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How To Wean Off Cymbalta Without Any Withdrawal Effects?
Question: Hi my name is XXXXXXX and I have been on an antidepressant for 17 years straight for an anxiety disorder. Well because I went through my changes and am doing bio identical hormone therapy I decided to wean off ( with a dr.) cymbalta. Turns out it was a great great mistake. Have had a bad case of anxiety. Psychiatrist wants to put me on ability because even on cymbalta I have been having yearly episodes of anxiety and he feels I need something more. What are your thoughts on this.
Brief Answer:
I feel that abilify is not good option
Detailed Answer:
Hi, thanks for writing through HCM.
I have read your query and understood your concerns.
I want some more information. Answer the following questions:
1. What is your diagnosis, made by a psychiatrist?
2. Is it continuous or episodic illness?
3. Do you have family history of depression or anxiety disorder?
4. How many percentage improvement is there in your condition with cymbalta and xanax? Mention the dose of both.
5. Do you have any stressor in your life that is bothering you continuously?
6. Does this anxiety come in episodes [like panic attack] or it is generalised [most of the time]?
Abilify is a antipsychotic drugs that can be used to augment antidepressant in the treatment of resistant depression not in anxiety disorder. If you have primary diagnosis of depression then your doctor is thinking in a right direction but I have not used or seen somebody using abilify for augmentation for anxiety disorder, even it is not indicated for that. For depression it is fine but for anxiety it is questionable.
In my patients I would have gone for remeron 15 mg at night initially and then the dose would be titrated gradually to even up to 60 mg at night. It is a good antidepressant and causes sedation and increases appetite. I have used it for anxiety disorder and even for augmentation of SSRI antidepressants in my patients and results are good.
Other option is to use paxil 12.5 mg initially and then titrate it upwards gradually.
I feel that you should discuss all of these with your psychiatrist and reach the treatment plan that is best for you.
Hope I have answered your query. Answer the questions I have asked. Waiting for your reply.
Wish you good health.
I feel that abilify is not good option
Detailed Answer:
Hi, thanks for writing through HCM.
I have read your query and understood your concerns.
I want some more information. Answer the following questions:
1. What is your diagnosis, made by a psychiatrist?
2. Is it continuous or episodic illness?
3. Do you have family history of depression or anxiety disorder?
4. How many percentage improvement is there in your condition with cymbalta and xanax? Mention the dose of both.
5. Do you have any stressor in your life that is bothering you continuously?
6. Does this anxiety come in episodes [like panic attack] or it is generalised [most of the time]?
Abilify is a antipsychotic drugs that can be used to augment antidepressant in the treatment of resistant depression not in anxiety disorder. If you have primary diagnosis of depression then your doctor is thinking in a right direction but I have not used or seen somebody using abilify for augmentation for anxiety disorder, even it is not indicated for that. For depression it is fine but for anxiety it is questionable.
In my patients I would have gone for remeron 15 mg at night initially and then the dose would be titrated gradually to even up to 60 mg at night. It is a good antidepressant and causes sedation and increases appetite. I have used it for anxiety disorder and even for augmentation of SSRI antidepressants in my patients and results are good.
Other option is to use paxil 12.5 mg initially and then titrate it upwards gradually.
I feel that you should discuss all of these with your psychiatrist and reach the treatment plan that is best for you.
Hope I have answered your query. Answer the questions I have asked. Waiting for your reply.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
It is not a typical anxiety disorder
Detailed Answer:
Hi, thanks for writing again.
As per your answers, I feel that it is more likely depression. Sometimes depression can be associated with significant anxiety. Yearly episodes favors depression. So, if your doctor wants to add abilify to your current drugs then let him do it. It will benefit you.
Abilify is used to augment antidepressants in case of decrease response to first drug. You shall feel changes by 15 to 20 days and shall get better.
Hope I have answered your query. If you d not have further clarifications then close the discussion and rate the answer.
Wish you good XXXXXXX
It is not a typical anxiety disorder
Detailed Answer:
Hi, thanks for writing again.
As per your answers, I feel that it is more likely depression. Sometimes depression can be associated with significant anxiety. Yearly episodes favors depression. So, if your doctor wants to add abilify to your current drugs then let him do it. It will benefit you.
Abilify is used to augment antidepressants in case of decrease response to first drug. You shall feel changes by 15 to 20 days and shall get better.
Hope I have answered your query. If you d not have further clarifications then close the discussion and rate the answer.
Wish you good XXXXXXX
Above answer was peer-reviewed by :
Dr. Prasad
I understand that the side effects are terrible. I have grave reservations about abilify. Do you suggest any other medication. I realize that my anxiety disorder is clearly not a general anxiety disorder, but something ( usually change of season time) actually changes my chemicals. I feel warning signs and my family notices changes in my eyes well before I actually get the anxiety and then I go into the state of anxiety. Usually for several months. Even on the antidepressant I get these bouts of anxiety. Could it possibly like bipolar?
Brief Answer:
Seasonal affective disorder should be ruled out
Detailed Answer:
Hi, thanks for writing through again.
Answer the following questions:
1. What are the symptoms do you experience during change of season?
2. Which season is associated with changes in mood symptoms, winter or summer?
3. Is it Winter depression or spring/summer depression?
4. Do the symptoms start at the same time every year?
5. How many years of seasonal illness have you spent?
6. Does it related to any seasonal stressful event? like excessive work load at march end or anything else?
7. What are the warning signs do you feel?
If you have seasonal affective disorder then on the basis of symptoms like whether it is depression or mania, specific drugs can be preferred.
In case of winter depression patient may benefit more from Bupropion than other antidepressant drugs. Light therapy is also indicated. If it is bipolar disorder then a mood stabilizer will be indicated.
It is possible to counter the seasonal episodes by taking drugs 15 days before the usual time of symptoms onset every year. There is no need to continue drugs for whole year, if it is seasonal affective disorder.
So, diagnosis of seasonal affective disorder is very crucial for management. Drugs will differ depending on the type of affective illness like depression or mania or mixed symptoms. Consult your psychiatrist and ask him to consider the possibility of seasonal affective disorder. Follow his advice. There is no indication for abilify in SAD.
Hope I have answered your query. If you d not have further clarifications then close the discussion and rate the answer.
Wish you good XXXXXXX
Seasonal affective disorder should be ruled out
Detailed Answer:
Hi, thanks for writing through again.
Answer the following questions:
1. What are the symptoms do you experience during change of season?
2. Which season is associated with changes in mood symptoms, winter or summer?
3. Is it Winter depression or spring/summer depression?
4. Do the symptoms start at the same time every year?
5. How many years of seasonal illness have you spent?
6. Does it related to any seasonal stressful event? like excessive work load at march end or anything else?
7. What are the warning signs do you feel?
If you have seasonal affective disorder then on the basis of symptoms like whether it is depression or mania, specific drugs can be preferred.
In case of winter depression patient may benefit more from Bupropion than other antidepressant drugs. Light therapy is also indicated. If it is bipolar disorder then a mood stabilizer will be indicated.
It is possible to counter the seasonal episodes by taking drugs 15 days before the usual time of symptoms onset every year. There is no need to continue drugs for whole year, if it is seasonal affective disorder.
So, diagnosis of seasonal affective disorder is very crucial for management. Drugs will differ depending on the type of affective illness like depression or mania or mixed symptoms. Consult your psychiatrist and ask him to consider the possibility of seasonal affective disorder. Follow his advice. There is no indication for abilify in SAD.
Hope I have answered your query. If you d not have further clarifications then close the discussion and rate the answer.
Wish you good XXXXXXX
Above answer was peer-reviewed by :
Dr. Shanthi.E
Usually beginning sometime in the February March area I start to get symptom such as disturbing dreams, irritability and then super senses to noise etc. They don't come one right after the other, but in spreads. I always in the past just put them aside as no big as not to make a big deal over them to feel like OH MY GOD< I'M GETTING sick. Instead I pay little or no attention to them. When my senses become very acute, then I have my bouts of anxiety. I am not usually depressed until I get these bouts because they don't pass so quickly or easily. They usually start in the spring, but have also during my changes come in the fall as well. I have been going through this for the best of 28 years, being on an antidepressant for the past 18-19 years before I decided to wean off of them. They are never related to stressful events. Remember, Twice I stopped taking synthroid medications for a long period of time accidentally. This has really messed up my body.
What is the difference between depression, mania and bipolar? Even on the antidepressant I have these bouts. Can that be seasonal affected disorder or should the anxiety not be present with the antidepressant?
My psychiatrist believes that I have something other than an anxiety disorder and wants to put in my abilify, which I have reservations about. Do you have suggestions of any other medications I can discuss with him?
What is the difference between depression, mania and bipolar? Even on the antidepressant I have these bouts. Can that be seasonal affected disorder or should the anxiety not be present with the antidepressant?
My psychiatrist believes that I have something other than an anxiety disorder and wants to put in my abilify, which I have reservations about. Do you have suggestions of any other medications I can discuss with him?
Brief Answer:
These are not typical depression symptoms
Detailed Answer:
Hi, thanks for writing again and sorry for the delay in my response.
The symptoms you have mentioned are not typical of depression or anxiety. These also have some psychotic touch and that is why your doctor wants to give you abilify which is a antipsychotic drugs. More important thing here is, if it was a part of depression or anxiety then it should have been improved with cymbalta but it has not and it still continues to appear and that warrants a drugs from other class. I feel your doctor is doing the right thing.
Abilify is aripiprazole, an antipsychotic drug which is a very good drug. It is a safest drug in terms of side effects. It does not cause extrapyramidal as well as metabolic side effects like other antipsychotics. The initial Gastric side effects develop with every drug which goes away with time. It can cause akathisia [inner restlessness and inability to sit still] but it more common in those who are physically ill or cognitively compromised. You should not worry about it's side effects because drug will benefit you more. If you develop any side effect with it, then you can report that to your doctor. He will give a solution for that.
The person having only depressive episodes are having major depressive disorder but those who have manic episode also are categorized under bipolar disorder. Bipolar disorder means that a person has both depression and episodes of mania or only mania. Usually in patient of bipolar disorder the episode of depression goes unnoticed.
I have already told you that if these episodes were of only depression or SAD, then they should have been improved by cymbalta, these are something more complicated than simple depression and SAD. That is why you need add on drugs to increase the effectiveness of cymblata.
As an alternative to abilify, I do not have any other option but the drugs like ziprasidone can be considered but it has more side effects than abilify. Don't make any reservations about drugs, the side effects are different in different people because body responses to the drugs differently. You may not have same side effects or may have the side effects but they may be mild.
You have mentioned about synthyroid medications. Do you have hypothyroidism? Are you taking drugs for that? What was your last thyroid report? What is the level of TSH at present? Hypothyroidism is associated with depression and anxiety commonly. If a patient has hypothyroidism and also a depression then antipderessant won't help because you have to normalise the thyroid function also.
Hope I have answered your query. If you d not have further clarifications then close the discussion and rate the answer.
Wish you good XXXXXXX
These are not typical depression symptoms
Detailed Answer:
Hi, thanks for writing again and sorry for the delay in my response.
The symptoms you have mentioned are not typical of depression or anxiety. These also have some psychotic touch and that is why your doctor wants to give you abilify which is a antipsychotic drugs. More important thing here is, if it was a part of depression or anxiety then it should have been improved with cymbalta but it has not and it still continues to appear and that warrants a drugs from other class. I feel your doctor is doing the right thing.
Abilify is aripiprazole, an antipsychotic drug which is a very good drug. It is a safest drug in terms of side effects. It does not cause extrapyramidal as well as metabolic side effects like other antipsychotics. The initial Gastric side effects develop with every drug which goes away with time. It can cause akathisia [inner restlessness and inability to sit still] but it more common in those who are physically ill or cognitively compromised. You should not worry about it's side effects because drug will benefit you more. If you develop any side effect with it, then you can report that to your doctor. He will give a solution for that.
The person having only depressive episodes are having major depressive disorder but those who have manic episode also are categorized under bipolar disorder. Bipolar disorder means that a person has both depression and episodes of mania or only mania. Usually in patient of bipolar disorder the episode of depression goes unnoticed.
I have already told you that if these episodes were of only depression or SAD, then they should have been improved by cymbalta, these are something more complicated than simple depression and SAD. That is why you need add on drugs to increase the effectiveness of cymblata.
As an alternative to abilify, I do not have any other option but the drugs like ziprasidone can be considered but it has more side effects than abilify. Don't make any reservations about drugs, the side effects are different in different people because body responses to the drugs differently. You may not have same side effects or may have the side effects but they may be mild.
You have mentioned about synthyroid medications. Do you have hypothyroidism? Are you taking drugs for that? What was your last thyroid report? What is the level of TSH at present? Hypothyroidism is associated with depression and anxiety commonly. If a patient has hypothyroidism and also a depression then antipderessant won't help because you have to normalise the thyroid function also.
Hope I have answered your query. If you d not have further clarifications then close the discussion and rate the answer.
Wish you good XXXXXXX
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
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