My Duloxetine Diary

[Jem21]

Hi to whoever is reading this, my name is Jemma and i'm 41.
I switched over from Citalopram to Duloxetine 10 days ago. This section of the forum is very quiet as i don't think many people are on this AD but I wanted post my journey in here for anyone else staring this med.
There is a great thread further down from 'Mr Red Shirt' and i have read it a lot and really helped me starting this so i wanted to do the same for anyone else starting out.
I hang out in the Venlafaxine forum mostly as there are more people in there taking that and it's a very similar med so i've teamed up with them and they have been a massive support to me.

So i stopped the citalopram and had a night with nothing then i started my first duloxetine at 8:30pm the next evening at 20mg. My doc has started me low as i tend to get bad side effects.
Slept fine the first night and woke about 6:20am with high anxiety and really bad nausea.

Day 2 the nausea continued and i found eating little and often helped with it, also drunk loads of water as felt quite thirsty. Walked to the shop and felt a bit faint but eating when i got home helped. Also very sleepy. My doctor has given me some 2mg diazepam for the switchover.

Day 3 to 8 went very similar to the above, high anxiety, tired during the day, bad nausea, took 1 diazepam most days.


Day 9 Less tired and the nausea started easing, had a fairly calm day with no diazepam. I have been sleeping good but wake up quite early. I have also been making myself go for a walk every day even if it's only round the block.

Day 10 which is today - Woke at 7am with some anxiety but got straight up and made a drink, it then went again, have felt calm since. My get up and go has got up and gone though, could quite happily lay in bed all day and do nothing, which i won't do though. I can't really be bothered to do anything but i'm not anxious about it. I'm hoping this is the duloxetine stating to do something, i have a review in 2 weeks at the doctors and i can see me having to increase to 30mg but i'll see how things go. Having to make myself keep busy today to stop me just doing nothing. Till tomorrow.

[MyNameIsTerry]

Until you hit 60mg it's just a SSRI. The usual starting protocol with anxiety is 30mg then upping to 60mg to get the "N" part. So, I expect your doctor will be aiming for that but it's just playing safe.

Duloxetine is annoying one because they are encapsulated so you can't split them and you have to live with the manufacturer dosages.

I hope it goes well for you. It's been a bad experience for me, although I'm still on it years later because I was naive and trusted my GP when he passed off the nightmare as my own anxiety getting worse, but I've read threads (and spoken to people on here) who have had no issues with start up so hopefully you will be one of them. I'm glad you found some of those posts.

[Jem21]

Hey Terry, my doc started me on 20 because I'm really sensitive to side effects, I asked him yesterday when I was there why he didn't start me on 30 as that seemed to be the standard and that's what he said. He is increasing me to 30 after 3 1/2 weeks if I need to.

I've read reviews too, some good, some bad some horrific. But I read the same on Citalopram and that worked great for me many times over the last 15 years.

I'm not sure on the difference between Ssri and snri is one better than the other for certain things? Can I ask why you are still on them if you find them that bad and they don't work for you? Why not try something else?

[MyNameIsTerry]

That's refreshing to hear from a doctor, many just go with the standard doses. the 20mg is the generic only so it gives them a little extra to play with. They can even combine a 30mg+20mg if working up if they want to pay twice but think it's better for the patient.

Yeah, I'm not a good review which is why I keep saying talk to the Ven guys as there is more of them around so it's at least some support for a similar process.

The first thing is, people often think SSRI's only work with Serotonin but it's actually just that they mainly work with Serotonin. So, they vary in their impacts on other neurotransmitters like norepinephrine (which is the "N" in your SNRI). This may account for some of the issues with sensitive buts that's a very complex issue and it is likely a combination of things.

All an SNRI does is add the "N" bit so it's prioritising two different neurotransmitters at a clinical level. This "N" part is supposed to be good in depression because it will push up adrenaline levels which will mean more motivation & energy for depressed patients.

As to why they help us with anxiety, I'm unsure on that still now since the last thing you would think we need is more adrenaline! Some people find them too activating and change to something else, some people get on well with them. There are certainly active Ven members who say it's helped them greatly with their anxiety.

So, in theory SNRI's should be more for depression. That was the intention but then SSRI's were made for depression too. Very few things seem to be more for anxiety it's just they've found they can work.

I've been on Cit before and I came off that after a few years with my GP pushing for it. I had no therapy or did any reading or talking about anxiety so thought I was better. I wasn't. I relapsed 6 months later worse than the original breakdown. My GP decided on Duloxetine because he said it was more for anxiety, which isn't a good argument as he should have reinstituted the Cit or tried another SSRI, which is what all the advice tells them to do. I've found his knowledge of these meds pretty poor.

He told me the med was fine and it was my anxiety getting worse. I was naïve and believed my doctor would know best. I got into a bad pattern of late sleeping and ended up living at night. This became an obsession in the OCD I only developed due to Duloxetine and it slowly made it harder to access my GP. I ended up disengaging from my GP and went my own way and had much more success.

It wasn't until I came here and started talking to the people on this Meds board that I realised so much of what I had been through was because of the Duloxetine. And since then I've been working on my own issues until I come through the other side and address the med. I'm wary of advice from my GP as his knowledge is poor and he blocked access to a psychiatrist (unless I go private) so I've lost faith in them really. I'm getting by better without them but I want to keep heading towards the goals before I test the waters removing the med.

That's why I say I'm not a good person to ask about this med in terms of experience. It hasn't done much for me and has created new anxiety issues I never had before. There are people on Ven and other meds who have been the same (even Cit & Sert) so this is a very individual issue for me and I wouldn't say anyone should look at it and be put off. Cit worked much better for me.

I remember when I went on the 30mg it was just like being on the Cit really, nothing really bad. I did have the nausea the first 2 days (it hit me within 20 mins of taking it but only lasted an hour or so) but it was nothing we aren't used to. It was the 60mg where things started for me, I know now it took me a very long time to get beyond the side effects. I still get some of them now years on but the first year was very bad. Don't be put off by this because I've read enough stories and spoken to enough people on here about a lot of these meds to know that experiences like mine are less common.

[Jem21]

My doctor is pretty great and he never takes costs into account which is really lucky for me. He even prescribes me 2 months worth of tablets but sees me every month so I only pay every 2 months. I think he learnt his lesson the first time when he put me straight on Citalopram at 20mg and 3 days later had me in his office climbing the walls and sobbing on him lol. He's also good at telling me side effects and what to expect and I get a hug before I leave. Can't complain at that really!

Thanks for the info on the difference I guess I'll have to wait and see if I get to 60mg or not. It's 30 next so I'll take it one step at a time.

Well yesterday was day 10 on the 20mg duloxetine and 11 days off the Citalopram, was a rubbish day! Felt so so tired all day which is a massive anxiety trigger for me so I spent the day fighting it and wound up taking a diazepam at tea time as I was so agitated. Also had a couple of crying spells which is unlike me. Just generally felt unwell really yesterday, weak, lots of aches which are probably tension, headache all day and a bit out of it and slow mentally.
I'm not sure if some of that could be Citalopram withdrawal or if it's just side effects.
I've wrote myself some reassurance notes today to carry round with me and I'll keep reminding myself of them.

[Mermaid16]

Hi Jem! I think the crying spells are linked to withdrawal of the Cit maybe. When I started the Sert taper, my moods were all over the place. One minute I was fine and the next bawling my eyes out for no reason. I also had the agitation as well. It did seem to get better better after about a week. It might be worth keeping a mood diary so you can see if it improving. You're doing great and the reassurance notes are a very good idea. I actually went on the treadmill today after you guys talking about getting out and doing a walk around the block etc. It really did help. Will give it a go again tomorrow. Xx

[Jem21]

Yay nice one Tracy, it does help doing some exercise. It's the tiredness that does me in though with the start up. Today hasn't been bad, kept busy and the tiredness hasn't been that bad. After yesterday anything would be a better day! Crazy little pills lol x

[Mermaid16]

Hi Jem! Glad you had a better day. I had a good day today also...thank goodness. Thought I was losing it yesterday the anxiety was so bad. I said to my partner it was either the last of the drug coming out of my body or trying to decrease the Valium. I had taken 1mg less the day before. Don't know if it would show that quickly though. I have decided just to wait until I see the new psych to change anything. I saw GP today and she wrote a referral to a new psych, so hope I can get in this week. I have been listening to Claire Weekes audio which has been helpful. It really does help. I also bought a book to read to try and get my mind off myself.

With the tiredness you get, can you sleep, or is it just feeling tired but you are wide awake?

You're doing great!!! Yes they are crazy little pills. We obviously need them though.

:hugs:

Always get a smile when I listen to Claire Weekes, when she says 'let's talk about the housewife'. Such different times back then. I think she was even talking about 1966 at one stage. So very knowledgeable about the illness.

[MyNameIsTerry]

Yeah Jem, my GP put me straight on 20mg Cit too and within 2 days I was in a real state. I think though that once you've been through this, whilst it's still horrible, you understand why you feel this way and can use that to keep hanging on. I did when I went on the Duloxetine and I would say to myself "any day now this will break (like a fever)". The 60mg dose was where I really struggled and it was day after about 8-10 days of hell that it did drop off a fair bit.

I think Tracy is right, the switch is unbalancing you in various ways. You are also dropping down in your dosage to build up. There will be come overlap with the Serotonin functionality but as the Cit drains out of you, the Duloxetine going in isn't going to be topping it up all the way again after about week as that's when Cit gets to <5% left.

Your doctor is playing safe and I think he is good for that. The trade off is going to possibly be some withdrawal as well as the possibility of some onset side effects.

If it truly gets too much, speak to him, but if you can handle it, it's always best to try to get through the other side. With titrating upwards it will mean some side effects potentially each time so he will likely give you some breathing space. Luckily Duloxetine has a much shorter half life than Cit so your blood plasma will stabilise quicker than the week it takes for Cit.

[Jem21]

Hey Tracy, it's a tiredness where I can just sleep, constantly and I really don't like that part. I think the worst of that bit is over fingers crossed. Clare weeks is very old fashioned and she makes me chuckle with some things but she really knew her stuff and some things I've read from her have really helped.

Hi Terry thanks for all the info, you only ever get so much from your doctor as they only have 10 mins. I asked him for a pdoc referral just before he started me on the duloxetine as I felt like I really wanted to explain my problem to a professional who had the time to listen and prescribe something tailored to that so I had a bit more confidence in what I was taking and had a plan but he actually said and I quote 'what will he tell you that you don't already know' I would imagine quite a lot seeing as he's a professional and I'm not. I'm going to give these a fair go but if they don't help or I get worse I'm off back to make him refer me. I have private cover so it's not like it's a problem to him.
Things have picked up slightly though after 12 days, I'm better than I was but certainly not doing cartwheels just yet!

[Jem21]

Day 14 on Duloxetine and day 15 off the Citalopram, I've been a bit emotional the last couple of days and cry very easily. I'm assuming this is the cit withdrawal.
Had some calmer times. I find I get wound up and agitated rather than anxious about it all at the moment. Still have to keep reminding myself I'm only on 20mg and just at the 2 week mark so not to expect miracles. Still having some anxiety here and there though. I'm going back to work today after 2 weeks off as I think being at home on my own all day gives me too much time to think and wind myself up. I just need to pass the time and let the meds do their job. Not sure how today will go but I'll update later.

[Jem21]

Not updated for a while, been on the 20mg for 4 weeks now and just increased to 30mg tonight! The 20 has helped but I wouldn't say I was back to normal yet! It has helped with the anxiety but I'm finding I'm very flat at the moment, not depressed but can't be bothered but not that bothered about it kind of thing! Still having some jaw clenching issues and still stuck on the hamster wheel with my thought process! I'm hoping the 30mg will help with all this. I didn't expect too much from the 20mg so the help with the anxiety has been good! I hope I don't get the side effects back from the increase but I'm expecting them to an extent. Here goes!!

[Jem21]

I've realised that i've not updated here in quite awhile so i thought i'd post an update.
Today is exactly 4 weeks on the 30mg, the increase from 20 to 30 was quite rough but i found it settling after a couple of weeks. i can certainly say i'm not obsessing so much in my mind anymore and the anxiety is calmer than it was but i still feel very flat and no motivation and little energy. Getting quite wound up about it all. Doctor has increased my dose to 60mg as that is the theraputic dose and the one that i have been aiming for. i also have a referral to a phych but not contacted him yet as i think i should give the 60mg a chance first. i have some diazepam for the increase, i've not taken any since the first couple of weeks on the 30mg and my doctor said its ok to take upto 3 x 2mg per day if i need to although i only take them when i really need to.
So i start the 60mg tonight at 8.30pm, very nervous about this but i'm not going to get any better unless i try so i'll update soon.

[Bike Rider]

Hi Jem, that exactly how I felt on Citalopram and my GP has changed me to Fluox to see if I get a lift from it.

I feel fed up, not depressed as such, with no motivation and its then that my anxiety thoughts try to get in. But have been reading a book on sleep and how affects mental health, plus things which I thought were not normal, turn out to be very normal.

[Mermaid16]

Hi Jem! I hope everything goes okay and you get through the updose without too many problems. I have just gone up to the max dose of Sertraline (200mg), which is double what I was taking when I came in here. I am shitting myself. I hate med increases. Think I will just lay in bed and curl up into a ball today. Hope it all works out and let us know how you get on. Xx

[dale12345]

I hope you both feel better.

[Jem21]

Today is day 10 on the 60mg, had a few side effects with the increase but not needed any diazepam which is a plus.
Anxiety is fairly minimal, little bit when I wake up, also need to remind myself to eat some days! The main side effect is jaw clenching and muscle tension in my arms and an overall feeling of tension where my body won't relax no matter how hard I try. I also feel very flat with no motivation. Nausea is on and off but not much of a problem. I'm making sure I keep busy and doing things even though I don't want to! I'm hoping that things improve more as I've read it can take a while longer yet! I have an appointment with a pdoc on the 17th so I'll keep going as by then it will be almost 4 weeks on this dose and he will be able to advise.

[Jem21]

Thought i would add an update, after doing a month on 20mg then a month on 30mg followed by 17 days on 60mg and then a month on 40mg i think i've done a fair trial to be able to say that cymbalta just isnt for me.
Mood wise it's been good, anxiety wise it's also been fairly good but it came at too much of a cost side effects wise.
It caused severe jaw clenching which tensed up all my arm muscles and then all my muscles became weak and it never stopped the whole time i was on it. It has also messed up my hormones in a big way, i started bleeding after being on these for 2 weeks and i havent stopped since then (coincidence maybe but i dont think so)
My doctor has done a straight swap with me from 40mg cymbalta to 50mg sertraline.
I have heard these are hell to come off and i must say, i did a night with nothing then started the sert last night and this morning i feel horrific.
I have a banging headache and feel so sick and nothing is helping. I know i need to ride this out so fingers crossed.

[WhiteFairy]

This thread is old but thought I would write a comment anyway as it may help others.
I was on Cymbalta 60mg about 8 years ago for a couple of years and for me it was like a wonder drug. It just seemed to work where so many others failed. From being a nervous wreck and housebound I was able to leave the house and gradually got my life back.
I came off them gradually (gave myself about 6 months to do this) and had no major problems doing so.
Had a blip with my anxiety a few years later and was given Sertraline 30mg which helped some but once again, once I felt better, I reduced it gradually and came off them. This was about 5 years ago.
Now facing another blip with my anxiety at an all time high. Health anxiety for me is triggered by stress, but this time am trying to manage it through meditation and other methods. I may go back to the doc for medication if I find I can't cope but want to make it the last option. I would certainly consider taking Cymbalta again if I found it to be necessary.