Cymbalta withdrawal - coincidence?
 

I've been on quite a low dose of this drug for two and a half months for the pain of an idiopathic small fiber neuropathy badly affecting arms and legs. I've already tried Amitriptyline (heart palpitations after 3 years) and Gaberpentin. I have RA as well as Hypotgyroidism and have failed to tolerate many drugs. My general practitioner is keen to keep me on this drug if possible and tells me the side effects I'm suffereing are probably not caused by Cymbalta 30mg - if anything he wants me on a higher dose.

But I've had an awful headache, jaw crunching (ache around my jaw bone) and gastritis coming and going over the past month. I tried to come off this drug the other day but within 24 hours I was struggling with profound mood dip, anger, vomiting and worsenjng of headache. I felt I had no choice but to restart it again after 36 hours of hell. Does this correspond with anyone else's experience or is it just coincidence?

The SSRI type drugs really affect serotonin all over the body.
About 90% of serotonin is NOT in the brain. Serotonin is a major neurotransmitter in the GI tract, so many side effects or withdrawals involve that area quite often.

So the withdrawal effects, are body-wide. Some people are more sensitive to this than others....but doctors for some sad reason remain rather clueless about this.

You might have to carefully taper off.

Thanks for this Mrs D - you make complete sense re serotonin in the GI tract. My doctor is one such sad type unfortunately and refuses to acknowledge that withdrawing off it would be much of a problem - beyond a worsening of nerve pain. He would ideally like me to go up to 60mg as feels it is the ideal drug for me and that NSAIDs have caused my GI problems. He says that Omaprazole twice daily will resolve them but so far it hasn't and I've been on two a day for a week now.

It must be done ever so slowly
At least a month if not more
Alway tell your doctor
Please be careful
Withdrawal is dangerous
Me

No kidding! I thought I was dying today. I broke down and took a pill.
My doctor at least listens to me. If he doesn't believe me, then he doesn't say that. He is an endocrinologist. He is the only endo I've met who isn't a pompus ***. Thank God we have each other through this forum.

The Why and the Solution
 

Hi there,

I can speak from both a professional and personal perspective here.

First of all, bless your heart. Cymbalta withdrawal is brutal.

Contrary to a previous post, Cymbalta is actually a SNRI - serotonin-norepinephrine reuptake inhibitor. These include drugs such as Effexor, Pristiq, and Fetzima. They work like SSRIs, but they also work on norepinephrine receptors. SNRIs are particularly known for terrible withdrawal symptoms. Many patients describe a "zap like" feeling in the brain. It is thought that the norepinephrine reuptake inhibition is to blame. SSRIs can cause similar symptoms, especially Paxil, but many times people discontinue without a problem.

Here's why you're experiencing issues: your brain has auto receptors that respond to increases and decreases in serotonin and norepinephrine. When you first start taking Cymbalta, your brain detects increases in both chemicals and the auto receptors shut off for about a week, which is why it takes 1-3 weeks to see results. Eventually, they become desensitized and turn back on, thereby allowing CYMB to work. However, this isn't permanent. After discontinuing, the auto receptors are unable to compensate for the changes, and so your brain chemistry is out of wack. It takes up to a month or two for your chemistry to adjust.

The good news is, there is a fairly reliable solution that I've advised prescribers to use. Prozac, a SSRI, has a very long half life. It remains in the blood for about 2-3 weeks. Cymbalta has a short half-life, and remains in the blood for about 2-3 days. You simply take Cymbalta one day, Prozac the next, etc. for a week, then drop Cymbalta and remain on Prozac for 3-4 weeks. Then, you discontinue it. By having a long-half life, it has a built in taper that allows you to avoid the horrible withdrawals. There's an abundance of medical literature that supports this. Prozac does require a prescription, but your doctor is likely aware of SNRI withdrawal syndrome and will be on board.

Another option, in the meantime, would be to purchase chlorpheniramine, an OTC antihistamine, and take it as directed on the label. It has SNRI-like properties (it's a very old, cheap drug), and helps with symptoms.

Best of luck!