Anti-depressant withdrawal

[Jack-of-all-trades]

Prior to having back surgery, I was placed on Effexor as an attempt to help control my back pain, that frankly never really worked that well. I am now at the stage where the side effects far outweigh the benefits. Effexor acts on our bodies as a seritonin and norepinephrine re-uptake inhibitor kind of like Cymbalta.

Getting off this stuff is almost as bad as getting off opiates but with different symptoms. I'm tapering down but have no experience in what to expect. How long does it take to acclimate to a lower dose? What are the withdrawal symptoms like? Anything out there that helps with the withdrawal?

If I would have known there was a withdrawal problem I probably wouldn't have jump on this wagon without carefully researching it first.

[Justin]

Here's a great article on Antidepressant Discontinuation Syndrome: Antidepressant Discontinuation Syndrome - August 1, 2006 - American Family Physician.

[KBear]

Jack, Getting off of Cymbalta was worse than getting off of Morphine, Oxycodone and Hydrocodone combined. They had NOTHING on Cymbalta. You have to taper super, super slow and very small increments. I tried doing it too quickly and had horrible side effects. Google cymbalta withdrawal, I found a forum solely devoted to how hard it was to come off of it. There were also helpful tips on it. Good Luck, it is great to be off of it though (even though it took months)

[Jack-of-all-trades]

Thanks for the suggestions. There are several Topix discussions about coming off Effexor that are helpful.

As far as pain control is concerned, I would suggest thinking long and hard about using any antidepressant strictly for nerve pain. It seems anything that involves increasing seretonin causes severe withdrawals, at least that is my experience if tapered to fast or tried cold turkey, at least as bad as opiate withdrawal. I never used antidepressants in my work and really didn't research it much. BIG mistake.

If needed for depression, then that is another matter. If a person needs something for nerve pain control talk to an experienced prescriber who can give you all the pros-and-cons before taking this med.

[Justin]

Thanks for the suggestions. There are several Topix discussions about coming off Effexor that are helpful.

As far as pain control is concerned, I would suggest thinking long and hard about using any antidepressant strictly for nerve pain. It seems anything that involves increasing seretonin causes severe withdrawals, at least that is my experience if tapered to fast or tried cold turkey, at least as bad as opiate withdrawal. I never used antidepressants in my work and really didn't research it much. BIG mistake.

If needed for depression, then that is another matter. If a person needs something for nerve pain control talk to an experienced prescriber who can give you all the pros-and-cons before taking this med.

Jack, Cymbalta was just approved for pain. It has been used off label for pain in the past, but now it has an official indication from the FDA. Chronic pain and depression often go hand and hand--Cymbalta is a great medication for many Spine Patients. Many drugs have an inherent withdrawal mechanism. However, I believe it would behoof spine patients to speak with their medical providers about this medication to help *treat* their symptoms. "Worrying" about withdrawal should definitely be on the back burner, especially with antidepressants. The key is to treat the whole patient (physical, mental, spiritual, etc.) and address their symptoms accordingly.

[Jack-of-all-trades]

Justin,

I heard about Cymbalta too. I would suspect part of the reason Cymbalta got approved is that Eli Lilly still had a fair amount of time left on their patent and could afford to jump through the hoops of the FDA. Effexor, even the XR version is now off patent and has no $$$ reward. Both are seretonin/norephinephrine re-uptake inhibitors. What bothers me is docs not experienced in pain management, or afraid to Rx opiates, will jump on this as a first line "lets try it and see" med without considering long term effects if and when the med is no longer needed. If depression is a part of the patient's demeanor, it may be a good fit but not only long term but short term tolerance issues can make life miserable on top of chronic pain. I still see a PhD psychologist every couple of months that I started seeing when my spine pain was at it's worst. He works in a pain management clinic. He related to me that only about 50% of their pain patients could tolerate Cymbalta due to side effects.

Psychologically the only thing that kept me going was the belief that I would someday conquer the chronic pain issue and would get off all these mind fogging meds. If withdrawals are a problem, it needs to be figured into the mix.

[KBear]

Jack- I will say, as awful as the Cymbalta withdrawal was, it was without a doubt, one of the reasons I did not go off the deep end. And trust me, I was there on more than one occasion. It helped tremendously with my pain (more than I realized at the time, hence why I'm back on pain meds after being off all of them). I also had major depression from the pain. At first looking forward to the next 'fix' kept me going, but then when it would fail, I would hit all time lows. After almost a year of that, my doctor put me on Cymbalta (was my family doctor who prescribed it initially). Even knowing what I know now, I would still take it again if I were in that boat.

I just wish the doctors prescribing it were more educated in how to get patients off of it with the least amount of side effects (seemed none realized how hard it was to stop). I read on one forum where someone said that all doctors who prescribe it should have to take it for a few months and then wean off, so they get what it's like! LOL

[runagain]

Jack,

Interesting discussion because I was just put on a second antidepressant after another one failed because I could not stand the side effects. A few months back (last Dec.), my pain doc suggested Effexor (37.5 mg for seven days and then double that thereafter), I think it was XR?, and I took it for three days. I felt like I was going to loose my cookies, and I wanted to sleep all day long. Not a good thing for someone who needs to take care of children.
My pain doctor suggested it to decrease my pain.

I could not stand the side effects.and While last week at the pain appt, I am given another antidepressant, although I told the practitioner that the last one made me sick. This time, Lexapro 10mg (SSRI). He said this was a lesser dose and should be easier on me.
My last appt, I was nearly bawling because I was in so much pain, and I felt like I got thrown a medication. This medication is for major depressive disorder.
Nevertheless, my regular pain doc was not available and the opioid/nerve pain medication regimen could not be changed and so I agreed to try the med.
I took it in the morning and then I had severe back/leg pain plus a stomach ache. It made me feel fuzzy and really tired. Hence, I wanted to sleep all day again.

Like you, i didn't know much about antidepressants, meaning their full effects.
I did not know exactly how to taper them off slowly or any of that.
The person who prescribed the lexapro said he was certain it would help me and I cannot help thinking that he suggested this because I was crying in the office, which i have never done there.

I know that back pain and depression go hand in hand, however I was in such severe pain that day that I couldn't even imagine driving home and I told the practitioner that and he kind of ignored it. I was considering going straight to the ER from the appt, but went home instead. Home just seemed more comforting.

I ended up thinking: crying woman, put her on antidepressants. Still he did this even though I told him that none of my siblings could tolerate antidepressants. I knew my brother had a major problem as he was put on one for depression and ended up in a locked down unit. (I clarified this, but he does not remember which med it was but he said the dr. told him that with our American Indian descent we could not take that medication. It caused him to have a distortion with sounds. He said it was enough to drive him crazy, something like that).

I know that I am depressed--it goes with the territory--and I know antidepressants can be invaluable for treatment of depression. Like you, however, I would like to see the medical practitioner explain the side effects of the drugs, what happens long term if you are on them and how easy they are to wean off.

That's my two cents.

R

[Justin]

I ended up thinking: crying woman, put her on antidepressants. Still he did this even though I told him that none of my siblings could tolerate antidepressants. I knew my brother had a major problem as he was put on one for depression and ended up in a locked down unit. (I clarified this, but he does not remember which med it was but he said the dr. told him that with our American Indian descent we could not take that medication. It caused him to have a distortion with sounds. He said it was enough to drive him crazy, something like that).

I'm sorry you had so much trouble. Runagain, are you sure that his side effects were related to an antidepressant? It sounds more like Haloperidol (or a similar drug) to me.

BTW...antidepressant medications take at least 4-6 weeks to start "working."

[Cindylou]

I have been on anti-depressants for a number of years. I initially started due to my menopausal symptoms, which I still have, but now I take it more for coping with the depression of pain. You have to get over the initial stigma of it. R, I would definitely give it a try again, until you find one that is agreeable to your system, and yes, as J said, it takes 4-6 weeks to really take effect. I even had to go up a knotch w the recent death of my best friend, and it has made a huge difference. I expect to taper back to my normal dosage w/I 6 months. I could not cope at all w/o my anti-depressant, and of course my pain mess. Last night I cried myself to sleep as my pain was horrific....ended up not sleeping much at all, but I digress. I personally highly recommend an antidepressant to anyone dealing with severe chronic pain. Just my 2 cents. Not medical advice. CL