Side effect of cymbalta

Reprinted with the kind permission of Margaret B. Schroeder

It took my doctor a year to convince me to “take something” for fibromyalgia and about two months for me to decide to never do it again. I’ve grappled with whether or not to blog about this because maybe it’s TMI. This is an older post that I deleted, but after talking with a few Fibromytees, I decided to re-post it this week. Maybe this will help some of you who are wondering about Cymbalta for fibromyalgia.

The unprecedented volatility in the North Texas barometric pressure caused me a great deal of pain in the first half of 2015. After living through a severe migraine for three days, I gave in and asked my doctor to go over her medication plan one more time. “It’s a very low dose of Cymbalta, much lower than what you were probably on when you were taking it for depression,” she said. Actually, because of my body weight and higher sensitivity to medications, I was on a low dose even when I was at the height of my treatment for depression. But I let her continue. “There are no side effects at this dosage,” she reassured me.

I don’t remember a whole lot about the side effects when I was taking it for depression because there was so much else going on at the time. What I do remember, though, was the strange feeling I had while driving during the first two weeks. Everything on the freeway seemed extra-sparkly and kind of swimmy. I lived alone at that time and I had to get myself to the outpatient clinic every day, so I pushed through it. Looking back at that experience, I’d advise anyone else to find help with the driving for the first two weeks on Cymbalta.

This time, I decided to start it after a major family weekend event was over so I could hunker down on the couch if necessary. The first thing I noticed was an amazing clarity of pain perception. No longer could I feel the heavy burden of that all-over body throb. Now I could really feel the other sources of pain in my body. Now I felt what physical therapists describe as a “toothache-like throb” in my pulled hamstring. I could specifically feel my golfer’s elbow. I don’t think I could ever get excited about the arthritis pain in my neck or the stiffness in my shoulders, but I will tell you that it’s exciting to know that it doesn’t necessarily have to radiate all over your body. That’s probably not an accurate medical description of arthritis pain, but it’s a decent way to describe fibromyalgia on a good day.

The best news is, fibromyalgia pain relief came immediately upon starting the minimum dose of Cymbalta. The little aches I felt from my other problems seemed tiny in comparison to the load I’d just dropped. I was elated.

And then the side effects started kicking in. During my two-week ramp-up, my husband noticed a little bobble here and there in my steps. Vertigo is my come-and-go companion, so I didn’t notice it that much but it was getting worse. Within two weeks, I started having difficulty urinating. Now this is not a topic I like talking about but it’s a part of life. I would sit on the toilet, my bladder bursting for relief and I’d say aloud, “release, release, release.” Sometimes it could take as much as five minutes before I could start to pee. The process was so frustrating I found myself putting it off, which made matters worse.

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Not long after I noticed the peeing problem, I started noticing that I was also constipated. I increased my fruit and vegetable intake and drank a lot more water. It helped a little, but when you’re as uncomfortable as I was, a big dietary effort for just a little effect makes no sense. My diet was never the thing that needed fixing anyway, having adhered to low carbs, clean protein, and lots of fruits and vegetables for a long time already.

Right about this time in my Cymbalta treatment, my husband and I both noticed a marked improvement in my clarity of thought. It was amazing, and I loved being able to hold discussions where I didn’t have to make people wait for me to come up with the words I was visualizing. Fibro fog is something I’ve been fighting for a long time. The ability to talk without struggling was beautiful, and it reminded me of the good ol’ days in the corporate world when I had a fast mind and a sharp tongue. It was fun to relive for a while.

Here comes the TMI part. All of the selective serotonin reuptake inhibitors (SSRIs), including Cymbalta, have the potential to negatively affect sexual function. Some people have reduced libido and others cannot reach orgasm. In my case, libido wasn’t the problem. Let’s just say that within a few weeks, my husband was the only one enjoying our intimacy. This was a really big deal for us. We lost our pillow talk time and our cuddling, things that contribute to a healthy, intimate relationship. “That could wreck a marriage,” a friend said. Yes, it could. Without ever being able to have an orgasm, I really didn’t need the rest of it either. I could see the future of this and decided to draw my boundaries. At that point, I’d been taking Cymbalta for less than three months.

There’s so much going on in the body with fibromyalgia – the constant aches and pains, the occasional migraines, the exhaustion, the brain fog. Why would I give up the one experience I can have that creates all-over body pleasure and makes me forget everything else? Even if the effects of an orgasm are temporary, it just can’t be overrated for someone who’s in pain all the time. So with my husband’s support, I went back to my couch for a couple of weeks to endure the weaning-off period, which sometimes comes with nasty withdrawal symptoms. Gradually over that two weeks, the brain fog returned and my general pain returned. It took another couple of weeks for my sexual function to return to normal.

For some people, the side effects might be a fair trade for cessation of symptoms. And not everyone reacts to Cymbalta the same way I did. I like how one of my friends got to the point of the problem: “If you can’t pee, poo, or c**, where’s your quality of life?” I snorted coffee through my nose when she said that. A few seconds later, I admitted she was right. “You’re so crude,” I teased, and she said, “I know.” Her smile came through the phone. The point she was making, and I agree, is that we can’t give up too much just because someone with a lot of education and the license to write prescriptions makes a suggestion. What I learned from this experience is, I can live with pain but I can’t live without intimacy in my marriage.

Last week, I was trying to hold up my end of a conversation with my husband. I just looked at him and said, “Oh, hell, just read my mind. At least I can have an orgasm.” He looked over at me in a moment of disbelief. Then he laughed, held out his hand and said, “You’re a nut.” I put my hand in his and thought to myself, “I can’t live without this.”

See ABCNews.com about the sexual side effects of SSRIs. Also see Wikipedia’s article on Duloxetine. Google anorgasmia and Cymbalta.

Margaret B. Schroeder writes about neuroscience, fibromyalgia, fitness, and yoga. She is the President of the DFW Fibromyalgia Support Group and staff writer for the Dallas Area Parkinsonism Society Newsletter.

How to prevent serotonin syndrome from drug-drug interactions

Practice Points

• Know which drugs are associated with serotonin syndrome.

• Understand the types of drug interactions that may precipitate serotonin syndrome and use drug information resources such as Micromedex, Lexicomp, Physicians’ Desk Reference, AHFS Drug Information, and Facts and Comparisons.

• Know what prescription medications your patient is receiving from other providers as well as any over-the-counter and illicit drugs they may be using.

Ms. B, age 22, is brought to the emergency department (ED) by her roommate for evaluation of confusion. Ms. B has a history of migraines and major depressive disorder and has been taking fluoxetine, 40 mg/d, for 1 year. A week ago, she started amitriptyline, 50 mg/d, when her migraines became more frequent. According to her roommate, Ms. B experienced a migraine early in the morning and had taken 2 doses of sumatriptan, 50 mg. She later complained of nausea and vomiting, and when her roommate returned from work that evening Ms. B was disoriented and her leg muscles would not stop twitching.

In the ED, Ms. B is diaphoretic and increasingly agitated. Blood alcohol and urine drug screens are negative. Blood glucose is 95 mg/dL. Complete blood count, basic metabolic panel, liver function, and kidney function tests are within normal limits. Her physical examination reveals a blood pressure of 130/85 mm Hg, heart rate of 130 beats per minute, respiratory rate of 21 breaths per minute, and body temperature of 38.6°C (101. 4°F). Myoclonus and hyperreflexia affect her lower extremities. Ms. B is admitted with a preliminary diagnosis of serotonin (5-HT) syndrome.

Serotonin syndrome: What is it?

Serotonin syndrome is a rare but potentially serious adverse event resulting from excess serotonergic activity at central and peripheral 5-HT2A and 5-HT1A receptors. Serotonin syndrome toxicity ranges from relatively mild to severe, and may be lethal. Symptoms develop rapidly—within hours—and may include altered mental status, clonus, tremor, hyperthermia, diaphoresis, tachycardia, mydriasis, and akathisia ( Table 1 ).1-3 Fortunately, if recognized promptly and offending agents are discontinued, serotonin syndrome often resolves within a couple of days.

The differential diagnosis includes neuroleptic malignant syndrome (NMS), anticholinergic toxicity, and malignant hyperthermia.1 Differentiating serotonin syndrome from NMS can be difficult. NMS results from dopamine blockade; however, many NMS symptoms are similar to those experienced with serotonin syndrome. Obtaining a history of recent medication and/or illicit drug use, conducting a physical exam, and evaluating the patient’s clinical course help clarify a likely diagnosis. NMS generally has a slower onset—within days—and patients demonstrate neuromuscular rigidity and bradykinesia rather than the neuromuscular hyperreactivity (myoclonus, hyperreflexia) seen with serotonin syndrome.

Table 1

Characteristics of serotonin syndrome*

Recent addition or dose increase of a serotonergic agent

Tremor plus hyperreflexia

Muscle rigidity plus fever plus clonus

Spontaneous clonus

Ocular clonus plus agitation or diaphoresis

Inducible clonus plus agitation or diaphoresis

*A combination of these characteristics may indicate serotonin syndrome

Source: References 1-3

Interactions that increase risk

A drug interaction is a pharmacologic or clinical response to a combination of medications that differs from the agents’ known effects if given on their own. In the context of serotonin syndrome, the serotonergic activity of a drug can be increased as a result of a pharmacokinetic (PK) interaction, a pharmacodynamic (PD) interaction, or a combination of both.

PK interactions may result from the coadministration of a drug that alters absorption, distribution, metabolism, or elimination parameters of \>1 other drugs. Serotonergic antidepressants usually are metabolized by cytochrome P450 (CYP450) enzymes. Any drug that inhibits a CYP450 enzyme responsible for biotransformation of 1 of these antidepressants may increase exposure to the antidepressant and raise the risk of serotonin syndrome. CYP450 inhibitors include prescription medications as well as seemingly benign over-the-counter (OTC) drugs.

PD interactions may result from an additive or synergistic pharmacologic effect caused by coadministration of 2 agents that produce the same or similar end result. In Ms. B’s case, agents inhibiting 5-HT reuptake (fluoxetine and amitriptyline) were combined with a direct 5-HT agonist (sumatriptan). The resulting potentiation of 5-HT via 2 distinct mechanisms increased Ms. B’s risk of serotonin syndrome. Similarly, simultaneous use of 2 agents potentiating 5-HT through identical mechanisms, such as combining 2 serotonin reuptake inhibitors, also may increase the risk of serotonin syndrome ( Table 2 ).1

A combination of PK and PD interactions also may increase the risk of serotonin syndrome. For example, Ms. B is taking fluoxetine and amitriptyline for different therapeutic reasons. Both of these agents inhibit 5-HT reuptake, potentiating 5-HT. In addition, amitriptyline is a substrate for CYP2D6 and fluoxetine is a robust CYP2D6 inhibitor. The coadministration of fluoxetine with tricyclic antidepressants (TCAs) results in a 4- to 5-fold increase in TCA exposure, which may increase the risk of serotonin syndrome and other sequelae from TCA toxicity.4,5

>An investigation to determine any underlying causes that may be contributing to an individual’s symptoms should include questions such as:

  • Is there a serotonin deficiency or low levels of serotonin?
  • Are any unknown food allergies causing internal swelling or metabolism concerns?
  • Is the individual’s thyroid level low?
  • Is there an accumulation of neurotoxins, such as heavy metals, which are contributing to symptoms?

By reviewing factors such as these with an professional, the individual is able to eliminate many obstacles that may be making it harder to discontinue Cymbalta.

Counseling or Therapy for Cymbalta Abuse

In addition to an integrative approach, which focuses on potential underlying issues, we always recommend seeing a counselor or therapist to have support through the process of discontinuing Cymbalta. When an individual is dealing with Cymbalta withdrawal or side effects, the fatigue and depression will often create a need to have professional support to deal with the emotional trauma.

Certain forms of counseling have shown to be as effective as the medication itself. As an example, CBT, or Cognitive Behavioral Therapy, is reported as being very successful for symptoms such as anxiety and PTSD. For an individual who is having lighter symptoms and just in need of some encouragement, a life coach or therapist could help provide support in the healing process.

Whatever the situation, it is important that if someone wishes to discontinue Cymbalta, they need to find like-minded support.

Potential Symptoms when Discontinuing Cymbalta

The long-term effects of Cymbalta, as well as painful side effects, are enough to make many users want to come off the medication. There are many alternatives to Cymbalta, and if used under the supervision of a licensed professional, discontinuing Cymbalta safely is possible. However, Cymbalta withdrawal is known to be a difficult process, and while it does not affect every person who attempts to stop taking Cymbalta, it is estimated that many users will experience Cymbalta Discontinuation Syndrome.

Symptoms reported of Cymbalta Discontinuation Syndrome include:

    • Dizziness
    • Fatigue
    • Anxiety
    • Anger or aggression
    • Fear
    • Ruminating thoughts
    • Paresthesia – burning sensation or prickling in limbs

<li”>Vomiting

  • Sleeplessness or insomnia
  • Brain zaps

In more extreme cases, serious medical issues such as seizures or damage to the liver have been reported.

If you or a loved one is experiencing any of the above symptoms due to Cymbalta withdrawal or the long-term effects of Cymbalta use, a can be performed to determine what level of treatment is needed in order to begin the healing process.

Treatment for Long-Term Effects of Cymbalta and Cymbalta Discontinuation Syndrome

For many individuals, the symptoms caused by discontinuing Cymbalta could be so severe that medical attention is required in order for the person to move on. Severe symptoms like brain zaps, shaking, sweating, delusions, and burning or tingling sensations will often indicate there is a need for a high level of care. Many individuals who attempt to stop taking Cymbalta on their own, without professional guidance, will find themselves either back on the medication, on a new medication, or dealing with long-term side effects.

At select integrative healing centers, such as Alternative to Meds Center in Sedona, Arizona, licensed will oversee the process of slowly tapering off Cymbalta, and will provide an assessment and treatment for the underlying issues. Entering an inpatient mental health facility to help come off the antidepressant is one way to ensure the process goes as smoothly as possible.

Alternative to Meds clients are able to stay in a therapeutic atmosphere with daily relaxing and rejuvenating activities, while being treated to all-organic meals and learning the tools needed to get healthy again. With the right care and attention from trained and licensed team members, individuals can heal from the long-term effects of Cymbalta.

Cymbalta Discontinuation Success

For many who are dealing with Cymbalta Discontinuation Syndrome, or antidepressant withdrawal, hope is hard to come by. Feeling like they will never heal, never feel better, or never sleep well again is a common theme. It is important for those suffering to understand that recovery is possible.

Each year, thousands of individuals are able to taper off their antidepressants safely and adopt a healthier, more holistic lifestyle. Stories of Cymbalta withdrawal success and can help to offer hope, even during the most difficult of times.

Many individuals who have found themselves institutionalized or hospitalized as a result of Cymbalta withdrawal or Cymbalta side effects have been able to begin their recovery at Alternative to Meds Center. For more than 12 years, clients attending our Sedona, AZ wellness center have been able to find a safe place to heal and recover from the effects of depression medication.

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