How to deal with severe SNRI withdrawal symptoms?
May 6, 2015 9:28 AM Subscribe
After a few months on Cymbalta, I was hit with pretty intolerable side effects - extreme fatigue, weakness, and dizziness being predominant. I asked my doctor if he could take me off it, and he did so - albeit with a very rapid taper, which I (and he?) felt was justified by the side effects. It has been 2.5 weeks since I stopped the Cymbalta, and I have been experiencing intense withdrawal on top of the effects I had been feeling previously.
The effects are stronger after mental exertion - I've tried working from home (disability benefits ended yesterday), but I just get sicker. Symptoms include:
Shortness of breath (doesn't feel like I ever get "enough" oxygen)
Nausea
Vertigo, especially when I read (like on the computer)
Feeling about to faint
Shaking
Mania (once, for a couple of hours - never happened before)
The brain zaps have gone away, although they were strong while they were there.
When I asked my doctor what to do, he sort of looked puzzled and said "breathing exercises, maybe?" He did put me on a low dose of Prozac to try to counteract things, but it's not working yet.
I know you are not my doctor, and I'm not looking for a diagnosis. I'm more hoping that one of you has suggestions on what you did when the symptoms got really bad, so that I can use them in the moment.
Thanks!
The effects are stronger after mental exertion - I've tried working from home (disability benefits ended yesterday), but I just get sicker. Symptoms include:
Shortness of breath (doesn't feel like I ever get "enough" oxygen)
Nausea
Vertigo, especially when I read (like on the computer)
Feeling about to faint
Shaking
Mania (once, for a couple of hours - never happened before)
The brain zaps have gone away, although they were strong while they were there.
When I asked my doctor what to do, he sort of looked puzzled and said "breathing exercises, maybe?" He did put me on a low dose of Prozac to try to counteract things, but it's not working yet.
I know you are not my doctor, and I'm not looking for a diagnosis. I'm more hoping that one of you has suggestions on what you did when the symptoms got really bad, so that I can use them in the moment.
Thanks!
I am not suggesting that anyone else do so without consulting with a physician, but I found it extremely helpful when I was withdrawing from Cymbalta to take a tyrosine supplement (which is supposed to help the body produce norepinephrine) and a B-vitamin supplement (which is supposed to help with stress in general) and to eat a lot of tyrosine-rich seaweed (dried snacks, seawood salads at sushi restaurants). I have read other recommendations to add a tryptophan supplement, but as that is supposed to increase serotonin and I was worried about too much serotonin, I skipped that one. If I had been prescribed Prozac, which increases available serotonin, I would absolutely have skipped anything else that worked on serotonin.
This thread on Cymbalta withdrawal may also be helpful.
posted by jaguar at 9:55 AM on May 6, 2015
This thread on Cymbalta withdrawal may also be helpful.
posted by jaguar at 9:55 AM on May 6, 2015
For many people, tapering an SNRI according to the official pharm schedule doesn't work without huge side effects.
Someone close to me went on Effexxor for a very short time for a depression related to a life circumstance. When they wanted to taper off the medication after about a month or two, they were hit by such bad vertigo that they found the only way to wean gradually enough was to open the capsule, literally count out the beads, and wean off it in such small increments that it was about two beads less a day at a time or something like that.
It worked. PITA but the available tapering doses were not working with this person's brain chemistry. The weaning process took much longer than the period of actually just being on Effexxor...
posted by third rail at 9:59 AM on May 6, 2015 [1 favorite]
Someone close to me went on Effexxor for a very short time for a depression related to a life circumstance. When they wanted to taper off the medication after about a month or two, they were hit by such bad vertigo that they found the only way to wean gradually enough was to open the capsule, literally count out the beads, and wean off it in such small increments that it was about two beads less a day at a time or something like that.
It worked. PITA but the available tapering doses were not working with this person's brain chemistry. The weaning process took much longer than the period of actually just being on Effexxor...
posted by third rail at 9:59 AM on May 6, 2015 [1 favorite]
Yeah, unfortunately the main thing that would have helped was a slow taper (I go twice as slow as recommended and still get symptoms). But you are nearly 3 weeks in and past the brain zaps... the thing to do is wait it out. Your nervous system is saying WTF IS HAPPENING. You are going to feel that.
Rest as much as possible and be nice to yourself... low stimulation environment, natural light, plenty of water, comfy clothes, comfort food, fresh air, stretching, etc. I used cold packs, warm packs, turning on the AC and snuggling under blankets... anything to make the good feels override the buzzing in my nervous system. Really it's the same thing I do for bad migraine.
posted by zennie at 10:00 AM on May 6, 2015 [1 favorite]
Rest as much as possible and be nice to yourself... low stimulation environment, natural light, plenty of water, comfy clothes, comfort food, fresh air, stretching, etc. I used cold packs, warm packs, turning on the AC and snuggling under blankets... anything to make the good feels override the buzzing in my nervous system. Really it's the same thing I do for bad migraine.
posted by zennie at 10:00 AM on May 6, 2015 [1 favorite]
Also make sure you are eating enough. Hope you feel better soon.
posted by zennie at 10:09 AM on May 6, 2015
posted by zennie at 10:09 AM on May 6, 2015
It will pass. That's not really the answer you want but if it was possible to not have the side effects, then you wouldn't be having them.
When my husband was going through it, I tried to be extra patient with him and nagged him to stay hydrated, and he did have to practice what I think of as "migraine accommodation" - being really careful of bright lights/eye strain, resting in a cool dark room when he was really miserable, taking a little advil when he had a headache.
I kept ginger ale around, which was probably as much psychosomatic as medicinal, and Pedialyte popsicles are my go-to for nausea treatment (and the electrolytes/potassium tend to make you feel a smidge better when you don't feel good). We ate a little more comfort food than normal.
Once he was well and truly off the Cymbalta and up to speed on something else, we realized just how day-to-day not great the Cymbalta period was. As sucky as the withdrawal was, it was actually worth it to be on something that wasn't grinding him down as hard as it was.
posted by Lyn Never at 10:42 AM on May 6, 2015 [1 favorite]
When my husband was going through it, I tried to be extra patient with him and nagged him to stay hydrated, and he did have to practice what I think of as "migraine accommodation" - being really careful of bright lights/eye strain, resting in a cool dark room when he was really miserable, taking a little advil when he had a headache.
I kept ginger ale around, which was probably as much psychosomatic as medicinal, and Pedialyte popsicles are my go-to for nausea treatment (and the electrolytes/potassium tend to make you feel a smidge better when you don't feel good). We ate a little more comfort food than normal.
Once he was well and truly off the Cymbalta and up to speed on something else, we realized just how day-to-day not great the Cymbalta period was. As sucky as the withdrawal was, it was actually worth it to be on something that wasn't grinding him down as hard as it was.
posted by Lyn Never at 10:42 AM on May 6, 2015 [1 favorite]
doesn't feel like I ever get "enough" oxygen
This and some of your other symptoms sound to me like you may be anemic. Anemia literally is about not being able to get enough oxygen because your blood doesn't have sufficient capacity to carry as much oxygen as you need.
Severe anemia was part of the equation for one of my worst drug withdrawal experiences. The fatigue and other issues began to improve when I began taking iron supplements and b vitamins. It takes at least 48 hours to produce new red blood cells. So you need to give it a few days to see if the supplements are helping. One dose will not tell you anything. You need to start taking them and persist for a bit to see if this is one of the issues.
I often have nausea. Eating rice sometimes helps put a stop to that. Real ginger, like in good quality ginger ale, can also help take the edge off of nausea.
You might also try working on your electrolytes. Good quality sea salt and enough magnesium, calcium and potassium have helped enormously with some of my neurological issues.
Coconut oil or palm oil or other oils high in medium chain triglycerides do good things for the nerve sheath. That has helped with some of my neurological issues. However, you need to be conservative when introducing these things to your diet or taking them as a supplement. Don't go overboard with it. Large quantities can lead to severe diarrhea.
A little bit of sugar, like from eating one or two sugar cookies, has been helpful in taking the edge off the misery of withdrawal. It doesn't work like a pain killer. You don't stop hurting or whatever. But it just feels more bearable. I feel less wrung out and pushed passed my limit.
posted by Michele in California at 11:09 AM on May 6, 2015
This and some of your other symptoms sound to me like you may be anemic. Anemia literally is about not being able to get enough oxygen because your blood doesn't have sufficient capacity to carry as much oxygen as you need.
Severe anemia was part of the equation for one of my worst drug withdrawal experiences. The fatigue and other issues began to improve when I began taking iron supplements and b vitamins. It takes at least 48 hours to produce new red blood cells. So you need to give it a few days to see if the supplements are helping. One dose will not tell you anything. You need to start taking them and persist for a bit to see if this is one of the issues.
I often have nausea. Eating rice sometimes helps put a stop to that. Real ginger, like in good quality ginger ale, can also help take the edge off of nausea.
You might also try working on your electrolytes. Good quality sea salt and enough magnesium, calcium and potassium have helped enormously with some of my neurological issues.
Coconut oil or palm oil or other oils high in medium chain triglycerides do good things for the nerve sheath. That has helped with some of my neurological issues. However, you need to be conservative when introducing these things to your diet or taking them as a supplement. Don't go overboard with it. Large quantities can lead to severe diarrhea.
A little bit of sugar, like from eating one or two sugar cookies, has been helpful in taking the edge off the misery of withdrawal. It doesn't work like a pain killer. You don't stop hurting or whatever. But it just feels more bearable. I feel less wrung out and pushed passed my limit.
posted by Michele in California at 11:09 AM on May 6, 2015
If you don't have to go to work or school or anything then just clear your calendar and ride it out. I personally found that marathoning TV shows on Netflix until I passed out for a few weeks was sufficient distraction to get me through the withdrawal period.
posted by Jacqueline at 1:17 PM on May 6, 2015 [1 favorite]
posted by Jacqueline at 1:17 PM on May 6, 2015 [1 favorite]
Commenting here for the benefit of someone searching a year from now.
Unfortunately, one source of misery doesn't prevent another from clobbering you. Difficulty breathing is always something worth discussing with a doctor -- you could have bad allergies or chest infection complicating the med withdrawal.
The last time I went off Paxil, I cross tapered off Paxil liquid for six weeks while starting Prozac liquid. My shrink told me that Paxil clears the body so quickly that day to day changes make a difference. On the other hand, Prozac works so slowly that taking the full liquid dose just begins to work when I was done tapering to zero Paxil. My brain zaps only lasted a week. I was miserable in the thinking department for six weeks, but them's the breaks.
posted by Jesse the K at 4:30 PM on May 6, 2015
Unfortunately, one source of misery doesn't prevent another from clobbering you. Difficulty breathing is always something worth discussing with a doctor -- you could have bad allergies or chest infection complicating the med withdrawal.
The last time I went off Paxil, I cross tapered off Paxil liquid for six weeks while starting Prozac liquid. My shrink told me that Paxil clears the body so quickly that day to day changes make a difference. On the other hand, Prozac works so slowly that taking the full liquid dose just begins to work when I was done tapering to zero Paxil. My brain zaps only lasted a week. I was miserable in the thinking department for six weeks, but them's the breaks.
posted by Jesse the K at 4:30 PM on May 6, 2015
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posted by rabbitrabbit at 9:33 AM on May 6, 2015