man screaming in pain or anger

We were taken to task recently by a reader who thought our answer to a question from someone having a terrible time with Cymbalta withdrawal indicated a lack of respect. None was intended.

Q. You blew it in your answer to a person who lost insurance and went off Cymbalta.

You suggested ways to manage depression without medication. Would you suggest someone “manage” diabetes without medication?

Maybe one can manage moodiness or the blues without medication, but not mental illness. Mental illness is a disease, not just a bad mood.

This person should try to go through her or his local health department to get the needed medication for a reduced cost.

A. Stopping antidepressants like duloxetine (Cymbalta) suddenly can be disastrous. The person who wrote us had seizures, brain zaps, nausea and emotional distress when she ran out of medicine because of a gap in insurance.

Your suggestion about checking with the health department is worthwhile, but this person might not have qualified because she had a job.

Advance Warning Must Be Given

People who are prescribed such medications need to be forewarned against discontinuing them abruptly and given guidance if they ever need to stop. Sometimes a longer-acting drug like fluoxetine can help with gradual withdrawal.

We certainly agree that mental illness is serious and deserves appropriate treatment. Sometimes, though, nondrug approaches can be helpful. They should be undertaken with medical supervision to make sure that they benefit rather than harm the individual.

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  1. Kathy
    Whidbey island wa
    Reply

    I took Cymbalta for quite a few years. It never really helped that much, never put depression and anxiety into remission. I was also prescribed Lamactal as a second drug. The side affects were a little scary as my brain felt a little Zapped. I decided to go in for acupuncture for my depression and anxiety.

    I went off Lamactal and Cymbalta cold turkey a few weeks ago and it has been absolute torture!!! I am freezing cold a lot, jerky motions, anxiety on steroids and get so incredibly hot at times. I also have felt confusion and lack of concentration. There are times I think I see things out of the corner of my eye and are not really there. I am never going back to the drugs!!!!!!!!!! Cold turkey is not for the faint of heart, however.

  2. Helen
    Massachusetts
    Reply

    My PCP referred my to a psychiatrist because he felt I was over reacting to my severe abdominal pain and severe body pain which caused me to make several trips to the ER. The pain was so severe I was admitted several times. He insisted my ab pain was due to anxiety. BTW after meeting a great gastro doctor at one admission i was diagnosed with Small Intestinal Bacterial Overgrowth.

    PCP put me on gabapentin 100 mg 3 times daily with instructions to increase it but no plan for how to increase it. I gained 12 lbs. in one week so did not increase it, When I saw the psychiatrist she told me to taper the gabapentin and started me on cymbalta 20 mg. daily. So, now I was on a gabapentin taper and cymbalta. I thought it wasn’t smart. So I tapered down to 100 mg gabapentin once a day with no problem. I had tapered off of gabapentin once before with no problem. I’m sensitive to many drugs and at least had sense enough to ask for the lowest possible dose of cymbalta. After 2 doses the severe abdominal pain was back, anxiety was incredible with crying jags daily and pain increased. I even had panic attacks which I’d never had before.

    I called the pharmacist who said it could cause increased anxiety in some people. I then called the psychiatrist who told me to give it one week and call her back, Things got worse. When I called she said to stop the cymbalta. When i asked about withdrawal she said well you can take it every other day for a week if you want to then stop. She felt withdrawal affects would not be a problem. I did the every other day thing for a few days and was on a roller coaster of symptoms.

    So I stopped it. I am dizzy, have blurry vision, feel like someone else has invaded my body, have headaches can’t leave the house, body aches are worse than ever. She is considering putting me on something else. I will refuse. Although I had pain before I was able to function. I am so frustrated I haven’t been out with friends or been able to do any of my regular activities not even take my dog out to play with her or train or take her to training class. These are things that I enjoyed so much and always had a calming effect. I’m to see a pain management specialist soon and will hope he can help control the pain without meds. I, as most others here, was never told of side effects or withdrawal symptoms of cymbalta. I will never take another drug that works on the brain again. I will be seeing both doctors next week and am prepared for both of them to “fire” me!!! So sorry for the long post.

  3. nancy
    frederick,md
    Reply

    I have battled severe depression and cognitive impairment for over 20 years due to Lyme disease which doctors are trained not to treat.
    Instead I had nothing to do but take antidepressants and chronic oral antibiotics to allow me to barely function. The best for me personally was Cymbalta which I took for about ten years. I had been doing well and wanted to try and stop. The first few times I tried to stop Cymbalta, I had severe withdrawal symptoms that I mistook for my own mental illness flaring up.

    When I read online about other folks suffering similar withdrawal symptoms, I worked with my Dr. and online forums to wean off slowly. (My Dr. still maintains that there are no withdrawal symptoms associated with Cymbalta and she has never had any patients who have had them.I guess I don’t count). After 2 years, I was down to 20mg daily, the lowest dose available and had stabilized with no more withdrawal. At that time the insurance company felt it was in their best interest to switch to generic duloxitine. I took one generic dose and had a precipitous drop in my blood glucose and a mild serotonin syndrome which lasted 3 days. In spite of having to be transported by ambulance to the ER, my Dr. says there is no difference in brand vs generic and despite those symptoms being classic side effects for that chemical, the physicians refused to make a drug report and I had to get the pharmacist to do it.

    That was the last dose of either cymbalta or duloxitine I ever took. Luckily I was at the endpoint of my weaning period.

  4. carole
    N. C.
    Reply

    With all the painful joints etc. Have any of you had a tick disease panel done? I had what I thought was just plain old age arthritis. The kind where you get up in the morning and shuffle until your joints are warmed up and less painful to move. After a few years of that, found I had Rocky mountain spotted fever. The second day on Doxy, no more joint pain and none since. That was over ten years ago. 70 this year and no drugs and no pain or swollen joints. use a lot of tumeric and fish oil as well as tart cherry.

  5. Kathleen A Ruela
    United States
    Reply

    I was diagnosed with fibromyalgia 23 years ago. I did support groups, seeing a great rheumotologist, who advised to be active, exercise, diet. I would go into a remission for long periods, but extreme stress issues would cause a flare up and after trying several meds, Celebrex would take the edge off for me. I used it sparingly. Over the years, the addition of arthritis throughout my body, and two surgeries one on foot and one on shoulder, set back my exercise. Stenosis in neck/back also have crept in. So, pain all the time. Went for pain managemnt and was receiving epidurals in neck. Great. But then I developed blood clot and had to put in a vena cava filter. Meaning, off all NSAIDS and no more epidurals. Moved prior to that and found a new rheumotologist prescribed cymbalta, (which I declined over the years). I figured it would give relief. On the contrary, had more pain, increased dosages more pain and then my hair started to fall out. Well, never had a problem with my hair, now I am walking with a cane. I am worse than
    before, but I had to wean myself off, even though it was only a few months, because of the side affects if stopping abruptly. Now, I have found a good yoga class and balance instructor, in physical therapy, and do acupuncture and massage therapy. All these combined, have increased my stamina, and are part of my pain management program. Off the drugs and just keep moving as my rheumotologist recommends for me. I, too, recommend this plan for me. No side effects.

  6. bernice
    Reply

    I have had many years of taking antidepressants, for both anxiety and depression. I have been taking Wellbutrin, Cymbalta, and Seroquel. When I asked my doctor about Cymbalta he just said “do YOU want to get off of it?” On my own, I have not been taking the Wellbutrin and only every other day the Cymbalta. I don’t think that I am getting worse, but do depend on Xanax, .025, if needed.

    • Ed
      United States
      Reply

      I have been using Wellbutrin SR for about eighteen years but not for depression. I have never been depressed, actually I am the opposite, or so I’m told. I am 77 years old and was diagnosed as have ADD. The psychiatrist that I went to feels that with my background of having problems in school I had ADD. Since I have taken it I, as well as my wife and people I worked with up till my retirement, could see a dramatic change in how I interacted with people and handled tasks.
      It has worked wonders for me.

  7. PGYx
    Midwest
    Reply

    I’m a physician. I re-read last week’s Q&A. You did not recommend non-drug management as a substitute for pharmacologic treatment of depression. However, some depressed folks do very well with non-drug management alone.

    For those who benefit from prescription anti-depressants, various non-pharmacologic (and non-supplement/herbal) interventions can be very helpful when used adjunctively. Dr. Andrew Weil’s book, Spontaneous Happiness, describes many of these strategies in detail. Unfortunately, long-term SSRI/SNRI use has side effects which outweigh the benefits for the many folks who benefit only mildly from the medication. For those people, non-drug strategies are essential.

    And yes, it is better to manage conditions like hypertension and non-insulin-dependent diabetes without drugs (diet, exercise, weight loss) when possible. Similarly, even those diabetics who produce no insulin benefit from a whole food plant-based diet and daily exercise to improve their insulin sensitivity, reduce total insulin requirements, and improve blood sugar stability.

  8. Hanna
    Oregon
    Reply

    I was trained extensively in ethics. Treating clinical depression is a two-pronged intervention. Appropriate medication needs to be combined with insight-oriented counseling. Many times if the person is able to address the cause of the depression and learn coping skills, need for medication may be lessened. Other times depression is genetically embedded in families, and it is not so easy to just stop medication. It is NOT a one-size fits all issue.

  9. elena
    smithtown, long island
    Reply

    I went cold turkey off Cymbalta because of undesirable side effects and had no bad reactions. Eventually all side effects ceased. A few months later resumed dose, side effects returned and I quit for good including the Neurontin I was taking in tandem.

  10. O.G.
    SC
    Reply

    I thought your answer was measured, careful, and thoughtful, as always at The People’s Pharmacy.

    I’ve posted my comments about Cymbalta–which was prescribed for me by a neurologist as an analgesic–before on this site, but will also say again that my Cymbalta-induced three-day descent into a very dark, depressed Hell gave me a vivid view of a dangerous drug’s side effects.

    I filed a written complaint with the FDA about Cymbalta.

    I’m grateful I was on it for such a short time, and feel enormous sympathy for patients who have to attempt to get off the stuff after more lengthy use. Thank you, People’s Pharmacy, for doing your best to educate and help.

  11. Cara H.
    Coupeville
    Reply

    A person who is severely depressed needs to find out the reason for the depression, not just try to get rid of the symptoms. Was the person abused as a child? What are their struggles? Too many doctors don’t take the time to figure out causes of an illness. They just hand over a pill and treat symptoms.

  12. Janae
    Boston, Ma
    Reply

    I also think your responses were inappropriate, insensitive, and just plain bad medical advice. I am unsubscribing!

  13. P.
    New Jersey
    Reply

    Some years ago, I was given Cymbalta for fibromyalgia, another “off label” condition that Cymbalta is supposed to help. I had some side effects and after 3 weeks, went off the medication. I had a horrible time coming off this drug, sweats, irritability, the feeling that I was going crazy and completely out of control. After this experience, I decided I would never go back on this drug. It’s awful, it’s dangerous and my doctor never told me there would be side effects from going off it. If someone is on it and decides to go off, please, please ask your doctor how to do it gradually. I think I did it cold turkey and that’s not the way to go. Please tell others to stay off this drug. It is dangerous to your health.

    • PGYx
      Reply

      Cymbalta is FDA-approved for treatment of fibromyalgia. This is no longer an off-label use. Thanks for sharing your experience.

  14. REM
    Jersey
    Reply

    There is mounting evidence that Cymbalta is a terrifically difficult drug to come off of — it can take many, many months of incremental dosage reductions to wean your brain of this nasty drug. Some patients have found that even after months or even years off of the drug, they may be subject to sudden bouts of depression, brain zaps, vertigo, confusion and more. Cymbalta also shows evidence of altering brain function over the long term, so that coming off the drug doesn’t just reset you back to normal. Many prescribing doctors seem unaware that Cymbalta can have a very negative and permanent impact on patients, beyond whatever real or imagined benefits the manufacturer claims for it, and the fact that it is frequently prescribed “off label” for a host of ailments further confuses the issue. If you are now on Cymbalta, or your doctor wants to prescribe it for you, dig really deep into complaints and discussions on the internet about the long term effects of this very tenacious and nasty habitual drug with questionable benefits. And if your doctor wants you to suddenly stop taking it, find another doctor — detox must be done carefully, patiently and with full medical supervision by a professional that understands the serious issue of Cymbalta addiction. And if you have a choice, don’t mess with Cymbalta.

  15. Ruth Cobb
    Elkins, West Virginia
    Reply

    It is possible she might qualify to receive Patient Assistance through the pharmaceutical company itself. The forms are available through the company.

    That being said, I stopped Cymbalta, given for the constant pain and had only small problems. I didn’t like the after effects of this and other medications with the potential of causing my to be tired, sick and mixed up. Mixing Neurotin for diabetic neuropathy, phenergan to control the nausea Cymbalta causes, a musc.e relaxant, etc. caused a lot of problems. My doctor approved my removing the meds, after the fact. I should have consulted them prior to stopping them, but it was over the Christmas holidays and I didn’t want to wait.

  16. Michael
    Australia
    Reply

    I have been following the Cymbalta article in ‘The People’s Pharmacy’ with great interest and would caution anyone to do their research first before even getting on this evil drug, let alone getting off it. To all like mind suffers: persevere; find a support group; or surround yourself with encouraging and understanding folk. I have the luxury of all these.

    BUT it is not easy. I am now in my fifth week of Cymbalta withdrawal. I went off it cold turkey and cannot believe how terrible this drug is affecting me after all these weeks. Just knowing in several months time I will be over the worst of it, is keeping me going.

    BUT I ask, “how could such a drug like this be on the market?”

    BUT why I ask, “is that I have been through seven previous [all cold turkey] prescription drug withdrawals when my specialists and doctors kept changing my medication for migraine control”. Most of them were powerful drugs BUT I only had at least a two week sweat-out period from all of them.

    TOO MANY BUT’S

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