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TherapistMarryAnn, Therapist
Category: Mental Health
Satisfied Customers: 5824
Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Kate, Just letting you know I'm still around and still

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Hi Kate,
Just letting you know I'm still around and still working on my anxiety/panic problem but good things are happening.
First, my anxiety level has gone down a lot. A few weeks ago I had two sleep apnea tests done right before and right after the New Year. Sleep doctor agrees I'm a good cantidate for the mask - Whoopee - so as soon as I get it I know I'll finally be getting a good night's sleep every night which should help a whole lot. Hopefully it will be some time late this week.,
Secondly, Dr. Hernz finally "heard" me when I said I was so depressed and he suggested it's time to change from the Effexor XR to Cymbalta. I just started this past Wednesday, 20mg. No side effects, thank you Lord. I have to call him tomorrow to let him know how I'm doing on it. I don't know when he will start weaning me off the Effexor but I hope that doesn't cause a problem.
Between getting the C-Pap (or whatever you call it) and the new anti-depressant, I am feeling very hopeful about the future. All the tests are finally done, which were very stressful for me because it was one after the other plus not knowing I was dealing with depression although I mentioned that to Hernz a number of times.
I am very proud of myself because I went through the two sleep labs dealing with a high level of anxiety but I didn't let it stop me. I stayed through both nights. Of course the Xanax helped but not really all that much.
The only test I have left to do is get another thyroid test. I'm actually past due for another one but I'll get it this week. The result of that should be interesting. I mean, I had a thyroid problem for years until the endo doctor said I didn't last September. This time my family gp will get the results and handle it.
I was supposed to see a neurosurgeon the end of December about my back but I chose to cancel it for right now. My stress level was sky-high and I didn't know why but I knew I couldn't handle another physical determination right then. Now I know I have to handle my problems one at a time.
Hope all is well with you.

Rita, it is so good to hear from you!

Thank you for the update on how you are progressing. Sleep apnea can cause anxiety because of the lack of deep sleep and depression as well. I am glad that you were able to narrow down this problem and address it. It should help you a lot.

You have been telling Dr. Hernz for a long time about how you felt. It's good he finally heard you! It is such a blessing that you found a medication that it easier for you to take and that may help you feel better. Side effects can often be worse than the illness itself causing a lot of frustration.

Good for you that you got through two nights of testing. I think that many people have trouble with sleep tests. My husband went for one and it caused him anxiety, and he is usually not bothered by tests.

Spacing your tests out is a very smart idea. Only you know how much anxiety is ok for you to handle. Plus, testing is so invasive and crosses into your boundaries. Too much of that can be very overwhelming. And as a patient, you are quite vulnerable which also triggers anxiety. Saying no and keeping control of your medical needs is a very good way to handle it.

God has taken such good care of you, Rita. I can tell he is watching over you and helping you. I will keep praying for you. You are in my thoughts.

Write anytime. I love hearing from you.


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Hi Kate,

It's so good to know you are still here if and when I need someone to talk to and to answer my questions. I hope all is well with you.

It's been a month and half since I've been dealing with sleep apnea. If anyone had told me how hard it would be to find a face mask that fits or how hard it would be to get used to wearing one, I don't think I'd ever try it. But I'm finally barely getting the hang of it and I have to say I do get a good nights sleep with the mask on than I did without it.

Since then Dr. Hernz and I agreed that the Effexor XR 150mg was no longer working after almost 13 years. It probably wasn't working for a long time but we put all our emphasis on the Xanax instead. I had to tell him that I didn't think it was working any more before before he did something about it. I don't think that was right but it's water over the dam now. Anyway, he started me on Cymbalta 20mg. for a couple of weeks along with the Effexor, then upped the Cymbalta to 40mg and began weaning me off Effexor. Today I started my last 37.5mg of Effexor.

I had no problem weaning off until last week. Either I have this virus that's going around that knocks the socks off you and makes you feel extremely tired and weak or my body is finally reacting to having the Effexor, Cymbalta, and 2mg. of Xanax in my body. I was find up until maybe Tuesday and then I just got knocked out and each day it's gotten worse. Called him Friday and he agreed I could go down to the 37.5 for at least a week but maybe a little more before stopping all together.

What's scaring me the most it my loss of memory. That's getting much worse but Hernz said it's the Xanax and as soon as we know I'm okay from getting off the Effexor and see if I need more Cymbalta or not, then we'll start weaning off the Xanax. But I'm scared, Kate, really scared.

I just woke up from a little nap and thought it was Monday night and got upset because my TV wasn't working right. I tried to think what day was today and I coldn't remember until I saw the TVGuide. It's not like I don't remember names or things like that...but if caught off guard I can't remember being told something. It's strange and hard to explain but I don't like it.

Will I get my memory back when I get some of the Xanax out of my system? Is the sleep I'm getting from wearing the mask doing something to me? Hernz thinks it's great that I'm feeling sort of sedated because that shows I don't need the Xanax like I did before. Remember when 2mg. did nothing and I was still having anxiety attacks? I don't have any of them anymore, just the opposite. I'm feeling draggy, tired, my mind is dull and I feel I could sleep for hours, especially in the morning.

Any advise or help, Kate?

God bless,


Customer: replied 5 years ago.

Hi Kate,

I was just wondering if you got my message that I sent last night. Of course I know you have a life of your own to live and might be away but it's so unusual not to hear back from you rather quickly. I guess you got me spoiled!!

I just want to make sure you are still working with Just Answer.



Hi Rita, it's so good to hear from you!

Yes, I'm still here! I'm just out for the day. I will be back later tonight on JA. I hope that it ok.

Talk to you soon,


Customer: replied 5 years ago.

Whew! Happy you are still here. Hope you have an enjoyable day.

Talk to you later.


Rita, it's so good to talk with you again. You have been in my thoughts and prayers.

Cymbalta does have the side effect of memory loss. It would be highly unlikely that Xanax would suddenly start causing new symptoms unless you increased it. And even then, you would most likely experience the same symptoms you had when you started Xanax.

Cymbalta, on the other hand, has the following neurological symptoms:

headache, trouble concentrating, memory problems, weakness, feeling unsteady, loss of coordination, fainting, seizure, shallow breathing, agitation and hallucinations.

It sounds like you have had a reaction to the medication in the form of memory loss.

Cymbalta is one of the drugs considered an anti-cholinergic which blocks the neurotransmitter acetylcholine, which is responsible for the memory and cognitive function in your brain.

What you are having is a serious reaction to the mediation. Let your doctor know that you are having this reaction and that you need to try another type of medication. Living with memory loss can be frightening. You may eventually get used to the medication and the symptom might go away, but if you are feeling anxious about it then it's worth talking to the doctor about it.

Let me know how it goes,


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Hi Kate,

I called Hernz about my memory loss and dull-headedness plus hallucinations the other day. He didn't say much other than go down to the last 37.5 Effexor for a week and then stop taking it completely.

To tell you the truth I feel I'm on way too many meds but what could we do when my depression got so bad? I wanted to start going off the Xanax but he said we had to get the depression fixed first. I'm hoping and trusting God that when I get the last of the Effexor out of my system completely and only on one dose of Cymbalta my memory will slightly improve. The memory loss started last March when he upped the Xanax to 2mg and got worse after a while when he added Cymbalta. Then I was taking two antidepressants plus double my usual dose of Xanax.

Since Xanax also has memory loss as a side effect, I'm hoping things improve soon. Maybe it's just a coincidence but I think my memory has gotten worse since I started my apnea treatment. Of course it could be just me because that's all I've been concentrating on for two months. I had no idea that getting started with the cpap masks was going to be such a hard thing. It's been awful. I'm still having a hard time finding the right mask for me and I have tried at least 6 or 7 masks but now I've run out of my testing trial period from my supply company. But when I do sleep it's a much better sleep. What wakes me up is the air escaping around the outer lining of the masks, As long as I sleep in one spot I'm fine but apparently as soon as I turn around the mask slips and the out comes the air. It wouldn't be such a problem but we discovered my mouth opens when I sleep so I have to use a full mask instead of just lighter weight pillows.

I'll have to see how this week goes as I get down to the lower dose of effexor and try something new in my mask. What else can I do except take it one thing at a time? At least I'm not depressed and I don't have anxiety any more. As far as the memory loss, as long as I pay attention to what I'm doing, I'm okay. For example, I'm taking a Xanax 4 different times a day, two different antidepressants twice a day. I never forget the morning or nighttime meds but I have a problem remembering to take the middle of the day meds because I'm usually busy doing something else and I feel fine. So what I do is set my stove clock to go off at one and five. But if I'm out during the day, I always forget to take my meds because I just feel normal.

It will all be over soon. I'm a lot closer than I was the last time we talked.

I'm so happy you're here, Kate,



I am glad to talk to you again too. I enjoy our time together and sharing our faith.

You certainly are on a lot of medications, I agree with you there. When you start changing the chemical messengers that travel in the cells of your brain through medication, a number of changes can take place to your thought processes. Some of these are good, like not feeling as anxious or depressed. But most of the drugs you are taking, especially in the amounts you are taking, can have some other less desirable effects. For example, when you sleep, some of these chemicals are combined in the brain to help solidify memories. But when you take this number of medications the process can be impaired. You may find that you do not remember as well as you did before. The good news is that as the medications are reduced over time, you should see some improvement. But you may find that as you reduce the other medications, the Cymbalta side effects remain. Then you will know what is causing your memory loss.

What happened with the counselor you were seeing? Was that helpful with your symptoms?

Do you feel that your apnea masks are interfering in your ability to sleep well? It could be that between your waking with the apnea masks and the new medication, you are not getting enough REM sleep, which can definitely affect your memory.

Whatever this is, we'll try to figure it out together. Try not to worry. Just focus on getting some good rest tonight.


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

I felt crappy yesterday, really out of it. Talked again to Hernz. The last time I talked to him last week he told me to open the capsule of Cymbulta, which surprised me, and pour out half. I did that for three days and each day I felt a little worse than the day before. Yesterday he said to go back up to the whole 37.5, which I did today.

I feel better than yesterday but a little anxious with slight palpitations this morning which I haven't felt in a long time. I may be wrong but I figure it was my body (or brain?) reacting to the removing of the meds in the capsules., When I feel better and decide it's time to get off the last dose, I'm going to do it my way by the every other day method for a week and then see how I feel. If I have to I'll go every two days, etc.

I don't know why he doesn't like that method of reducing meds but it's worked the best for me in the past. I have become friendly with my CVS druggest and she said the same thing about the 2mg of XanaxXR that Hernz did, that 2mg is really a small dose for someone who has had Panic Disorder as long as I have

Customer: replied 5 years ago.

Tuesday, March 06, 2012 3:01 PM EST

I felt crappy yesterday, really out of it. Talked again to Hernz. The last time I talked to him last week he told me to open the capsule of Cymbulta, which surprised me, and pour out half. I did that for three days and each day I felt a little worse than the day before. Yesterday he said to go back up to the whole 37.5, which I did today.

I feel better than yesterday but a little anxious with slight palpitations this morning which I haven't felt in a long time. I may be wrong but I figure it was my body (or brain?) reacting to the removing of the meds in the capsules., When I feel better and decide it's time to get off the last dose, I'm going to do it my way by the every other day method for a week and then see how I feel. If I have to I'll go every two days, etc.

I don't know why he doesn't like that method of reducing meds but it's worked the best for me in the past. I have become friendly with my CVS druggest and she said the same thing about the 2mg of XanaxXR that Hernz did, that 2mg is really a small dose for someone who has had Panic Disorder as long as I have but if I can go down even one pill it would be great, which would mean 1.50mg. Even that would help my memory problems. We'll cross that bridge when we get there.

Just a question I'm curious about....have you ever heard that when weaning off a med like Effexorxr or whatever, some people have withdrawal symptoms right off the bat while others have a hard time getting off the last dose? I think I did but I'm not sure.

I stopped going to the therapist because she was only available if you made an appointment. If you were having a small problem and needed to ask her something, she wouldn't discuss it on the had to come in to see her. I never ran into that before especially when insurance paid for the therapy. Her appointments were only 45 minutes long so she could get ready for the next client and she never went a minute over. Maybe that's the way every therapist runs their appointments and clients but she was a little too ridgid for me. If I needed to talk longer and time ran out, I had to make another appointment for later that week.

My sleep therapy is going well now that I'm learning the ins and outs of cpap masks. What a big difference my sleep is with and without the mask. I sleep so much better and calmer with the mask on than without. The problem is the medical supply company do not give out info like a real tech should so you're sort of left on your own.

God bless....

Hi Rita,

As far as I know you accepted all the posts. Even if you didn't Rita, don't worry about it. I'm fine with it.

It could be that you felt anxious about the medication and all the changes you have had to make with everything you are taking and that is why you are experiencing palpations. You have been through a lot with adding medications, reducing medications, and increasing the dosages. That can give you symptoms that make you feel edgy.

People can react in many different ways to the withdrawl from medications. Everyone's body chemistry is different so how you react will be different than someone else. But Effexor can be a very difficult drug to withdrawl from. Many people experience symptoms including headaches and nausea. And Effexor has to be withdrawn slowly due to the dependence it causes when you are on it. So you may react strongly to withdrawl because of that.

I'm sorry that it did not work out with your therapist. Some therapists put a high priority about the timing of their appointments because they want to be sure to have enough time with each person, but being available by phone is part of the job.

I'm glad to hear you are getting used to the mask. I could imagine that it difficult at best! It's good you are getting more sleep though. That can really help you feel better.


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Kate, here I am again all anxious and feeling uneasy, like I'm waiting for the next shoe to fall. Once again it's the meds. Today was my last day on Effexor. Yesterday Dr, Hernz upped my Cymbalta another 20mg, making a total of 60mg. a day which is basically the same amount of Effexor I used to take. The new dose I'm to take in the morning with my Xanax and the other 40mg at 1:00 pm with my second dose of Xanax. He said eventually he will have me take the entire 60mg. in the a.m.

To tell you the truth, I'm scared and anxious. All the "I wonder" thoughts going through my mind....I wonder if I'll have to go through another week of withdrawal from the last of the 37.5 Effexor? I wonder if the Cymbalta is going to work? I wonder if the way I feel is from weaning off the Effexor or from the Cymbalta? I wonder is this ever going to end? On and on and on...

I just can't relax today. Last week, the second week of Effexor withdrawal, I started having episodes of anxiety, nothing I couldn't handle, here and there. Hernz said it was breakthrough anxiety from withdrawal but also showed the Effexor was being washed out of my body. or did he say brain? Can't remember and that I might have some withdrawal symptoms this next week but the extra Cymbalta should blunt them.

That was last night and today is the new beginning. Like I said, it's like waiting for the other shoe to fall. And being off Effexor completely after all these years is scary too. Isn't that crazy? Supposed now that I'm off it, things get worse instead of better with the Cymbalta?

And the cpap face mask! Anyone who says it's easy is lying! I sleep really well and don't move around at all but I don't know that I'm really relaxed while I'm asleep. I still don't know what's going on with it all because I haven't seen my sleep doctor yet for my first check up. I am finally seeing him on the 20th and I'm writing all my questions down. Just say a prayer I'll be feeling ok physically on that day - no withdrawal symptoms - so I can go and really hear what he has to say. Right now I have more questions than answers.

I know, I feel so out of control of my life right now. You know how I hate not knowing what's going to happen tomorrow. One problem at a time I can handle but this is too much for me right now today. I just have to keep telling myself one day at a time and tomorrow is another day and I could feel completely different than I do today,

Am I making any sense, Kate, or am I just an old fool making a mountain out of a molehill? I probably am but I must say in my defense I'm doing much better than I was this time last year.

Tell me honestly, Kate, will all this physical crap settle down in time and things will be back to normal? Is what I'm feeling just a transition time and normal?

I feel like I've been beat up and my nerves are stretched like a rubberband.

Thanks friend,


Hi Rita!

You are not making a mountain out of a molehill, Rita. I think what you are feeling is anxiety over the change in medications. You are used to taking the Effexor all these years and now you are changing to Cymbalta. It causes you to feel out of control because there is no way to predict how you will react to the new medication. In the past, you have experienced problems with medication side effects and it frightened you. This is about control over your medication reactions and control over your body. Any sense of a loss of control, and your anxiety is triggered.

The difficulty over the CPAP is probably interrupting your sleep as well. That can cause you to feel tired and therefore less able to cope with your anxiety, producing that stretched like a rubber band feeling with your nerves.

If you focus on helping yourself to reduce your anxiety symptoms, you will find that you feel better. Start by using your relaxation techniques. If you still have the ones we worked on before, you can start with those. If not, try progressive muscle relaxation. Practice it until you can get yourself to relax fairly quickly. Also, try thought changing. Write down the thoughts that are making you feel anxious. Then take each thought and counter it with another more positive thought. For example, if you think that the medication is going to make you feel more anxious, counter that with "If my medication makes me feel more anxious, then I will be able to do something about it by calling Dr. Hernz." Make a plan on how to handle this problem. Discuss the problem with Dr. Hernz ahead of time and ask what your options are, for example. This will help you know what steps to take if you do feel bad. Once you have a plan, you will feel less anxious.

You will feel better soon. It just takes time to see if the new medication works and let the other get out of your system. A little longer and you will find that you are back to normal.


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Hi Kate,

I'm having a rough few days. Last Thursday was my final day on Effexor and my first day of 60mg, of Cymbalta. I know it's only been a week and my brain chemicals are not adjusted yet to the changes going on but I feel like it's been a month.

I can't say I feel awful, just discombobulated, especially in the morning like always. I still can go out and do what I have to but I just don't feel good. I have to see Dr. Hernz in a couple of weeks. But what I'm feeling, at least for the past couple of days, is fear that this is how I'm always going to's never going to get better.

Maybe I should call Hernz and make an appointment to see him sooner just to ask him if how I'm feeling is true or not but that seems to be a waste of a lot of money just to be reassured. I've called him so many times just to tell him how bad I'm feeling that I feel like I can't keep doing it again and again.

One thing I think I'm right about is that it takes more than a week for my body and brain to regulate takes at least 3 weeks to a month at least.

Am I right about this as far as you know? I really need someone to hold my hand right now.

Thanks for listening....

God bless,


Hi Rita,

Medications can often take up to a 5 or 6 weeks to work depending on your metabolism and the strength of the medication. You may be experiencing symptoms from the introduction of a new medication and the tapering and discontinuation of the other and the way they are acting with each other to create a stronger reaction. Plus the new medication needs time on it's own in your body to adjust to the chemicals in your brain and your metabolism.

Also, you may want to consider that the anxiety is making your symptoms seem worse. Anxiety will take a symptom you may not even notice and highlight it for you, so it seems way bigger than it really is. That is because anxiety is often expressed through physical symptoms. And it's usually much worse in the morning than later in the day, when you have had time to think things through and gain some control over how you feel.

I know you are probably using your relaxation techniques, but if not, it might be a good time to use them. You may also want to use some cognitive behavioral techniques to help you change your thoughts and therefore control your anxiety better.

Using a pen and paper, write down your fears. For example, number one could be "I am afraid that my medication will...." then fill in what your fear is. Down below the statement or next to it, refute the statement. For example, you could write "what I fear has never happened before so it's highly unlikely to happen now.". This will give you something to help calm you down next time you feel anxious about your medications.

I'm here anytime you need to talk, Rita! I'll be praying that you feel better soon,


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Kate, I just called Dr Hernz because my gp is out of the office for the weekend. I was looking at the summery they give you after your visit and under my vital signs it has my pulse rate at 103 and my blood pressure 153/109!!!

I haven't ever been that high that I know of. That's why I asked Dr. H to call me back to find out if it has anything to do with my feelings of withdrawal. I also gained 11 lbs in the past 6 weeks.

What is going on here? Dr. H. said he wanted to see me when I get done (paraphrased) so I'm also going to ask him what length of time was he talking about.

He said that after raising the cymbulta on the last day of Effexor.

It will be one year Sunday that the panic attacks started up again. My memory may be poor but I remember that day like it was yesterday.

Going downstairs to put on earphones and listen to relaxation tapes.


It certainly sounds like something is going on, Rita. It could be a number of things:

1) You are reacting to the new medication. It could be a side effect or it could be a reaction of some sort. Cymbalta can cause changes in weight. Dr. Hernz will be able to tell you the likelihood of that occurring, but since you have had many changes in a short time, it should be considered.

2) Your anxiety is making your BP go up. You could also be eating more because you are anxious. Some people react that way, even if they did not before.

3) There was a metabolism change for some reason. Your weight gain in such a short time is unusual.

This needs attention. I would ask for an appointment as soon as you can to see what is going on. But try to relax the best you can. It's hard, I know. All you need is to hear bad news like this to make you feel more anxious. But relaxing like you are doing with your tapes helps a lot. And keep in mind, your doctors will help you with this. You are not on your own. Whatever the reasons for the BP and weight, they will help you figure it out.

Let me know what happens,


TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Hi Kate,

Dr. Hernz said you can't really tell if you have high blood pressure until it's taken 3 times a day for awhile. But he said that when I was wearing the heart monitor overnight it didn't show HB and that was only a couple of months ago.

He said to wait another two, three weeks and then come in to see him. It could take that long for things to either settle down and to see how the Cymbalta is working for me. I'll call and make an appointment Monday. I forgot to mention the weight gain but a nurse who took my vitals said her husband gained 10 lbs when they put him on Cymbalta. In the meantime I'm watching very closely what I eat and have banned all sugar from my diet as much as possible.

I'm also trying real hard to keep my eyes on Jesus and not my problems. I saw something in a book I got from Kindle yesterday. It's called A Confident Heart by Renee Swope, It's about struggling with doubt and a lack of self-confidence. Talking about herself, she said God led her beyond believing in Him to really believing Him by relying on the power of His words and living like they are true no matter what my feelings tell me. Those words hit me right between the eyes. I knew that I believed in Him but I didn't always believe what he said, especially when my feelings and/or circumstances say something opposite than what God says. Then I put all my faith in my feelings and what I see and none in Him until I hear something that reminds me of the Truth. Then I get back on track again.

Just the little bit I've read from the book has showed me I totally lack in self-confidence and my life is full of doubt. I understand why I am this way but I never recognized that was the source of most of my physical problems and no one ever said it to me before. Now I have something "real" to work on instead of anxiety/panic/depression. How could I have been so blind? But God's timing is always perfect. Now I can walk in a therapist's office and say exactly what my problem is and have something to work on.

I called my gp last week (before I got this book) and asked him for a name of a therapist in our surrounding area and his nurse said he would leave me a list of therapists he uses at the front desk. I haven't picked it up yet but now I have a good reason to. God knew what I would need and he has it all ready for me. Now I have to pray for wisdom to pick out the right one. I sure wish your name was on the list, Kate. If it was, then we could say it was a real, true miracle.

Hope you have a great weekend and thanks for your prayers.....


Thank you so much, Rita. What you said was so kind. I do wish my name was on that list. It would be truly wonderful to be able to talk with you face to face.

I have not heard of that book before either. I think I will pick up a copy. The author's insight is amazing. I never thought of seeing self confidence and doubt in that way either. Now I need to change my thinking to include her ideas as well. God certainly directed you to this book at the right time. He does all things when they are supposed to happen, not in our time (though I often wish it was in my time!).

It is odd that your BP is high when it wasn't just a few weeks ago. Can you take it at home? That will give you a more accurate reading. And I did hear that Cymbalta does cause either weight loss or gain. Watching your diet should help.

Good night, Rita. I hope you sleep well.


Customer: replied 5 years ago.

Kate, my BP might have been high because of a couple of things. One, the doctor's office was in a hospital and I had quite a long walk to get to his suite which exasperated my back pain a lot. Plus I just wasn't feeling like myself. Sort of dull headed and not in control.

I'm going to call my gp on Monday and see what he suggests. I know he'll want me to come in every day just to get it checked until he's satisfied. When my husband had his two cancers (I don't think I ever got to tell you that story that glorified Christ)

three years ago I know we had a BP machine but I think we threw it away because it wasn't working right. I'll have to check on that. Remind me to tell you Joe's story if I haven't already. It was a true miracle from beginning to end.

Yes, try the book. I got it from Amazon. I wish I had a couple of friends to have a Bible study with the book. Let me know how you like it.

BTW, I meant to tell you that what you said about experiencing symptoms from the introduction of a new med and the tapering and discontinuation of the other, etc. (see your email above) helped me so much that I printed it out to keep close by so I can remind myself of what you said, especially when I'm feeling low and tired of it all.



Thanks for the update. Let me know what happens at the doctors.

I would love to know what happened with your husband. It sounds like an inspiring story!

I'm glad what I said helped you. Anything I can do to help you I will. I want to be here for you.

Have a good weekend!


Customer: replied 5 years ago.

Hi Kate,

I had to write to you because I'm in a state of high anxiety and need to hear from you. You always seem to say just what I need to hear.

I'm anxious because Thursday Dr. Hernz decided if I wanted to I could start lowering my XanaxXR 2mg down one one .5 dose. In case you don't remember, I was taking .5 four times daily - 8am, 1pm, 6pm, and between 10 and 11 at night before bed. We decided the 6pm dose would be the one to start eliminating because that usually is a relaxed time of day for me.

I have been completely off EffexorXr 150mg for 28 days. I started Cymbalta 2 1/2 months ago but 16 days ago he lowered it from 60mg to 40mg because it was making me feel too anxious, dizzy, headachy, etc. I had only been on the 60mg 12 days when he lowered it back to 40. I went in to see him because I was feeling more sedated with each passing day. He was delighted to hear that because it told him I was getting better and better. That's the reason for starting the lowering of the Xanax but he said it was my call. Of course I said yes because I want to get my energy back and rid of the sedation that was not only holding me back from enjoying life but was also making me anxious because I felt so out of control. That is when we got into the conversation about how to lower the dose. Another thing that bothers me is that I've only been on 40mg Cymbalta for less than three weeks. Does the 16 days that I upped the Cymbalta then lowered it take away the effect of being on it for now almost three months? Am I making myself clear? I'm also scared that Hernz is

lowering the doses too quickly. He lowered the Effexor every 12 days and I had some bad side effects to deal with. I don't want to go through that again. He also told me Thursday that getting off Effexor is like getting off cocaine. I was successful but don't want to go there again.

There is another way I could use to wean down that would take a month for each .5 dose but again, I don't trust my own thinking right now. Here is the way I think I would be more comfortable with: (remember we're talking about 4 doses a day)


Week 1: Starting tonight - 4 doses. Sunday - 3 doses Monday - 4. Tuesday 3. Wednesday 4. Thursday - 3. Friday - 4.

Week 2: Saturday and Sunday - 3. Monday - 4. Tues & Wed. - 3. Thursday - 4. Friday - 3

Week 3: Sat. 3 - Sun. 4 Mon & Tues 3. Wed. 4. - Thurs & Fri 3. (actually repeating 2nd week doses)

Week 4: Saturday - 4. Sunday 3. Monday 3. Tuesday 3 - Wednesday 4 - Thurs., Friday and from then on stay on the 3 doses daily every day, dropping the 4th dose completely.

That would take one month to wean off from 4 Xanax daily down to 3 Xanax daily. Much slower but less chance for bothersome side effects or so it would seem. Do you know if Xanax is as potent as Effexor or do I really want to know?

Please help me, Kate. I trust your way of thinking....

God bless,


How does this sound to you? And do you know why I'm having these feelings of anxiety when I have so much meds that make me feel sedated most of the time? I just can't help myself right now to make any sense of anything. What is wrong with me tonight?


Everybody is different in how they react to medications. But most of the time, your body is not sensitive to it unless you are having a reaction. The short time that you raised the Cymbalta then lowered it will not have an effect three months out. By now, your body has adjusted to the level in your bloodstream.

It's understandable that you are concerned with weaning off the Xanax. You have been on it for a long while and going off will seem overwhelming. But Dr. Hernz's idea is a good one. If he could reduce the amount from .5 to .25 that would be ideal, but otherwise it's a good plan. The plan you are suggesting will keep the level of Xanax in your bloodstream the same and will not help you taper at all. That is because it is taking the level of the Xanax down then it is raising it again, making your body adjust to a lower level then upping it again soon after so you would be at the level you are at right now. The only thing it might do is cause symptoms, but it will keep the level essentially the same.

You may want to talk to Dr. Hernz about tapering your level of Xanax even slower than .5, if possible. I understand that this is not easy and might make you feel anxious. But this is about your thoughts and not so much about the medication. Your thoughts about weaning are making you feel hypervigilent and anxious. It may be helpful to think about what is making you feel anxious about tapering off the Xanax. What do you feel would happen to you if you went off Xanax? And if those things happen, what would it mean? Exploring your feelings about tapering will help you feel in more control and help you lower your anxiety.

Remember, God is watching over you. He has gotten you through a lot and will keep taking care of you through this too.


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Customer: replied 5 years ago.

Kate, I keep trying to get back to you but for some reason I keep losing you.

Thanks for your answer. The lowering of the doses program was given to me by a qualified pharmacist at CVS but what you said does make sense. I will talk to Dr Hernz tomorrow about going down .25 at a time.

I'm telling myself that the idea I have no control, which makes me feel so anxious, is just a feeling and not true. I do have control. I can either get up and do something or I can first do my breathing exercises, etc. It might take me a while to get myself calm again but I do eventually.

You know, Kate, I don't know what I'm so afraid of....well, yes I do, maybe. I'm afraid I'll never get better again and this is what I'll have to deal with the rest of my life. I forgot to tell you I just started seeing a retired pastor that uses the holistic healing approach. I liked him a lot because he talked to me, gave me something to think about. I'm sure you will be happy to hear that.

Back to taking the ,25 instead of cutting the whole amount out. That makes me feel a lot better because it's not so drastic. I wish I could find another doctor to go over my meds and give me his opinion. I'm going to ask my gp if he knows a good one. I think that would make me feel better too.

I'll let you know how I'm doing in a few days. Thanks again, Kate.

God bless,



You're welcome!

You will get better. The thing to remember is that you keep trying. Motivation is a guarantee that you will get better because it helps you find an answer and will not let you settle for anything else. You may not feel the solution is perfect, but it will be much better than you are dealing with now.

I think getting off the Xanax is key. It will help you to feel better and you will have less stress around your medications. And tapering slower will help you feel more in control.

I'm glad to hear that you are talking to someone. That will also help.

Please do let me know how you are doing. You are in my thoughts and prayers.


Customer: replied 5 years ago.

Dear Kate, I pushed myself to go to church for the first time in a long time this morning. Felt good to be back...I needed to be among people and also hear the Word. I definitely willl be going back Wednesday nights.

I realize I have been putting more faith in my meds than in the Lord. Something I need to talk to God about. On the way home I thought I'm so tired of trying to figure out why I'm still feeling this way when there is no answer....I just am. Only God knows why and I just turned it over to Him to take care of.

I definitely will take the .25 and if I have to, I'll cut another one in half and take .12....whatever it takes to get through. The one thing I will not do this time or ever again is be my own doctor and cut back too fast just because I'm too impatient,

BTW, back in March, I believe you wrote to me: "Medications can often take up to a 5 or 6 weeks to work depending on your metabolism and the strength of the medication. You may be experiencing symptoms from the introduction of a new medication and the tapering and discontinuation of the other and the way they are acting with each other to create a stronger reaction. Plus the new medication needs time on it's own in your body to adjust to the chemicals in your brain and your metabolism."

I had printed that out and kept it with me so I could read it when I get myself all tangled up because I think I should be feeling better by now. I showed Dr. Hernz what you wrote and he said that it was really good and who told me this? He said actually that is what is happening in my body right now. 2 1/2 months on Cymbalta is not really a long time because during that time I was weaning off Effexor. And 28 days off Effexor is not all that long, It's gonna take time for everything to straighten itself out in my brain.

I wanted to let you know how smart he thought you were but do you agree with him about the changes in meds? He said it's going to take awhile being on the same med at the same strength for some time before we see some really good results. If you agree that he is right, I'll feel more relaxed about the whole situation.

I also decided to ask my new therapist, George Bustard, an Associate of Springfield for the name of a psych. at the center.

Thanks again,



I'm glad you made it back to church! Sometimes it is hard to get there but once you are there, the effort is worth it. I feel like when I go that God fills me up with good stuff so I can survive the week. And I imagine from what you said that you feel the same.

Yes, trust in God before medications is very smart. It is so easy to get caught up in every day things that you lose your path. But you are absolutely right, allowing God to lead you is the best way to get what you need. He is the ultimate physician and therapist!

Thank you for the kudos! It was good to hear that Dr. Hernz concurred. I do agree with Dr. Hernz with your change in medications. You have been on both Effexor and Xanax for a long time and over that time, the medication becomes less effective because your body adjusts to it. Plus both medications have addictive qualities, which make them very hard to wean off of. Getting off both of them will help you a lot in the long run. And many people are on Cymbalta now because it seems to work for so many people with few issues.

I would give this all time, Rita. Your body may have a slower metabolism so all these changes will take time to sort themselves out. But each day will get easier.

Let me know how it goes with your new therapist, when you get one.


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