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Suggest remedies for withdrawal symptoms of Cymbalta

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Posted on Thu, 19 May 2016
Question: I'm having severe withdrawal symptoms from Cymbalta (Protracted withdrawal syndrom) even 4 months after reinstatement to my maximum dose 60 mg.
My problem is my neurologist never warned me about possibilities of withdrawal symptoms, and took me cold-turkey off Deanxit and Cipralex 10 mg after 1 year of using them, and few moths later rapidly
lowered dose of Cymbalta twice time (of course I had no idea about slow tapering then ).
So here is my story in details:
03/2014 - 03/2015 - 1 Deanxit pill and 10mg of Escitalopram and Clonazepam 1mg daily. Prescribed for sensations in the foot, when "all" other exams returned nothing. Diagnostic processing has never finished.
Neurologist diagnosis was "Dysfunction of autonomic nerve system".
I was scheduled for operation (uterine fibroids) and 4 days before operation my neurologist took me off Deanxit and Cipralex cold-turkey (03/2015)
I had mild withdrawal symptoms: flu-like symptoms, headache, eyes pain, eyes burning sensation and muscle pains in neck,arms,upper back. At the same time I had a cold, so I didnt connected those symptoms with antidepressants
I felt sick more then a month so I had to cancelled my operation which was very important to me cause I want to try stay pregnant.
With all this symptoms I came back to the same neurologist ( who said its nothing wrong with me) prescribed me Cymbalta . I was on 60mg of Cymbalta from 06/2015 to 09/2015.
I wanted to stop taking Cymbalta after 3 moths when I realized that it isn’t helping me, and during one week I lowered my dose from 60mg to zero (as the same neurologist told me to)
I still didn't know about possible withdrawal and my neurologist have never mentioned it.
After few days I got extreme brain zaps and while moving eyes and abnormal EEG. Immediately I got back to 60mg and 2 days later everything was OK. 2 weeks I was on 60mg and feeling stable,then switched from 60 mg to 30 and 3 weeks later extreme withdrawal symptoms have started (abdominal cramps,stomach pain, bitterness, nausea, hypersalivation, diarrhea, vomiting, electric shock sensations while moving eyes,
rapid eyes movement when my eyes are close, myoclonic jerks of all parts of the body, shaking, sensory overload).
10 days later (07th of November) I got back to my maximum dose (60 mg) which stopped progression of symptoms ( I would ended up with convulsions if I didn't came back), but although I reinstated to my maximum dose symptoms didn't go away. 4 months later I still have severe withdrawal symptoms: myoclonic jerks of arms, legs, shoulders,mouth,abdominal muscles, muscle twitching, sometimes diarrhea, constant nausea, attacks of extreme lethargy and sleepiness, stomach pain like I have sea sickness-strongly increased while moving, all I can is slowly walking, periodic problems while moving eyes (can't focus on anything, example-watching out of bus, objects moves too fast and triggers extreme discomfort in my brain), pains in my whole back and muscles and joint of arms and legs (this is new symptom after reinstatement) , extreme sensory overload to the any kind of sound.
My symptoms are very variable, few weeks I am having gastrointestinal problems,nausea,stomach pains,cramps, with attacks of lethargy, with decreased eyes and sounds problems,and pains,then in one day everything turns around .Only constant in this are myoclonic jerks mostly in legs, foot, sometimes arms,head,even in my abdominal muscles. I have them almost every day,sometimes 1 per day,and
sometimes whole day while standing still with extreme tension in my body.
In the meanwhile I have read everything on-line about withdrawal and I'm fully aware of my situation. Unfortunately, I didn't know all this before.
Of course I want to take this poison out of my body/brain as soon as possible , but now I just want to stabilize so I can go to work again and at least try to have normal life and then start slow tapering.
I'm taking every supplement I read it could help: Omega 3 fish-oil, calcium, magnesium, folid acid, zinc, vitamins (D, B1, B6, B12), antioxidant, probiotics and taking baths in Epsom salt.

Sorry for long intro, I don't know how is relevant to write everything.
So, long story short, more than 4 months after reinstatement I have minimum improvement of my symptoms and don't know what to do and how to stabilize.
This whole time I'm taking 1mg of Clonazepam .My doctor wants me to start slow tapering (1-2% monthly) ,he said if I haven't stabilize till now, I maybe wont stabilize for moths and years.
He said that lots of my symptoms can be also side effects of Cymbalta (he mentioned something about and he is very concerned about neurological symptoms I am having that are not decreasing (myoclonic jerks-dyskinesia).
I am very confused and scared. I was completely health person until I was improperly took of this drugs.
I need suggestions, advice about therapy, what can stabilize me, should I start tapering and how, if you have ever had patient in this situation, is there any treatment for this condition?

doctor
Answered by Dr. Alexander H. Sheppe (1 hour later)
Brief Answer:
Consultation

Detailed Answer:
Hello, and thank you for your question.

I have had many patients in this situation. There are a couple ways to proceed.

First, I agree with tapering clonazepam. Tapering 1-2% monthly is not possible (this would involve cutting your pills into 100 pieces, essentially), so I would aim for about 10% monthly, which is safe, effective, and would not cause withdrawal. This could help some of your symptoms.

If you want immediately stabilization, the way to avoid withdrawal of ANY substance is to restart it and then taper it off SLOWLY. Your brain is withdrawing from serotonin, so you need more of it -- and the only way to do this is to restart an antidepressant (either Cymbalta, or the longer-acting Prozac) and then taper off slowly. This is a common technique in psychiatry for serotonin withdrawal, and is very effective.

I do NOT think what you are describing are side effects of Cymbalta. I disagree with your doctor on this.

I believe what you are describing are clear symptoms of Serotonin withdrawal. If you want to avoid Cymbalta and restart a different antidepressant such as Prozac, and then slowly taper it off, this would be a reasonable strategy.



Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (43 hours later)
Thank you for your answer. We may be misunderstood, I have RESTARTED taking Cymbalta 60 mg 4 months ago which is my XXXXXXX dose I have ever taken (and I have taken Cymbalta only 3 months). That was 4 months ago. Since then I’m constantly ON Cymbalta 60 mg and still in protracted withdrawal unable to stabilize. I am not in the „pre-covulsion“ state where I was that few days before I have started taking 60 mg again. After restarting I have even started getting new symptoms. I have 30 at least physical symptoms that are exchanging every few weeks so I don’t know even what to write. The worsted are myoclonic jerks, dyskinesia (or whatever it’s called) and nerve pains. I am bedridden for months. After I got myoclonic jerks of abdominal muscles/diaphragm that push my breath away I got so scared that I have started tapering 1% per week. It is possible to do that by counting beads in the capsule (because Cymbalta has 550- 600 beads in 60 mg capsule, so I take out 6 beads, then 12 beads, then 18 beads… every 7-10 days). I think is better to take out smaller percentage often, then 10 % monthly. I don’t know, , but I believe I could not tolerate 10 % drop in this state. After I have started tapering 1 months ago nothing much changed, I actually had few “better” days last week but today I am sick again, my whole back are burning from pain, and I am nauseous and extremely sleepy and sick. No one in this Earth deserve this hell. I was completely healthy person before this happened. This Cymbalta is poison. I measured concentration of duloxetine in the blood last month that shows lower range : <10, and range is 30-120. I don’t know does that has to do with anything. Anyway increasing Cymbalta is NOT option. I was in protracted withdrawal from “ cold turkey “of Escitalopram and Deanxit at the moment I have started taking Cymbalta for the first time and I have never felt worst in my life then while I was on Cymbalta that first 3 months of use before I have tried stop using it. Tell me please every possible options for me.


Thank you for your answer.
1. Can you please explain me how my metabolism is creating low range level of Cymbalta NOW and this wasn’t the case 6 months ago when I have started using Cymbalta?
2. You are stating my current level of Cymbalta in blood is 5-10. According to this I could drop my dosage from 60 to 10 mg, and I wouldn’t feel any additional problems and new withdrawal symptoms? This is absolutely not true, because if you have read carefully what I had written, when I dropped Cymbalta from 60 to 30 mg, I had extremely severe symptoms that I literally taught I would die.
3. If I add the Prozac to my therapy, isn’t there danger for me to develop Serotonin syndrome?
4. Please suggest me dosage, how much of Prozac would you add to my therapy, together with 60 mg of Cymbalta?
5. Also, as I stated in my opening post, my main goal is to get off all medication as soon as possible, so I can get pregnant due to my gynecological issues and gynecology suggestion to stay pregnant as soon as possible. Increasing Cymbalta to 120 mg isn’t the way to go. If I couldn’t stabilized on 60 mg, nobody can predict I would stabilize on 120. IF my dose is now 5-10 mg, on 120 mg would be double: 10-20 mg, also under reference range, so where is the meaning of increasing it?
6. Do you consider any antidepressant is “safe” to take during pregnancy, and which one?
Thank you
doctor
Answered by Dr. Alexander H. Sheppe (14 minutes later)
Brief Answer:
Followup

Detailed Answer:
I understand the situation now, thanks!

There are two solutions here.

First, your Cymbalta level is low (<10). This indicates the functional dosage you are taking is really around 5-10mg due to your metabolism. You should therefore increase the dose, as high as 120mg, and recheck Cymbalta levels until it is therapeutic (>30). Withdrawal symptoms should disappear, and then you can slowly taper off monitoring carefully for withdrawal.

A less effective alternative would be to add Prozac and increase the dose until withdrawal stops. This would make up for the serotonin deficit. You can then taper slowly off Cymbalta, monitoring carefully for withdrawal, and then taper of the Prozac later.

Either of these solutions is common and would work. I prefer the first.

Please remember to rate and close this answer thread when you are finished and satisfied.

tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
doctor
Answered by Dr. Alexander H. Sheppe (40 minutes later)
Brief Answer:
Followup

Detailed Answer:
1. Hard to say, but metabolism can change over time with diet, other medications, stress, or simply because of natural variations in the body.

2. This is not what I am saying at all. A drastic reduction of the dose could cause worsening withdrawal no matter what the blood level is (even a blood level drop from 10 to 0 could cause significant problems). This is consistent with your history.

3. No, serotonin syndrome does not develop with SSRI+SNRI, only with a TCA+SSRI or MAOi+SSRI.

4. Start at 10mg, increase gradually as high as 80mg daily until withdrawal stops.

5. Your understanding of pharmacodynamics is incorrect. Blood levels do not increase linearly, they increase irregularly. An increase up to 120mg may cause a much higher level than 30, the only way to know how your body will respond is to increase the dose slowly and check the level regularly as I suggested.

6. Yes, all SSRIs and SNRIs are safe with pregnancy.

Please remember to rate and close this answer thread when you are finished and satisfied.


Above answer was peer-reviewed by : Dr. Naveen Kumar
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Dr. Alexander H. Sheppe

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Suggest remedies for withdrawal symptoms of Cymbalta

Brief Answer: Consultation Detailed Answer: Hello, and thank you for your question. I have had many patients in this situation. There are a couple ways to proceed. First, I agree with tapering clonazepam. Tapering 1-2% monthly is not possible (this would involve cutting your pills into 100 pieces, essentially), so I would aim for about 10% monthly, which is safe, effective, and would not cause withdrawal. This could help some of your symptoms. If you want immediately stabilization, the way to avoid withdrawal of ANY substance is to restart it and then taper it off SLOWLY. Your brain is withdrawing from serotonin, so you need more of it -- and the only way to do this is to restart an antidepressant (either Cymbalta, or the longer-acting Prozac) and then taper off slowly. This is a common technique in psychiatry for serotonin withdrawal, and is very effective. I do NOT think what you are describing are side effects of Cymbalta. I disagree with your doctor on this. I believe what you are describing are clear symptoms of Serotonin withdrawal. If you want to avoid Cymbalta and restart a different antidepressant such as Prozac, and then slowly taper it off, this would be a reasonable strategy.