Help Me Break the Cymbalta Cycle

August 25, 2008 5:21 PM

Hellacious Cymbalta withdrawal (I'm two weeks in). The side effects are beginning to overwhelm me. What can I do to make this withdrawal process easier?

A little background: I was on 60mg Cymbalta for about a year and a half, prescribed by my therapist. When it was determined that my sluggish thyroid played a huge part in my depression and my Synthroid dosage was upped significantly recently, my therapist and I decided I could taper off the Cymbalta (I am still on Wellbutrin). He gave me a week's worth of 30 mg, so I went from the 60 to the week's worth of 30, to nothing. I have been completely off of all Cymbalta now for two weeks and have experienced: nausea, digestive problems, insomnia, mood swings at the drop of the hat (crying jags, increased irritability, even rage for the slightest offenses), confusion, brain zaps, lack of concentration to the point of not being able to remember simple words or conversations that just took place (just writing this question was laborious), hot flashes and sweating followed by chills and sneezing fits, and now headaches that go right down into my teeth and jaw and just. won't. stop.

So, Mefites, any advice to help minimize the effects of withdrawal? Keep in mind that I have asked my therapist and he is at a loss other than, "Well, we could put you back on the Cymbalta and taper you off slowly over a period of weeks," which I am just not willing to do; these last two weeks have been so difficult (I've never had this kind of withdrawal from any other drug, and have taken Prozac and Serzone in the past) that I don't want to have anything to do with Cymbalta ever again. I have also on a few occasions resorted to an over-the-counter sleep aid for the insomnia but don't want to become dependent on it.

I know YANMD, etc. Please do not direct me to the Elli Lily website, insist that the side effects are minor or that it is all in my head, etc. All constructive advice is appreciated!

posted by misha to Health & Fitness (15 answers total)

you won't become dependent on an over-the-counter sleep aid--they are just antihistamines (same ingredient as benadryl). worse comes to worst, you'll get constipated and wake up with a dry mouth. they are totally safe and non-addictive.

in fact, a lot of newer sleep aids are also non-addictive, so it's worth talking to your doctor about. getting better-quality sleep probably will help with some of your symptoms. likewise, a muscle relaxant might help with the jaw-clenching. an over-the-counter nighttime mouth guard might help, too--some of your headaches/toothaches are probably from that.

talk to your doctor about taking st. john's wort. although the jury is still out, i think, on its effectiveness, i found it helped with my anxiety and irritability before i found lexapro. i just don't know if it's safe to take with cymbalta--it can interact badly with some antidepressants, so you want to check with the doc first.
posted by thinkingwoman at 5:29 PM on August 25, 2008

I found that Rescue Remedy was intermittently useful when I was going through extra-rough patches when coming off Lovan and Valium.
posted by turgid dahlia at 6:02 PM on August 25, 2008 [2 favorites]

How was life on the 30's? If you were not experiencing hellacious withdrawlas on the 30s than I would go back to those and taper down to 0 over four to six weeks. I know you're saying you don't want to have anything to do with Cymbalata ever again, but... this isn't Cymbalata, this is withdrawal. You can get it coming off a ton of these drugs (I'm looking at you, Effexor.) If you want the insomnia and brain fudge to stop, you need to taper slowly. Two drops in two weeks is not slowly.

Your doctor sounds like an idiot, by the way.
posted by DarlingBri at 6:04 PM on August 25, 2008 [1 favorite]

I'm tapering off Effexor, which is known as being particularly hellish to get off of (wish I would have known that before I started taking it, but the brain fog of depression makes you take anything that promises to help you). That being said, it sounds like you tapered off Cymbalta really quickly -- it takes longer than a week for your body to get used to a new dose, so it's hard to go from 60 to 0 in two weeks.
I don't know what form the Cymbalta comes in, but if it's pills, you could take half of a 30 every day, or take a 30 every other day, 'till the side effects subside. Then keep tapering off -- a 30 every two days, or half a 30 every two days...
Again, I'm on Effexor, and I'm taking it reaaaally slowly, but I've been lucky so far (and feel so much better already!). Take your time, and tell your doctor if the withdrawal is too much.
posted by OLechat at 6:11 PM on August 25, 2008

As a patient and a (non-psych) MD, I think you were tapered way too quickly. I know you don't want to go back on Cymbalta, but if I were to taper you, rather than going from 60 mg to 30 mg to nothing in 2 weeks, I would have you do the following:

Week 1: empty capsule into glass of water, drink full glass daily
Week 2: empty capsule into glass of water, drink half glass daily
Week 3: empty capsule into glass of water, drink quarter glass daily

This would probably be sufficient, and I don't think you would need to repeat with the 30 mg dose.

Caveats: this worked for me starting (I did the above in reverse) and coming off of Prozac after not tolerating Paxil years earlier, and, later, for coming off Effexor. To repeat, psych is not my specialty, so this is no better than regular old anecdotal evidence, but from all I've read (and experienced), I think your taper was just too quick. It may be easier to re-start and re-taper down.

On preview: what the others said.
posted by ssmug at 6:16 PM on August 25, 2008 [2 favorites]

I am no more of an expert than any of the above posters, but I have a different view. I agree with you that you should not "waste" the two weeks of suffering you have already done. I would tough it out for another two weeks, by getting the mouth guard as suggested, by getting a muscle relaxant to use when you become overly tense and taking tylenol pm's at night. They are not medically addictive, but you can start to think you need them to sleep and get anxious about falling asleep if you stop taking them after you have for a period.
posted by JohnnyGunn at 6:24 PM on August 25, 2008

I can only speak from personal experience, but withdrawal from a (much smaller dosage) of antidepressants was pure hell. The symptoms lasted for a month or so but then I got better -- and was much happier than before. You could try tapering down slower, as others have mentioned, but I'd agree with JohnnyGunn -- try sticking it out for a few more weeks.

But I understand! It's a tough process -- take advantages of any opportunities to get out of your own head, go do things, etc. -- that's what made it a lot easier for me.
posted by elisabethjw at 6:38 PM on August 25, 2008

I withdrew from Zoloft and had many of the same symptoms. The zaps were what bothered me the most. They went away after about a month. I just gritted my teeth and bore it.

My theory is that antidepressants "desensitize" you from some kinds of stimulation. When you go off them, some of your sensory apparatus becomes over stimulated and it takes a while for everything to get back to normal.
posted by gjc at 6:51 PM on August 25, 2008 [2 favorites]

60mg to 30mg for only a week and then zero? That fast of a taper (if you can even call it that) can send one over the edge. Put me down solidly with those who would suggest a slower taper. After a year and a half, a proper taper should be on the order of months - not a couple of weeks. Too many doctors simply do not understand the seriousness of anti-depressant withdrawal - excuse me - 'discontinuance syndrome' as they like to call it.

My heart and best wishes go out to you. Good luck!
posted by Gerard Sorme at 7:07 PM on August 25, 2008 [1 favorite]

Another alternative is to weaning off more slowly is to open the capsules and pour increasing amounts of the powder out. It would probably taste better than mixing it with water ;). I have a friend who did this to go off of Effexor safely.
posted by Raichle at 7:40 PM on August 25, 2008 [1 favorite]

Best answer: IANAD and I'm taking Vicodin right now (surgery), so I'm sorry if this is totally incoherent.

Exactly what JohnnyGun andy elisabethjw said. Tough it out and don't slip back. It sucks really really bad, but you KNOW you want to be off it. After two weeks, you probably won't see much relief if you start a very low dose, and you'll probably just set yourself back. Unfortunately, "discontinuation syndrome" seems to be doctors don't know a lot about "discontinuation syndrome," and no one can really give you a straight answer on how to handle it so you won't suffer. The brain zaps are real. Everything you're experiencing is very real. Don't let anyone tell you otherwise.

I came off Effexor earlier this year and this is all very familiar to me. I can't speak specifically for Cymbalta, but I was sick for a little over a month. I tapered down very quickly, nearly the same schedule as you, because I was sick of not being able to remember anything and being a complete zombie. Also, I was hitting the bottle pretty hard. I did this all without a doctor, which was probably a really stupid idea. You know your body better than anyone on the Internet (or most doctors) can. If something feels really wrong, go to your doctor and don't be afraid to advocate for yourself. Since you're having trouble remembering, try to keep a log of symptoms. The Wellbutrin helped me to feel a lot sharper as the Effexor left my body. I started feeling much less fuzzy around the 3 week mark.

What kind of Wellbutrin are you taking? The SR or the XL? If you're taking the SR (the twice daily kind), take your second pill as you're about to hit the pillow. Eat some crackers, take the pill with a big glass of water, and immediately get into bed. Even after taking it for quite some time, it still screws with my sleep if I don't take it immediately before bed. A good night's sleep will help a great deal. As mentioned above, an OTC sleep aid (or just plain benadryl if you don't want to buy a box of new pills. Actually, the sneezing could be seasonal allergies) is perfectly safe to use for as long as you need it. Don't take Tylenol PM unless Tylenol helps your headaches. Buy the "Simply Sleep" kind.

I don't know what your daily life situation is, but if you can take any sort of pressure off yourself, please do so. Are you working? If so, can you take some sick time or half days? Your therapist seems really understanding; I bet he would be willing to write you a doctor's note. Carry some saltines or other bland, dry food with you wherever you go to combat the nausea. Eating a little bit every hour seems to help. Eat whatever sounds appetizing, with little regard to nutritional value, if that's what it takes. For the digestive problems, try to sneak in something that has added fiber, and eat some yogurt (or take probiotics if you don't like yogurt).

And if you've been known to grind your teeth in the past, it might be worth your while to see if your insurance company will cover a mouth guard for you to wear at night.

Sorry about the novel. Take care and be good to yourself. I'm rooting for you!
posted by giraffe at 7:52 PM on August 25, 2008 [2 favorites]

People who are withdrawing from benzodiazepines sometimes switch to valium or librium because of their long half-lives. So the withdrawal process is much smoother. In the same way, people withdrawing from SSRI's (and SNRI's like Cymbalta) may find it easier to switch to Prozac (which has a very long half-life compared to almost every other SSRI) and withdraw from that. Cymbalta, incidentally, has a very short half-life, even shorter than Paxil, which is widely regarded as having one of the worst withdrawal syndromes.

You've withdrawn from Prozac previously with no problems, so it seems like it could be a good choice, especially if you don't want to go back onto the Cymbalta.

With regard to sleep aids, while over-the-counter stuff isn't addictive, it can be habit forming. (eg. you don't crave it or become physically dependent, but you can end up finding it impossible to sleep without it). The general rule seems to be that it's fine to take as needed so long as it's not most nights.
posted by xchmp at 8:36 PM on August 25, 2008

IANAD, but you and your doctor might want to work out a more gradual tapering schedule (i.e. 60mg -> 45mg -> 30mg -> 15mg, with a week at each dose). Rather than mixing the contents of the Cymbalta capsules with water (which might mess with the extended-release function), what would be even more accurate is to have your dosages measured and capsuled at a compounding pharmacy.
posted by thisjax at 9:27 PM on August 25, 2008 [1 favorite]

Best answer: I've been on this drug and that one for a long time -- manic depressive here, and it took me a long time to finally reach medicinal armistice with this son of a bitch. (Though I have, in recent years.) Anyways, I'd tried Cymbalta as an add-on for Welbutrin, and it worked well, but I wasn't really sure I needed it, nor was the doc, once I'd gotten through some situational stuff, so I (we) decided to get off it. I've gotten off of most everything/anything in years past, this drug or that, never a problem, ho hum. But Cymbalta kicked the shit out of me. Man oh man.

I've got a friend who was a crackhead at one time in her life, she told me that getting off crack was a walk in the park compared to getting off Cymbalta. I suspect she was not bs'ing me.

Like others in this thread have suggested, it's an insane schedule you were on. GO SLOWLY. 5mg at a time, esp as you get down to the end, maybe when you hit 10mg start going down at 2.5mg at a time, and each step at least two weeks. Even with all that I was shaky as hell, nutty as a fruitcake and about as ugly, and about as popular.

Not a fun time. It took some time, some patience (a lot of patience), it took some gritting it out.

Your doc is either nuts or inexperienced or both. IMO. IANAD. That said, I've been around the block a time or two, or three. Lots of butchers out there have made it through med school and a psych residency so's they can torture us with their various foolishnesses. I really like thisjax's idea about getting the doses measured and capsuled at a pharmacy, so as to keep everything clear, you'll KNOW what you're doing, each step of the way.

Hang on; it can be quite a ride.

Good luck.

Peace.

dancestoblue
posted by dancestoblue at 2:20 AM on August 26, 2008 [2 favorites]

I love my Cymbalta, but oy, the withdrawal. I've been on it and off it and back on it as needed, and I agree that your tapering down was way too fast.

What's worked for me has been to treat the last 30 days' supply as the tapering-off supply, and to get a bag of empty capsules from GNC and start dividing on my own. You have to be careful not to spill anything, but the good news is the stuff inside Cymbalta capsules is in little balls and not powder, so it's not too bad if you've got reasonably steady hands, and your dividing doesn't have to be precise. I'd recommend a week each at full dose, 45 mg, 30 mg, and 15 mg, and from there, if you need it, go to 15 mg every other day, then 15 mg every three days. I'm usually able to discontinue with almost no symptoms by the 15 mg daily phase, but of course results may vary.

Since you've been off it completely for two weeks, I don't know if the above will help you in this situation. Perhaps try going on 30mg or 15mg for a week and starting a more gradual tapering from there?
posted by Metroid Baby at 6:53 AM on August 26, 2008 [1 favorite]