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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jessers11581 on May 23, 2005, at 8:15:43
Hello fellow babblers! I just want to relay my current situation and see if anyone can share similar experiences, tips, support, etc. I came off of 30 mg. Cymbalta about one week ago. There was no tapering down from that--I just stopped (my doctor said I could). The first 3-4 days were fantastic. I did have some of the brain zapping, electrical body shivers, etc., but my mood was incredible. I felt so ALIVE and euphoric almost, and clear-headed for the first time in 8 years. My irritability and agitation disappeared, I became super-productive, I was really nice to people, etc. However, it is now day 7 and I'm feeling crappy. The electrical impulse things have gotten much worse- I can feel them surging throughout my whole body anytime I move too fast, or hold my breath. The euphoria is definitely gone, and has been replaced with a sort of melancholy. I've had a few crying spells and my anxiety seems to have resurfaced. I'm also having trouble thinking straight and feel disorinted much of the time. So anyway, it seems the tables have turned! I guess I'm just wondering how long these effects will last, and is it normal to get hypomanic when first coming off AD's? Man, I'd love to feel like that again! Even with the withdrawal effects, though, I'm still glad I decided to quit meds and am adamant about staying "clean" for as long as possible. This is the first time I haven't been on an anti-depressant in 7.5 years. Does anyone have any suggestions for improving the down-times while I'm waiting for the high-times to come back (at least I HOPE they'll come back!). What about reducing the amount of "brain shivering" and dizziness? Also, has anyone found that drinking alcohol while withdrawing from meds made the side-effects much worse? I did have a few beers the night before last, and the next day was TERRIBLE. Well, I'm sure I've written enough for one sitting. Please respond with ANY information, experiences, etc. I'd really appreciate it!
P.S. My sex drive is back with a vengeance, even throughout these withdrawal effects. And that's soooooo important to me. That alone will make this worth the effort, I think.
Posted by SLS on May 23, 2005, at 8:54:44
In reply to stopped Cymbalta-need advice, support, posted by jessers11581 on May 23, 2005, at 8:15:43
> Hello fellow babblers! I just want to relay my current situation and see if anyone can share similar experiences, tips, support, etc. I came off of 30 mg. Cymbalta about one week ago. There was no tapering down from that--I just stopped (my doctor said I could). The first 3-4 days were fantastic. I did have some of the brain zapping, electrical body shivers, etc., but my mood was incredible. I felt so ALIVE and euphoric almost, and clear-headed for the first time in 8 years. My irritability and agitation disappeared, I became super-productive, I was really nice to people, etc. However, it is now day 7 and I'm feeling crappy. The electrical impulse things have gotten much worse- I can feel them surging throughout my whole body anytime I move too fast, or hold my breath. The euphoria is definitely gone, and has been replaced with a sort of melancholy. I've had a few crying spells and my anxiety seems to have resurfaced. I'm also having trouble thinking straight and feel disorinted much of the time. So anyway, it seems the tables have turned! I guess I'm just wondering how long these effects will last, and is it normal to get hypomanic when first coming off AD's? Man, I'd love to feel like that again! Even with the withdrawal effects, though, I'm still glad I decided to quit meds and am adamant about staying "clean" for as long as possible. This is the first time I haven't been on an anti-depressant in 7.5 years. Does anyone have any suggestions for improving the down-times while I'm waiting for the high-times to come back (at least I HOPE they'll come back!). What about reducing the amount of "brain shivering" and dizziness? Also, has anyone found that drinking alcohol while withdrawing from meds made the side-effects much worse? I did have a few beers the night before last, and the next day was TERRIBLE. Well, I'm sure I've written enough for one sitting. Please respond with ANY information, experiences, etc. I'd really appreciate it!
>
> P.S. My sex drive is back with a vengeance, even throughout these withdrawal effects. And that's soooooo important to me. That alone will make this worth the effort, I think.
Hi.First of all, it sounds like you may have experienced a withdrawal "rebound-improvement". This is a phenomenon that occurs with some people where they actually feel transiently better for having reduced the dosage of an antidepressant or discontinue it abruptly. It usually doesn't last for very long. This is what those first 4 days were about. However, it often takes 3 days or so for the negative withdrawal symptoms to develop after stopping one of these drugs.
So, the question now becomes, what are you willing to do about it?
If you look back on the earlier threads on this board, you will find many that deal with discontinuing Effexor. I would use the same strategies to discontinue Cymbalta that others have found successful for Effexor.
If it were me, I would restart the Cymbalta at 20-30mg per day. However, it now becomes important to split this daily dosage into at least 3 doses spaced apart by 6-8 hours. I have had great success using a "flexible-dosing" strategy. I simply wait for the beginnings of the withdrawal syndrome to appear and then take a small dose that will relieve it for about 6-8 hours. I do not take my next dose until symptoms re-appear. For you, perhaps you can use the appearance of brain-zaps as an alarm that it is time for you to take your next dose. This will take some experimentation in the beginning to find the right amounts to take at each dose. Of course, you must monitor your total intake of medication for the day and don't exceed your daily alottment. I would probably start by taking 5mg doses 4 times a day to start with. If this proves enough to prevent withdrawal symptoms from appearing, move to 5mg 3 times a day. After you go a few days without symptoms, begin to allow them to appear before taking your next dose. If you can split the doses into amounts smaller than 5mg, this would be ideal. You could continue to reduce the size of each dose while monitoring for withdrawal symptoms. You should find that you use less and less to last 6-8 hours. Alternatively, you will find that you can go longer and longer between 5mg doses.
Perhaps the best way to divide capsules is to add them to a glass of juice and drink fractional amounts. This was suggested the other day by someone here. Just be sure to mix the combination well before drinking it. Since I have never done this with any of these drugs, I don't know if the contents of the capsules actually dissolve or if they settle to the bottom or remain in suspension. People often open a capsule and count pellets. I really don't think that you need to be too precise. A little more or a little less will simply change the amount of time you go between doses. Flexibility works as long as you allow your body determine dosing and not the clock.
A completely different strategy involves taking Prozac for a few days as a substitute and allowing this long-lasting drug to leave your system gradually and naturally. Prozac and its active metabolites have a half-life of over a week.
- Scott
Posted by jessers11581 on May 23, 2005, at 10:09:43
In reply to Re: stopped Cymbalta-need advice, support » jessers11581, posted by SLS on May 23, 2005, at 8:54:44
> Hi.
>
> First of all, it sounds like you may have experienced a withdrawal "rebound-improvement". This is a phenomenon that occurs with some people where they actually feel transiently better for having reduced the dosage of an antidepressant or discontinue it abruptly. It usually doesn't last for very long. This is what those first 4 days were about. However, it often takes 3 days or so for the negative withdrawal symptoms to develop after stopping one of these drugs.
>
> So, the question now becomes, what are you willing to do about it?
>
> If you look back on the earlier threads on this board, you will find many that deal with discontinuing Effexor. I would use the same strategies to discontinue Cymbalta that others have found successful for Effexor.
>
> If it were me, I would restart the Cymbalta at 20-30mg per day. However, it now becomes important to split this daily dosage into at least 3 doses spaced apart by 6-8 hours. I have had great success using a "flexible-dosing" strategy. I simply wait for the beginnings of the withdrawal syndrome to appear and then take a small dose that will relieve it for about 6-8 hours. I do not take my next dose until symptoms re-appear. For you, perhaps you can use the appearance of brain-zaps as an alarm that it is time for you to take your next dose. This will take some experimentation in the beginning to find the right amounts to take at each dose. Of course, you must monitor your total intake of medication for the day and don't exceed your daily alottment. I would probably start by taking 5mg doses 4 times a day to start with. If this proves enough to prevent withdrawal symptoms from appearing, move to 5mg 3 times a day. After you go a few days without symptoms, begin to allow them to appear before taking your next dose. If you can split the doses into amounts smaller than 5mg, this would be ideal. You could continue to reduce the size of each dose while monitoring for withdrawal symptoms. You should find that you use less and less to last 6-8 hours. Alternatively, you will find that you can go longer and longer between 5mg doses.
>
> Perhaps the best way to divide capsules is to add them to a glass of juice and drink fractional amounts. This was suggested the other day by someone here. Just be sure to mix the combination well before drinking it. Since I have never done this with any of these drugs, I don't know if the contents of the capsules actually dissolve or if they settle to the bottom or remain in suspension. People often open a capsule and count pellets. I really don't think that you need to be too precise. A little more or a little less will simply change the amount of time you go between doses. Flexibility works as long as you allow your body determine dosing and not the clock.
>
> A completely different strategy involves taking Prozac for a few days as a substitute and allowing this long-lasting drug to leave your system gradually and naturally. Prozac and its active metabolites have a half-life of over a week.
>
>
> - Scott
>
>Wow, thank you so much for such a detailed response! About an hour and a half after posting my original message, I was feeling completely hopeless and had a fit of crying and uncontrollable rage (aaaggghhh!). This is truly unbearable. So what I did was empty out half of a 30 mg. Cymbalta cap and take the rest (approx. 15 mg.) all at once. I'm hoping that this will kick in at some point today. From now on, I am definitely going to try the divided doses and see if that makes a difference. I don't know much about the pharmacological makeup of Effoxor, Prozac, or other meds, but Cymbalta pellets are enterically coated and I don't think they're supposed to be mixed with anything (juice, etc.). So I will will probably just use empty capsules to break it up. Man, I feel horrible. I don't want to see or speak to anyone for fear of losing control over my emotions. How long should tapering last? Do you think that the 15 mg. I took earlier will help me today? Anyway, thanks again for your support. I appreciate the advice and will certainly give it a shot. :)
Posted by SLS on May 23, 2005, at 10:31:57
In reply to Re: stopped Cymbalta-need advice, support » SLS, posted by jessers11581 on May 23, 2005, at 10:09:43
Hi.
My guess is that you should feel the effects of restarting Cymbalta within an hour.
I really don't think it matters whether or not you use the capsule or not. It just melts in the stomach anyway. You can certainly use fractions of the capsule as you have done. That's the way I did it in the beginning of my taper off of Effexor XR. Later in the tapering process, I simply "eye-balled" and estimated the number of pellets that I wanted to ingest and simply licked them from the spoon and washed them down with water. The enteric coating is probably what prevented them from tasting bitter. There is nothing wrong with exercising a little creativity to accomplish the goal.
I guarantee that you will be able to discontinue Cymbalta with very little trouble using this kind of taper method.
Feel better.
- Scott
Posted by owenus32 on May 23, 2005, at 13:42:29
In reply to stopped Cymbalta-need advice, support, posted by jessers11581 on May 23, 2005, at 8:15:43
I felt the EXACT same way stopping from 15 mgs. Brain shivers were literally constant, if i moved my head it would happen. And I got extremely depressed yet was dying to have sex, really bad combination lol. I went back on it bc my life is in chaos right now and I think I did this out of anger or to make things worse for me. I think it will pass for you , probably takes a month but I'd say you should be in very good shape life money wise etc and then exercise eat right and see it probably takes a month. Good luck
Posted by jessers11581 on May 23, 2005, at 16:10:06
In reply to Re: stopped Cymbalta-need advice, support, posted by owenus32 on May 23, 2005, at 13:42:29
Thanks for responding, everyone. I am definitely noticing a difference after having taken the 15 mg. earlier. My brain shivers are occurring less frequently, and my mood is a bit better. I just finished exercising for an hour, and that always makes me feel better too.
Posted by SLS on May 23, 2005, at 16:38:30
In reply to Re: stopped Cymbalta-need advice, support, posted by owenus32 on May 23, 2005, at 13:42:29
> I think it will pass for you , probably takes a month but I'd say you should be in very good shape...
Using a kindling model to explain a persistent withdrawal syndrome is only a hypothesis of mine, but I am concerned that to even allow several days of the syndrome to persist without remediation is to set oneself up for increased severity of withdrawal symptoms and a condition whereby these symptoms last for weeks or months after the drug is discontinued. It is far better to taper in such a way as to avoid the syndrome entirely.
- Scott
Posted by 4WD on May 27, 2005, at 21:45:58
In reply to Re: stopped Cymbalta-need advice, support, posted by SLS on May 23, 2005, at 16:38:30
> > I think it will pass for you , probably takes a month but I'd say you should be in very good shape...
>
> Using a kindling model to explain a persistent withdrawal syndrome is only a hypothesis of mine, but I am concerned that to even allow several days of the syndrome to persist without remediation is to set oneself up for increased severity of withdrawal symptoms and a condition whereby these symptoms last for weeks or months after the drug is discontinued. It is far better to taper in such a way as to avoid the syndrome entirely.
>
>
> - ScottScott, I think you might be right. I did a real quick taper of Effexor when switching from it to Cymbalta and again from Effxor to Celexa. I didn't experience physical symptoms but the anxiety, fear and terror that surfaced within the first week or two completely off Effexor were probably a sign that I tapered too quickly. I didn't know about kindling--it never ocurred to me I could be making it worse.
That could explain why it's two and a half months now and I'm still living in fear )although better).
Marsha
>
Posted by katia on May 31, 2005, at 14:55:15
In reply to Re: stopped Cymbalta-need advice, support » SLS, posted by 4WD on May 27, 2005, at 21:45:58
> That could explain why it's two and a half months now and I'm still living in fear )although better).
>
> MarshaI went off of Paxil about two months ago and I have not been the same since. I live in fear with anxiety like you. How long do the w/drawals last? Or is this just depression? How can you tell? I'm considering going on another AD b/c of this anxiety, guilt, dread, fear, negative thinking. I'm considering Cymbalta, but do not want to go thru' another terrible w/drawal like I've experienced on Paxil, Zoloft, and Effexor.
Posted by SLS on May 31, 2005, at 17:21:34
In reply to W/drawal or depression? » 4WD, posted by katia on May 31, 2005, at 14:55:15
Hi.
> I went off of Paxil about two months ago and I have not been the same since. I live in fear with anxiety like you. How long do the w/drawals last? Or is this just depression? How can you tell? I'm considering going on another AD b/c of this anxiety, guilt, dread, fear, negative thinking. I'm considering Cymbalta, but do not want to go thru' another terrible w/drawal like I've experienced on Paxil, Zoloft, and Effexor.
You might very well be suffering a relapse of depression with anxiety that is not a manifestation of a withdrawal syndrome. Your description of your present condition included the terms "guilt" and "negative thinking". The feelings of guilt in particular might differentiate withdrawal from depression.
How long was it after you discontinued medication that the depression symptoms emerged?
If you want to choose a drug that isn't so hard to discontinue, opt for a tricyclic. If you want to stay with an SRI, choose Prozac. If you had tremendous success with a particular drug, use that. Cymbalta might not be any easier to discontinue than any other drug. At some point, you have to choose what works and worry about discontinuation if and when the time comes. I would love to respond to Paxil or Effexor. I would not think to place more importance on discontinuation than on remission.
How many times have you been on and off antidepressants? If more than once, why do you feel it is so important to discontinue an antidepressant after achieving remission? Very simply, your brain might need indefinite medication in order to compensate for the chronic dysregulation that produces depression and anxiety. The reason you can continue to remain free of depression while taking the drugs is because the drugs continue to prevent relapse.
I wouldn't wait more than another month before restarting an antidepressant if by that time things have continued to deteriorate. Pay attention to the trend that your conditions displays.
It seems that the discontinuation of these medications can be accomplished with a much reduced withdrawal syndrome when they are tapered properly. There are several methods to do this. They have been described on this bulletin board frequently. Please take the time to review the threads. You might find a method that appeals to you. Abrupt discontinuation and going "cold-turkey" is not an option. It is the worst thing you can do to your nervous system. Doing so often leads to the continuation of withdrawal effects long after the drug is stopped. It is not necessary to suffer.
My advice to you is to first determine a trend in your symptomology. If depressive symptoms worsen, you should choose a drug that works best for you that has the least side effects and worry about withdrawal later.
- Scott
Posted by 4WD on May 31, 2005, at 21:46:10
In reply to W/drawal or depression? » 4WD, posted by katia on May 31, 2005, at 14:55:15
> > That could explain why it's two and a half months now and I'm still living in fear )although better).
> >
> > Marsha
>
> I went off of Paxil about two months ago and I have not been the same since. I live in fear with anxiety like you. How long do the w/drawals last? Or is this just depression? How can you tell? I'm considering going on another AD b/c of this anxiety, guilt, dread, fear, negative thinking. I'm considering Cymbalta, but do not want to go thru' another terrible w/drawal like I've experienced on Paxil, Zoloft, and Effexor.
This has happened to me several time when I tried to switch from Effexor to a different AD. I am on Celexa now so I don't think it is depression - I don't feel depressed unless the terror becomes so great that I cannot bear it and then I feel terrible despair. If I take a small amount of Klonopin, the despair goes away. Usually. At least once a week, the fear is so intense that the Klonopin doesn't relieve it.How long were you on Paxil? Did you taper off it? Have you been on other ADs before? Do you feel lethargic and apathetic? Or is it just the fear alone?
If you were on Paxil a while and stopped it abruptly I can see that you might have rebound anxiety. I think that may be what is happening to me. You could either go back to a low dose and then taper off it, switch to a different AD if you feel depressed, or use an anxiolytic drug like klonopin to get you through it.
I don't know how long it might last. For me, I was off Effexor (and on Cymbalta) for three months and I was still full of fear. I went back to Effexor for a couple of months because of the fear but it no longer worked (it had stopped working for depression years before). So now I've been off it for two months again (and on Celexa). I believe I see some improvement. I will know more in a couple of months.
I read somewhere here that one member of this board had tapered off Effexor and it took four-five months before the rebound anxiety and panic finally went away. That gave me hope that if I can just wait it out, it will go away. Did you have the fear when you withdrew from Effexor?
Marsha
Posted by katia on May 31, 2005, at 22:51:28
In reply to Re: W/drawal or depression? » katia, posted by 4WD on May 31, 2005, at 21:46:10
Hi Marsha, SLS, etc.
Thanks so much for responding. I'm not sure what's going on with me. I think I'm ok one minute (like now), then I'm despairing and anxious again.
Let's see...let me answer SLS questions, then yours Marsha.You make good points SLS. (Your description of your present condition included the terms "guilt" and "negative thinking". The feelings of guilt in particular might differentiate withdrawal from depression.) AND (I would not think to place more importance on discontinuation than on remission.)
Yes, something is happening with me. Just to put my life into context...I'm finishing up grad school this quarter (writing thesis and reading tons) am a single home owner as well and working part-time so lifestyle for sure adds to the anxiety at the moment.
Animals are a good measurement for me...i.e. two weeks ago I had to trap and surrender a badly off male cat to the shelter and right after him a girl kitten shows up getting raped everyday by the stray males in the neighborhood. I've been dealing with trying to find her a home while I protect her etc...This has caused so much anxiety and guilt. I'm constantly on edge. And when depressed, I "feel" animal pain too much - any animal suffering kills me.I started Paxil a year ago May and stopped it (why now I ask myself?) in January/Feb. tapered off and went bazeerko, so went back on half of what I was on and tapered slowly over the course of three weeks. I was only on 12.5 mg, which is NOTHING. I am super sensitive though. I'm considered bipolar II and am on Trileptal at 300mg now - was at 450...(later on that). So I offically finished Paxil probably two months ago. After all this, I wish I'd never stopped it now and am realizing I got to that level steady place where my mind tricked me into thinking that I was fine, so I didn't need meds....I'm sure you've been there...
To answer your questions:
**How many times have you been on and off antidepressants?Three years ago I started the whole med thing as I was in a suicidal depression. Tried and withdrew from five ADs in one year - went hypo on two and more depressed on the others. Two years ago BP dx and Mood stabilizer trials. Finally a year ago got to Trileptal and Seroquel for sleep (anywhere in between 12.5 - 50 mg a night), then added Paxil and felt quite steady and normal.
marsha your question:
(Do you feel lethargic and apathetic? Or is it just the fear alone?)
I'm actually wired. So I'm wondering if I'm cycling. I'm not sleeping as much as normal. I did just reduce my Trileptal from 450 - 300 due to cognitive stuff and I'm trying to finish grad school and need my brain.(> I read somewhere here that one member of this board had tapered off Effexor and it took four-five months before the rebound anxiety and panic finally went away. That gave me hope that if I can just wait it out, it will go away. Did you have the fear when you withdrew from Effexor?)
I was pretty screwed up after Effexor. That was like Two and half years ago. It made me hypo and then depressed. WHILE I was on Eff. I had those zaps and shocks, not to meniton my awful withdrawal. I went to Zoloft right after and went into zombie land.
So, what I'm thinking is this: If this is withdrawal, the last thing I want to do is add something else on top of this to confuse my entire state. BUT if this is a depression or mixed state, then I need to do something. Meds scare me, but so do my mood swings. I feel confused about the whole dx and med game....
Thanks for your replies. It means a lot
Katia
Posted by lunayo on March 31, 2009, at 9:44:35
In reply to Re: stopped Cymbalta-need advice, support » jessers11581, posted by SLS on May 23, 2005, at 8:54:44
I was on cymbalta for 3 years, 60mg. I found it stopped working and I hated the side effects: sweating, no sex drive, flu-like symptoms, etc. So I went to a psychiatrist. She had me go from 60mg to 30mg per day for 3 weeks, then take 30mg every other day for 1 week, then stop. Well, I did that and couldn't take the side effects, mostly the brain zaps. So, she prescribed a low dose of Prozac. Well, that worked! I'm now off Cymbalta for about a month and off Prozac. I do feel better and I hope my sex drive will come back. The sweating is decreasing a little, but so far I still have no sex drive. Although, I have sex dreams while sleeping. I'd like to know how long it will take to get my drive back.
This is the end of the thread.
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