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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
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Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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I was on Cymbalta for 10 years for fibromyalgia and I guess

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I was on Cymbalta for 10 years for fibromyalgia and I guess anxiety/depression. I found the Cymbalta to make me just 'not feel' and weaned off of it. Definitely needed something so doc put me on Prozac but after 1.5 weeks, I am getting panic attack-like symptoms. The fibromyalgia pain is back with a vengeance also. Any suggestions? Do I need to take Cymbalta? Was taking 60MG and doc put me all the way up to 120MG before I weaned off.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 2 years ago.
Hello. I believe I can be of help to you with this issue.

A newer, closer 'family member' to Cymbalta is an antidepressant called Effexor. More expensive, but also more specific and fewer side effects for some patients. You should talk to your doctor about going back onto Cymbalta or trying Effexor, rather than Prozac. You should be able to move from Cymbalta to Effexor with relative ease; So I'd talk to my doctor about trying Cymbalta and if this doesn't work, discuss trying this switch to Effexor.

There is growing recognition that fibromyalgia is truly a physiologically-based disorder but may have many different 'causes' for different people. Also, it is a disorder that is highly 'reactive' to anxiety, stress and mood changes e.g., many patients' symptoms get much worse when they are stressed emotionally or under physical fatigue, or when daily conflicts are building up. I'm concerned about whether you have a multi-component intervention approach going for your fibro. This would include gentle stretching exercises and some mindfulness activity such as yoga or meditation, spending regular time in a warm bath, sauna or hot tub if this helps your particular fibro symptom. Forms of cognitive behavioral therapy can reduce pain symptoms as well. I don't believe that fibromyalgia is 'psychological', but it is clear from available research that stress, anxiety, fatigue and daily conflicts/hassles exacerbates symptoms for many people. I'm going to pause here and solicit your feedback to this response so for.
Customer: replied 2 years ago.

Thank you for your response. One additional piece of information, in 1964 at the age of 9 I had a non-cancerous thyroidectomy. Although tests show normal, I do know there is some connection between thyroid and fibro. I do try to stretch and usually must stretch before I am even able to sleep. I did fairly well with the fibro with the Cymbalta but it just made me 'not feel' and I never really felt all that happy, just maybe not depressed. So I wanted to get off the Cymbalta (against doctor's wishes) but the only way to see if I still need medication is to get off of it and then see what happens.

 

I do think I need medication. I am getting minor panic buildup when it starts to get dark. I do need cognitive therapy but am not doing that right now. I just called doc and he put me on Prozac but I don't think it is enough.

 

So you think perhaps I would use Prozac and Effexor - or Effexor and Cymbalta?

Expert:  Dr. Michael replied 2 years ago.
You wouldn't use combinations of any of these medications, ever. You'd try one of them; adjust the dose over time, then perhaps switch if you found it wasn't helping you. But you wouldn't ever take two of them at a time. Switching from Prozac to Effexor would be harder (side effect-wise) than being on Cymbalta and then switching to Effexor.

I'd encourage the cognitive therapy. The fact that time of day and situational cues in the environment (getting dark outside), can cause you to feel anxiety or panic, shows that you've developed some emotional reactions that are classically conditioned or learned. So this is a real tip-off that cognitive-behavioral therapy might help.

Here are a couple of self-help workbooks you should look at because they are based on empirically-supported or validated treatments for anxiety/depression:


http://www.amazon.com/Mindfulness-Acceptance-Workbook-Depression-Commitment/dp/1572245484/ref=sr_1_7?s=books&ie=UTF8&qid=1326953323&sr=1-7

http://www.amazon.com/Cognitive-Behavioral-Workbook-Depression-Step-/dp/1572244739/ref=sr_1_4?s=books&ie=UTF8&qid=1326953323&sr=1-4

If you work on these with seriousness and diligence, you'll learn some helpful emotionl regulation coping skills, guaranteed. It won't eliminate your depression or fibro, but I can assure you that if you take them seriously, you'll get help and it will help prepare you for therapy with a cog-behavioral therapist or someone who practices Acceptance and Commitment Therapy or ACT, which is a variant of CBT.

I hope this information is helpful to you. Please click on the green Accept button at the bottom of the screen. Let me know if I've overlooked any aspect of your question.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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