Brief Answer:
Gapping with strong motivation may help

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

Although the best strategy is complete abstinence from the quit date but it is not always possible as in current situation. In that scenario increasing gaps in successive cigarettes can help some number of individuals in those who have strong motivation.

Regarding damage, I do not think somebody can questions the potential of damage caused by smoking. You need to understand that despite the technological advances, we are still far away to assess damage. In fact, the damage is not visualized through the available technique although damage remains there.

In my view, why not seek help and use Wellbutrin as an option during journey to complete abstinence from tobacco.

I hope this helps you.
Thanks and regards.

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Brief Answer:
Need to reduce it very slowly

Detailed Answer:
Hello,
Thanks for reverting back to me.

Regarding Cymbalta the first and most important thing is to reduce it slowly. In my practice I reduce it 25 % from the day one continue like this for next 10 days.

From day 11 again the same 25% is reduced to make it total 50% of original dose

Than after 10 days (21 th day) I go again for further 25% reduction and

from day 31 I take a call to remove it either completely or take some more time before stopping it.

I did not see any question about vaporising cigarettes but I like to make it clear that they are good for harm reduction and not a final solution.

I hope this assists you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

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Brief Answer:
I mean gradual reduction

Detailed Answer:
Hello,
Thanks for reverting back to me.

You need to go in the following way

From day one
50 mg per day (one 20 mg and another 30 mg)

From day 8
Total forty mg per day (20+20 mg)

From day 15
30 mg per day

From day 22
20 mg per day

From day 29
10 mg per day (Half tablet of 20 mg per day)

The change in plan is made considering the current dose and available options for Duzela.

Regarding the Nicotine if craving is there and patches are not helping I think option of wellbutrin should be considered.

I hope this assists you further.
Thanks and regards.

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Brief Answer:
Please read below

Detailed Answer:
Hello,
Thanks for reverting back to me.

First of all I like to clarify that it is counter productive although it appears so when looked superficially. This is because wellbutrin can be stopped in one go without slow withdrawal. Second it helps in craving and likely to help you deduction for nicotine.

Third it will smoothen the withdrawal for Cymbalta.

Now regarding as I said it is way of harm reduction and not a good idea. In my view the aim should be complete withdrawal of nicotine and not harm reduction. I think visiting a psychiatrist is warranted as you are struggling with many things which need specialist intervention.

I hope this helps you further.
Thanks and regards.

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Brief Answer:
Psychiatrist does not mean more medications

Detailed Answer:
Hello,
Thanks for reverting back to me.

I understand your concern about extra medications but psychiatrist does not mean more medications. It is possible that she may help you with less medications and more of education/counselling.


Considering the requirement of prescription as well as difficulties encountered by you I think psychiatrist will bear better option than MSW.

Thanks and regards.

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