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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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Hello,
My psychiatrist decided to switch me from Cymbalta to Viibryd about 3 weeks ago and the tapering of cymbalta has caused me some awful side effects. My diagnosis is Panic Disorder with Agoraphobia. So far no medications have really helped too much, and so we're hoping Viibryd will do the trick.
My question is in regards XXXXX XXXXX tapering of cymbalta. I started out on 60mg of Cymbalta, while concurrently beginning the starter pack of Viibryd at 10mg. After 5 days of 60mg of Cymbalta and 10mg of Viibryd, I was told to stop the cymbalta completely in the hopes that the Viibryd would catch it. This did not work, and I was having horrible panic attacks, sweating, tremors, nausea and awful brain zaps. Because of this, my doctor put me back up to 40mg of Cymbalta, while I started the 20 mg of Viibryd. I continued this until I started the 40 mg of Viibryd, which at that point I dropped the Cymbalta down to 20mg.
After 24 hours of dropping down to Cymbalta 20mg and increasing Viibryd to 40mg, The brain zaps, tremors and nausea returned with a vengeance. I went to the doctor again, and he told me to bring the Cymbalta back up to 40 mg, while concurrently taking the Viibryd 40mg. Tonight is the first night that I took both the cymbalta 40 and viibryd 40 and I am not having any brain zaps but still am having some muscle twitches and headaches. The new plan my doctor suggested is that I take the cymbalta at 40mg and viibryd at 40 mg for a few weeks so that it levels off before we continue to taper off the cymbalta.. and this time we will taper it by 10 mg at a time while continuing the Viibryd at 40mg.

So this is my question/concerns: I feel as if I will never be able to get off the cymbalta at this point..which Is a huge fear of mine. I am also petrified of developing serotonin syndrome from being on both the cymbalta and viibryd at 40mg each.

My question is.. is there any other safe way to taper cymbalta which will be less likely to cause as horrible symptoms that you could suggest. And, if it safe for me to continue with what my doctor has perscribes (the Cymbalta at 40mg and the Viibryd at 40mg). Because its at the point where I almost just want to tough it out, deal with the brain zaps, and just go back down to 20 mg cymbalta for a few days and then just stop it completely while continuing the Viibryd.
Submitted: 9 months ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 9 months ago.

Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help with this situation.

Elliott, LPCC, NCC :

There is a likelihood of severe discontinuation syndrome when tapering off of Cymbalta, a fact which is not adequately told to doctors or the public by the manufacturer Eli-Lilly.

Elliott, LPCC, NCC :

There is a site that offers treatment using nutraceuticals to ease the tapering off of Cymbalta. This site is recommended by the FDA:

Elliott, LPCC, NCC :

I have a client who used this method with great success.

Elliott, LPCC, NCC :

There is more information available on the FDA site about Cymbalta withdrawal. This site IS NOT OUT OF DATE although it has been put in FDA archive.

Elliott, LPCC, NCC :

The best withdrawal is extremely slow, over several months. Low doses will have to be prepared by a compounding pharmacy so that they are exactly measured.

Customer:

I was looking for an answer from a psychiatrist of pharmacist. I'm so sorry. Thank you for your help and prompt response though.

Elliott, LPCC, NCC :

You can get fast relief from your panic attacks and agoraphobia (which is often associated with panic attacks because it is a fear of being away from a safe place such as home when the panic sets in).

Elliott, LPCC, NCC :

The benzodiazepine anti-anxiety drug alprazolam (Xanax) has almost miraculous effects in stopping panic attacks and get start to work in a short while.

Elliott, LPCC, NCC :

Because Xanax and all benzos can be addictive when taken regularly and/or in larger doses, patients with Panic Disorder can take this medication as needed. It does not have to be taken on a schedule as Cymbalta or Viibryd which are antidepressants with some effect on anxiety.

Elliott, LPCC, NCC :

Because Xanax is sought after by some drug abusers, some physicians are afraid to give it out for fear of the FDA, which ironically approves Xanax for panic attacks, and is widely prescribed. Most physicians WILL prescribe Xanax for the appropriate situation and for you it is appropriate and will help you.

Elliott, LPCC, NCC :

It is MOST IMPORTANT that you not just treat the symptoms with meds but to find the causes/stressors that are making you anxious to the point that you have these attacks.

Elliott, LPCC, NCC :

While true that some people are more prone to anxiety and to panic (a form of anxiety), you can reduce your anxiety by working with an experienced psychotherapist (clinical counselor, clinical social worker, clinical psychologist) who can help you change your thinking and cope with these stressors. This is the best approach.

Elliott, LPCC, NCC :

The best "circuit-breaker" for panic disorder is Xanax or another benzo Klonopin (clonazepam).

Elliott, LPCC, NCC :

Let me also recommend a self-help workbook for control your own panic and anxiety. This book is excellent and can make a difference in your life:

Elliott, LPCC, NCC :

 


I believe that with a proper (very slow) tapering program you can get off the Cymbalta, control your panic as needed, and learn to deal with the stressors that bring it on.

Elliott, LPCC, NCC :

I wish you great success and shall keep you in my prayers.

Elliott, LPCC, NCC :

Warm regards,

Elliott, LPCC, NCC :

Elliott, MAE, LPCC, NCC, CCMHC

Expert:  Elliott, LPCC, NCC replied 9 months ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Elliott, LPCC, NCC replied 9 months ago.

I just finished and submitted this and see that you have already given me poor service for such excellent advice for which I spent a great deal o time writing this. Why did you give me this negative rating on my record when I have given you such caring advice?

 

Please reconsider. The advice is excellent and will help you. I am a knowledgeable professional who does this for a living and I deserve to be recognized for my positive contribution to you. Please reconsider. This is not fair. If you were trying to contact me while I was writing, it did not come through, as you can see from the transcript above.

 

Warm regards,

 

Elliott

Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Elliott, LPCC, NCC and other Mental Health Specialists are ready to help you
Customer: replied 9 months ago.
Relist: Other.
I would like to get another answer from someone who can verify whether it is safe for me to taper off the cymbalta as my doctor prescribed. So ideally I'd rather have a psychiatrist of pharmacist answer my question. The answer provided from this current expert, while good, was not geared towards my question.
Expert:  Elliott, LPCC, NCC replied 9 months ago.
If my answer was good and you wanted another opinion you could have relisted it without giving me negative feedback. Your tapering is "safe" because it won't kill you, but you will continue to suffer. It seems that you just want to put your faith in medications and don't want to get to the root of the problem. All medications have side effects and Cymbalta is particularly harsh upon withdrawal.

I have seen these kinds of reactions very often. Drugs suppress symptoms, they do not get at the problems in you your that cause you symptoms.

I wish you great success in coming to terms with your anxiety and in learning how to recognize kind, caring, and intelligent advice.

Warm regards,

Elliott
Expert:  Elliott, LPCC, NCC replied 9 months ago.
Dear Shiri,

Thank you so much for your kindness. If you need any more follow-ups on this question, I will be so happy to serve you (no additional cost to you, of course).

May God bless and heal you.

Elliott
Expert:  Dr. Vikas replied 9 months ago.

Hello ! Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today. If a patient start experiencing severe discontinuation symptoms / withdrawal symptoms during tapering process, the best strategy to control them is to again start the last previous tolerable dose of that antidepressant and then restart tapering down more slowly. Regarding tapering Cymbalta by reducing 10 mg at a time, I agree with your doctor here. In my view also, as you are not able to tolerate the 40 mg per day to 20 mg per day transition so it is better to start reducing by 10 mg every 5-7 days and see if you are able to tolerate it. If still not, then your doctor can try tapering down Cymbalta even more slowly for example by reducing 5 mg per week. Both Cymbalta and Viibryd can increase serotonin in the body and you are very correct here. I am sure, your doctor must be aware of the possibility of serotonin syndrome because of the combination you are taking and will take necessary precautions for it. Please feel free to discuss further if you have any other query. Kind regards Vikas

Customer: replied 9 months ago.

So just to clarify- as long as my doctor is aware of the possibility of serotonin syndrome, i should continue on both 40mg of cymbalta and the 40mg of viibryd concurrently(for a week) and taper by 10 from there as planned.


 


When I asked my doctor about serotonin syndrome possibility- he said it isn't likely to happen. I'm just nervous as I said.

Expert:  Dr. Vikas replied 9 months ago.

Yes, tapering down Cymbalta by 10 mg appears to be a good idea.

As seen in clinical practice, Serotonin syndrome is not very common but still your doctor should be vigilant about the symptoms and signs of Serotonin syndrome.

Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and other Mental Health Specialists are ready to help you

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