.
Benadryl?
- Scott
Posted by PhoenixGirl on January 13, 2013, at 21:40:17
In reply to Re: Cymbalta withdrawal HELL! » PhoenixGirl, posted by SLS on January 13, 2013, at 20:50:53
Emsam is supposed to have a better side effect profile than the other MAOIs. The dietary restrictions aren't necessary for the lower doses.
Posted by jono_in_adelaide on January 13, 2013, at 22:23:38
In reply to Re: Cymbalta withdrawal HELL!, posted by PhoenixGirl on January 13, 2013, at 21:40:17
I'd call your doctor and ask
1. if you can go back on 30mg for a few days, then take 15mg for a few days
2. If you can have a script for 14 Ativan 1mg tabs, to be used during the withdrawl period
3. If you can wait for the Cymbalta withdrawl to totaly pass before you try and cut out the Welbutrin, and wether you can do this stepwise using the 100mg tabs
Posted by Phillipa on January 13, 2013, at 22:36:04
In reply to Cymbalta withdrawal HELL!, posted by PhoenixGirl on January 13, 2013, at 18:03:25
Personally I did okay going fom 60mg to 30mg but also was taking benzos. When I suggested to the pdoc at the time that maybe from 30mg to 0 just like that he didn't mind me going slower. But I wasn't on wellbutrin also. Much too quick for both in my opinion. So is a two week washout also necessary for Ensam? I still like the idea of a patch. Phillipa
Posted by SLS on January 14, 2013, at 0:40:03
In reply to Re: Cymbalta withdrawal HELL!, posted by PhoenixGirl on January 13, 2013, at 21:40:17
> Emsam is supposed to have a better side effect profile than the other MAOIs. The dietary restrictions aren't necessary for the lower doses.
According to the manufacturer, dosages of 9mg/24hr and higher require dietary restrictions. I hope the 6mg/24hr dosage does the trick for you. You might feel a reduction in anxiety before an antidepressant response appears. I didn't like the way I felt on Emsam, so I didn't stay with it for very long. Nardil and Parnate seem to be better drugs for me.
* Apparently, selegiline (Emsam) does not act as an antidepressant until a dosage is reached that inhibits MAO-A as well as MAO-B. Personally, I was cautious about consuming large amounts of tyramine, even at the low dosage of 6mg/24mg. It might make sense to test smaller amounts of tyramine first. Be wary of a pounding headache located in the back of the neck at the base of the skull (occipital).
- Scott
Posted by NutellaBear on January 21, 2013, at 2:46:53
In reply to Re: Cymbalta withdrawal HELL! » PhoenixGirl, posted by SLS on January 14, 2013, at 0:40:03
I thought Cymbalta was an awful med. Actually the worse one I've ever taken. Still have tinnitus from taking it and I think it is a permanent side effect.
Getting off of it was hell no matter how slowly I tapered. Though it seems like the OP is on a similar path that I just recently took. Never used Adderall, but was using both Cymbalta and Wellbutrin. I kept the Lamictal and went on Emsam. Started with 6mg Emsam but went to 9mg then 12mg over the course of three months. Very happy with this regimen so far.
While Emsam has only been studied at 6mg for dietary conflicts, that was primarily because the main market for Emsam is Parkinson's patients who only use a low dose. Everything I've read seems to indicate that the high dose patches are also safe, but the margin of safety starts to go down on the higher dosages.
On the 6mg patch you'd have to eat more than a pound of cheddar within 30 minutes on an empty stomach to get a reaction. On 12 mg I think it went down to 6 ounces on an empty stomach. But if you eat other food and that 6 ounces of cheddar is part of a meal, the limit is tripled by the fact that you haven't fasted prior to exposure. So with a meal you might be able to eat a lot of cheddar again.
There was a fairly detailed study that I found on this and can dig it out if anyone wants to read the full report. The other aspect of it is the reaction is proportional to the exposure. So as you approach the limit you might feel something like palpitations and start getting a headache but only a mild rise in blood pressure at the beginning. The point of this being that this isn't like a "tipping point" where once you hit it you'll immediately end up flat on your back.
None of this is to say that you shouldn't exercise care with your diet. But it is also nothing that you need to freak out about either. And freak out is exactly what a lot of people do! One last example. Soy sauce has tyramine in it. So most lists tell you not to eat it. Soy sauce does indeed have tyramine -- specifically measured samples contained 300 - 500 mg of tyramine which would be enough to probably land you in a hospital if not dead. But that 300 - 500 mg of Tyramine was in a LITER of soy sauce. How many people would be tempted to use that much soy sauce in any dish? A teaspoon on your noodles would be perfectly safe.
I think something to be more careful of are the medication conflicts. Definitely stay away from ephedrine derivatives, Dextromethorphan, SSRI's, and Demerol in any amount. One other thing is what I said applies to 99% of the people out there taking an MAOI. But there are a small number of people who can't process tyramine properly in the first place. While you can say that if they avoid all tyramine they'd be safe taking an MAOI, in actuality it is probably not a good choice of medication for those people.
....wrote too much but oh well!
This is the end of the thread.
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