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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5108
Experience:  Dr. Mark is a PhD in psychology in private practice
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HelloI have withdrawn from duloxetine very, very slowly from

Resolved Question:

Hello
I have withdrawn from duloxetine very, very slowly from 60mg splitting the capules over weeks.
I have now been off the drug 2 weeks and feel really angry, cry a lot and have this awful buzzing and swooshing in my head when I move my eyes.
Is this all part of the withdrawal?
I have never been an angry person before and it scares me..I do not want to go back on this medication. I have worse problems coming off it last time I tried ( shaking , confusion despite following medical advice on tapering etc) but have gone even slower this time.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

Hi! I believe I can be of help with this issue

I can imagine how distressing and worrisome this situation must be for you. You seem to be exhibiting withdrawal symptoms from the duloxetine (Cymbalta is the brand name here in the US where it was developed). The swooshing, etc. feeling is what most people I work with call a "brain zap" and I have found it is very common in withdrawing from SSRIs and SNRIs. Doctors don't like to say that these withdrawal effects are common because in one sense they're not: I haven't seen really, really reliable studies with figures, but I imagine it's not 50% of people withdrawing from these meds who have brain zaps or extreme mood changes like you're experiencing. But I think it might be close to 25% and that's sizable. Duloxetine is an SNRI.

Let me link for you a couple of sites to start off with to ease your fears as much as we can. The symptoms you're describing are worrisome and of course make it miserable for you. That can't be minimized. But they are the ones experienced frequently and not the symptoms that would make you go to the emergency room. So that's good. Not being scared or worried overly about the symptoms can help in getting over them.

The first site is from a very prestigious American medical and research facility called the Mayo Clinic. This is their entry for Serotonin Syndrome. That is a fancy name but in your case it really only refers to the withdrawal symptoms you're experiencing. I am linking for you so that you know it is not uncommon:

http://www.mayoclinic.com/health/serotonin-syndrome/DS00860

This second link is to an excellent nonprofit informational organization and says very much the same things:

http://www.nmsis.org/content.asp?type=publications&src=pages/preventdiscontinuationsyndromes.asp&title=Tips+to+manage+and+prevent+discontinuation+syndromes

You've been completely off the duloxetine now for 2 weeks and that is the time period that most people have to wait who are sensitive to Serotonin before they start seeing relief. Some people have to wait it out longer. Whether you should take small amounts again and taper off from even those partial capsules by counting grains (yes, some people do that) is a question you and your doctor need to address if you don't start feeling it easing up in a week or 10 days. But stay the course for now with the knowledge that this is experienced by a lot of people who take this medication.


You might also consider adding a behavioral component to your treatment for your anxiety and/or depression. While behavioral treatment requires more effort from the patient than medications and is not as quick acting, it doesn't have the side effects nor withdrawal symptoms of the medications. If you would like to introduce a behavioral treatment, feel free to ask me another question about it. Just write “For Dr. Mark” at the beginning and everyone will know it’s for me.

Okay, I wish you the very best!

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Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5108
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.
Thank you for your reply Dr Mark. I did split the capsules and count the grains down over 8 weeks' reducing every week. I was doing ok until the very last stage where I stopped .

I am so relieved to hear its not just me, I have been well for a long time and everytime I try and stop the med I have felt like this and been told to go back on it ...the symptoms vanish immediately.

I did feel quite strongly that this was not like my depression of old and the articles you posted explain that perfectly. It would appearing am very suseptable to fluctuations in the levels but I am please to hear it will pass soon and will stick it out for another few weeks. My psychiatrist said go down to 30mg then stop...so glad I was more cautious.

To get a psychologist in the UK means you have to wait 6 months or more and I suspect I will feel better by the time I get to one and will have worked it all out for myself by then. I have had cognitive therapy before and use those methods to overcome my issues on a daily basis.

Thank you so much for your help you really put my mind at peace over whether my depression was coming back or not.

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