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Suggest Treatment For Withdrawal Symptoms Of Cymbalta
Posted on
Wed, 3 Feb 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Wed, 3 Feb 2016
Answered on
Tue, 12 Apr 2016
Last reviewed on
Question : I'm having severe withdrawal symptoms from Cymbalta (Protracted Cymbalta discontinuation syndrom) even 3 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 pain 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 has nothing to do with my footh pain 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 problems, and my neurologist have never mentioned it.
After few days I got extreme brain zaps while moving my eyes. Immediately I got back to 60mg and 2 days later everything was OK. 2 weeks I was on 60mg and feeling stable,then I started to lower my dose on 30mg.
3 weeks later while I was on 30 mg , 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 am sure 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. 3 months later I still have severe withdrawal symptoms: periodic myoclonic jerks of arms, legs, shoulders,mouth,
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),
periodic pains in my whole back and muscles of whole arms,even in the fingers of arms,pains in joints of arms(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 ,
that GI sickness decrease
and eyes,sensitivity to the sounds increased.Then few weeks after I got extreme muscle joint pains.Like I am in a circle. 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, and akathisia.I had few days period without them.
In the meanwhile I have read everything on-line about withdrawal, seen few doctors in my area (no use) 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 3 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 constantly-I don't need it any more I am just using it cause I am to afraid now to decrease it and cause benzo withdrawal. I have never need neither of this antidepressants,
they didn't helped in my pain anything. I cant forgive myself I was so stupid and believed that neurologist who gave me that diagnose without full diagnostic examination convinced me that I have
serotonergic disbalans and I have to take antidepressants to "stabilize".
One doctor now suggested me to try lowest dose (half pill of 25mg) of Seroquel and cut my Clonazepam to half (0.5 mg), saying it would help me to stabilize and get of Cymbalta,
but I'm too scared to take any additional drug, especially antipsychotics! Another doctor wants to increase Cymbalta-this is not option for me,I don't want to upper my dose,become addict to higher dose,
because if 60 mg didnt improve my withdrawal,higher dose can be useless as well. Thrid 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 senzatization) and he is very concern 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, if you have ever had patient in this situation, is there any treatment for this condition?
I am from Europe 32 years old. I am young medical doctor with no experience in this area of medicine.
Kind regards,
XXXX
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 pain 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 has nothing to do with my footh pain 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 problems, and my neurologist have never mentioned it.
After few days I got extreme brain zaps while moving my eyes. Immediately I got back to 60mg and 2 days later everything was OK. 2 weeks I was on 60mg and feeling stable,then I started to lower my dose on 30mg.
3 weeks later while I was on 30 mg , 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 am sure 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. 3 months later I still have severe withdrawal symptoms: periodic myoclonic jerks of arms, legs, shoulders,mouth,
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),
periodic pains in my whole back and muscles of whole arms,even in the fingers of arms,pains in joints of arms(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 ,
that GI sickness decrease
and eyes,sensitivity to the sounds increased.Then few weeks after I got extreme muscle joint pains.Like I am in a circle. 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, and akathisia.I had few days period without them.
In the meanwhile I have read everything on-line about withdrawal, seen few doctors in my area (no use) 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 3 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 constantly-I don't need it any more I am just using it cause I am to afraid now to decrease it and cause benzo withdrawal. I have never need neither of this antidepressants,
they didn't helped in my pain anything. I cant forgive myself I was so stupid and believed that neurologist who gave me that diagnose without full diagnostic examination convinced me that I have
serotonergic disbalans and I have to take antidepressants to "stabilize".
One doctor now suggested me to try lowest dose (half pill of 25mg) of Seroquel and cut my Clonazepam to half (0.5 mg), saying it would help me to stabilize and get of Cymbalta,
but I'm too scared to take any additional drug, especially antipsychotics! Another doctor wants to increase Cymbalta-this is not option for me,I don't want to upper my dose,become addict to higher dose,
because if 60 mg didnt improve my withdrawal,higher dose can be useless as well. Thrid 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 senzatization) and he is very concern 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, if you have ever had patient in this situation, is there any treatment for this condition?
I am from Europe 32 years old. I am young medical doctor with no experience in this area of medicine.
Kind regards,
XXXX
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
Everything you describe is indeed consistent with Cymbalta withdrawal/discontinuation syndrome. There are a few options to stabilize you before tapering it. Some of these have already been suggested by other doctors, so at the end I will suggest the one I think is best.
#1 Increase the Cymbalta dose. Your brain needs more Cymbalta now to stabilize, and once stable, you can then start a slow taper.
#2 Add an atypical antipsychotic such as Seroquel or Abilify. These act on seronin receptors in the brain and can stabilize them in withdrawal.
#3. Increase your Klonopin temporarily. This can often offset the anxious side effects of Cymbalta withdrawal.
#4. Add a low dose of a long-acting SSRI such as Prozac until you feel better, then begin tapering the Cymbalta slowly.
In my experience, the best option is #4. Prozac has a long half-life and can stabilize depleted serotonin receptors very well in withdrawal from other antidepressants. 10-20mg a day would do. Once you feel better, you can slowly taper off Cymbalta, and then take off the Prozac. This method often works very well.
Please remember to rate and close this answer thread when you are satisfied.
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
Everything you describe is indeed consistent with Cymbalta withdrawal/discontinuation syndrome. There are a few options to stabilize you before tapering it. Some of these have already been suggested by other doctors, so at the end I will suggest the one I think is best.
#1 Increase the Cymbalta dose. Your brain needs more Cymbalta now to stabilize, and once stable, you can then start a slow taper.
#2 Add an atypical antipsychotic such as Seroquel or Abilify. These act on seronin receptors in the brain and can stabilize them in withdrawal.
#3. Increase your Klonopin temporarily. This can often offset the anxious side effects of Cymbalta withdrawal.
#4. Add a low dose of a long-acting SSRI such as Prozac until you feel better, then begin tapering the Cymbalta slowly.
In my experience, the best option is #4. Prozac has a long half-life and can stabilize depleted serotonin receptors very well in withdrawal from other antidepressants. 10-20mg a day would do. Once you feel better, you can slowly taper off Cymbalta, and then take off the Prozac. This method often works very well.
Please remember to rate and close this answer thread when you are satisfied.
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Doctor,
I waited for my test results of blood concentration of Cymbalta. Results came back and my level of Cymbalta is under 10, where referent value is from 30 to 120.
Also I have measured serotonin level in blood, and it is also low, under 3. Ref. level is 3-250.
I’m on 60 mg of Cymbalta in continuity from 09th of November. I don’t know what you can conclude from these results, but for me it is showing that increasing Cymbalta level will not help me. I don’t see any other explanation for such a low level of Cymbalta in my blood, expect for protracted withdrawal that is lasting for 4 months now. I feel trapped, I can’t lower my dose of Cymbalta because horrible withdrawal symptoms and on the other hand this drug is not working for me, it has no effect. I’m most afraid of Myoclonic jerks which I have all the time, because I have read this can also be side effect from Cymbalta, as it is written in official Cymbalta document. My doctor is afraid to add Prozac, due to my hyper sensitivity and to avoid causing Serotonergic syndrome. I have tried to increase Clonazepam but it was no help. I can’t add Seroquel, because it can cause tardive dyskinesia, which would be very dangerous, having in mind my current problems with Myoclonic jerks.
Do you have any other suggestions or recommendation?
My ultimate goal is to get of this drug as soon as possible and to stay pregnant!
I waited for my test results of blood concentration of Cymbalta. Results came back and my level of Cymbalta is under 10, where referent value is from 30 to 120.
Also I have measured serotonin level in blood, and it is also low, under 3. Ref. level is 3-250.
I’m on 60 mg of Cymbalta in continuity from 09th of November. I don’t know what you can conclude from these results, but for me it is showing that increasing Cymbalta level will not help me. I don’t see any other explanation for such a low level of Cymbalta in my blood, expect for protracted withdrawal that is lasting for 4 months now. I feel trapped, I can’t lower my dose of Cymbalta because horrible withdrawal symptoms and on the other hand this drug is not working for me, it has no effect. I’m most afraid of Myoclonic jerks which I have all the time, because I have read this can also be side effect from Cymbalta, as it is written in official Cymbalta document. My doctor is afraid to add Prozac, due to my hyper sensitivity and to avoid causing Serotonergic syndrome. I have tried to increase Clonazepam but it was no help. I can’t add Seroquel, because it can cause tardive dyskinesia, which would be very dangerous, having in mind my current problems with Myoclonic jerks.
Do you have any other suggestions or recommendation?
My ultimate goal is to get of this drug as soon as possible and to stay pregnant!
Brief Answer:
Followup
Detailed Answer:
Welcome back to HCM.
Seroquel's risk of causing tardive dyskinesia is almost zero, especially with short term use. I strongly recommend this option given your hesitancy about the other options. Raising your Klonopin to an even higher dose until it is effective is still another option.
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Welcome back to HCM.
Seroquel's risk of causing tardive dyskinesia is almost zero, especially with short term use. I strongly recommend this option given your hesitancy about the other options. Raising your Klonopin to an even higher dose until it is effective is still another option.
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you for your answer.
Can you please tell me your opinion about level of Cymbalta in my blood. As I stated before, I done the test, and it is showing extreme low level of Cymbalta in my blood.
4 months now I'm taking 60 mg every day at the same time, so it is obviously that drug is not working. In the light of this, would you recommend for me to wait more
for stabilization, or to start tapering immediately?
My biggest concern now are Myoclonic jerks in my stomach, that are very severe and every time they "punch" air out of my lungs. This is new symptom, and that is way I'm
not sure to start tapering right now. In the official Cymbalta documentation it is stated that Myoclonic jerks are possible side effect. I can't distinct is this caused by the WD or by the
side effects?
Also, you suggested to increase Cloanzepam. Do you mean to increase it and wait to stabilize or to increase it and start tapering?
Can you please tell me your opinion about level of Cymbalta in my blood. As I stated before, I done the test, and it is showing extreme low level of Cymbalta in my blood.
4 months now I'm taking 60 mg every day at the same time, so it is obviously that drug is not working. In the light of this, would you recommend for me to wait more
for stabilization, or to start tapering immediately?
My biggest concern now are Myoclonic jerks in my stomach, that are very severe and every time they "punch" air out of my lungs. This is new symptom, and that is way I'm
not sure to start tapering right now. In the official Cymbalta documentation it is stated that Myoclonic jerks are possible side effect. I can't distinct is this caused by the WD or by the
side effects?
Also, you suggested to increase Cloanzepam. Do you mean to increase it and wait to stabilize or to increase it and start tapering?
Brief Answer:
Followup
Detailed Answer:
The Cymbalta level is low, suggesting that you metabolize Cymbalta faster than most people. This means you need more of it to stabilize, which is why I suggested:
"#1 Increase the Cymbalta dose. Your brain needs more Cymbalta now to stabilize, and once stable, you can then start a slow taper."
Myoclonic jerks refer to striated muscle, not smooth muscle. You cannot have myoclonic jerks of the stomach. What you are experiencing there is anxiety, which would treated by any of my suggestions above (#1 through #4).
Regarding increasing Klonopin, yes, I would increase it, wait until you are less anxious, and then begin tapering.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
The Cymbalta level is low, suggesting that you metabolize Cymbalta faster than most people. This means you need more of it to stabilize, which is why I suggested:
"#1 Increase the Cymbalta dose. Your brain needs more Cymbalta now to stabilize, and once stable, you can then start a slow taper."
Myoclonic jerks refer to striated muscle, not smooth muscle. You cannot have myoclonic jerks of the stomach. What you are experiencing there is anxiety, which would treated by any of my suggestions above (#1 through #4).
Regarding increasing Klonopin, yes, I would increase it, wait until you are less anxious, and then begin tapering.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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