I am cross-tapering from Cymbalta (been on 60mg for about 4 months) to Efexor.

I went from 60mg Cym to 30mg, simultaneously starting Efexor at 75mg. The first 3 days I had mild headaches that went away by themselves. Today is day 5. Yesterday and today the headaches have been BAD. Paracetamol (acetaminophen in the US) and aspirin are not touching them. I'm thinking of resorting to buying something with codeine, although I probably shouldn't add ANOTHER psychoactive substance to my cocktail (also includes Wellbutrin, Lamictal and Zopiclone).

I read up about Cym withdrawal and discovered headaches are frequently reported on withdrawal! Am I doubly screwed? After 7 days I am supposed to drop from 30mg Cym to stopping, and then raise the Efexor to 150mg. But if this is going to worsen the headaches, I'm worried about doing it! Anyone have any idea what the chances of that are?

I have spare empty capsules and I'm strongly considering using grapeape's capsule-splitting method to slow down the going off Cym. I did this before, when I went off Efexor previously (had been on it for years) and managed to get off in a month without any problems.

Perhaps I should even do the same with the increasing of the Efexor? - go from 75 to 112.5 and later to 150mg?

What is the general wisdom on this? I'm at work, took an aspirin/paracetamol combination, but my head is SO sore. I had start-up headaches with Efexor last time around, for about a week. If this is short-lived, I can probably bear it, but if the Cymbalta withdrawal is going to prolong it... then I don't know.... :(

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(Psychologists have to undergo therapy themselves as part of their training (at least here in SA). I think psychiatrists should be made to undergo some treatment regimens as part of their training too, with a few combos and switches...!!!)

This post has been edited by moonlightress: Jul 7 2008, 04:41 AM

moonlightress,

I'm not going to be very helpful, but there are several suggestions under the Cymbalta Withdrawal thread that might be helpful. Many people have had to cross-taper from one drug to another and give their advice as to how to best do so.

Good luck!

Sincerely,

Maddie

Thanks Maddie. It's a good thread. Yesterday's headache got so bad that I went to the pharmacy and asked how bad it would be if I took some painkillers with codeine (she knows what I'm on) and she sold me 20 and said not to worry about it, in the short-term it isn't an issue. By the end of the day, I was nauseous, lying in a darkened room, wondering if it was a migraine that I missed the aura of, wishing someone would chop off my head, and that was AFTER four of the painkillers. And that is how I became one year older! - I could write some interesting stories around the topic of "How I've spent my birthdays"...
I've decided to do the capsule-splitting method.. tomorrow I'll go from 30mg to 15mg and stay there a week and depending on how that goes, go to 7.5mg.
Advice: do this over a tray! Those expensive little micro-balls roll around!
And I'm cross with the pdoc for not warning me, grumble, grumble...

Moonlightress!

What a terrible birthday, but happy belated anyway. Is today better? You know there is a 20 mg. dosage of Cymbalta too if that helps instead of microball counting (which I know is necessary, but seems so absurd). Maybe that would be a smaller (and better) jump down than going to 15 mg.
Maybe if you upped your Effexor, it would help with the cross tapering. Have you asked your doc. about it?

Hi again MaddieL...
Today is day 6 on Cymbalta 30mg (down from 60mg) and Efexor 75mg (up from none). I'm going to document this cross-taper, like grapeape did coming off the Cymbalta, in case it helps anyone else with the Cym -> Efex scenario.

Today was no better. Headaches, nausea (which I can keep at bay with small meals), stomach ache. Feeling utterly miserable and cried a few times (compounded by the situation of one of my daughters no longer living with me - I feel bereft...) Called in sick at work. Essentially did nothing today. Spent some time splitting capsules and made some 15mg ones, some 10mg ones and some 7.5mg ones. (I thought of splitting a 60mg into 3 to make some 20mg caps, but didn't.)

I decided to go up to 150mg of Efexor a day earlier than the week prescribed (i.e. tomorrow), so I'll still be on 30mg Cymbalta at this time. Then I will reduce the Cym to 15mg. I anticipate a few rough days ahead.

But no brain zaps. Thank heavens! - they sound awful. Probably because of the cross-taper. (and maybe also due to Wellbutrin and Lamictal). Efexor worked so well for me before that I am very positive about getting back on it. Nasty start-up, I remember, but I just have to hang in. The pdoc said I should be able to feel some difference in 3 weeks.

This is my 6th med trial since December 2007. I'm ever so slightly sick of this...

Day 8 of the switchover: I've been on the increased dose of 150mg Efexor for 2 days and decreased the Cymbalta (30mg yesterday, 20mg today.)
Yesterday was horrible, I got such a bad headache I considered phoning the doc for a pain shot, but spent the afternoon in bed instead with some non-prescription painkillers. Nausea was bad and I struggled to eat. I have bad tremors - I assume from the Efexor. I also resorted to some senna for the worsening constipation. Having some trouble focusing and blurry eyes. Woke up this morning feeling so down I didn't want to face today... stayed in bed until around noon, called in sick at work again. I've been down the whole day, tearfulness. I'm trying not to think too much and at least I don't have those racing thoughts and anxiety, just a long stretch of inertia and flatness. I'm just waiting it out.

moonlightress!

You are being so brave! I don't know if I could have stood some of those side effects together with a cross taper. I certainly hope the Effexor does as well for you this time as last. Why did you go off of it again?

Maybe tomorrow will be the magic day. Thanks for keeping us posted!

Maddie

Dear Maddie
Don't know why anyone would want to follow this thread, but you are dear for replying.
Don't we all just do what we can to tough out the SEs...? I'm trying hard not to think about how I am doing, or to keep evaluating if it's working. I'll do that at the end of 2 weeks and again at the end of 3 weeks. I do know Efexor was rough last time I started it, so being forewarned has helped. I went off it previously, because it "pooped out", but the pdoc seemed to think there was a good chance it would work again, especially if I stick with the Wyeth brand and not the Cipla generic, as he says he has noted differences. I am having to pay the difference, but if the Efexor actually works it will be a small price to pay. I went into remission on it last time.

Yesterday's headaches weren't as bad, took some more senna for the constipation. I've been taking the full dose of zopiclone (15mg) that the doc prescribed, although it's a lot more than I've ever been given before. I sleep well with this though, - blissful escape! A bit groggy in the morning until about 10.

Don't know how I would have done this without a very lenient boss who has let me take all the time off. We're not busy, so there's hardly any work. Just as well, as I'm becoming a champion couch-potato with-dull-stare-into-space!

This post has been edited by moonlightress: Jul 10 2008, 11:21 PM

Day 9: no headaches - it should be a relief, but instead I have felt really badly down the last two days. Just really depressed.
C'est la vie...

Moonlightress,

I remember (like it was yesterday) how I felt about this time last year when going through some horrible side effects starting Cymbalta. I was so anxious that I'd write in all the time wanting reassurance that every tinge or ache I had was "normal." I received tremendous support from others on the board who had gone through the same thing. I remember getting really upset because I felt so bad all the time, and that in turn made me depressed. When the fog lifted and I started to feel myself, it was wonderful. The fact that your headaches have gotten better is a good sign. Something that really helped me was to sit outside and read or work on the computer. Do you have a porch or patio you can sit on? I think being outside is VERY helpful for a depressive personality.

Sincerely,

Maddie

Day 11. It seems the headaches are no longer happening; looking back they really only lasted a week, although it felt longer. As my pdoc would say, it is change, and change is good news, as it tends to mean something is happening. I think the headaches were due to the Efexor (had that reaction to Efexor before). So as far as the Cymbalta withdrawal, I'd have to say, it's been smooth. This morning I moved down from 20mg to 15mg (homemade; split a 60mg capsule into 4 capsules) and plan to spend 4 days on this dose.

I've been on Efexor 150mg for 4 days now.... and.... I REALLY don't want to jump the gun, or jinx it...
but I woke up feeling a little less sad this morning, a little more peaceful, a small step up from the very flat, barren, empty and sometimes tearful kind of feeling of the last 4 days.


Maddie - I agree with you.. but... I'm reluctant. Part of it is that it is so darn cold outside, and part is that whenever I go into the garden, it just reminds me of how much needs to be done and how little I have done. It's a mess. I've neglected so many aspects of my life that I'm a little scared of having to face them all again and handle all the backlog. Kind of that "afraid to get better 'cos I'll have to go out and face it all again" thing.

Moonlightress,

I know you don't want to get too hopeful (part of my anxiety is feeling like if I feel good, I'll somehow blow it), but that is great news on the headaches. I like what your doctor said too, as it's very true.

As for going outside, why don't you start small-like rake up the leaves (if applicable), or pull five weeds. Then as a reward you can read a book or play on the computer (whatevever you consider a reward). You could do a little more each day and reward yourself for doing something small. If that won't work, do you have a local, safe park or greenbelt area where you can walk or sit for awhile?

Glad it's getting better!

Maddie

Great idea... what I really should do, is trim the grapevine - it didn't get done last year, due to depression and I'm late for this year, and it needs it.
I'm still on 15mg Cymbalta, going down to 10mg from tomorrow. No problems that I can attribute to the Cym withdrawal process, they're clearly related to other meds. The Efexor is definitely helping my mood - I think I might even get well!