Van Halen for Bipolar Depression Relief

A few months ago some friends and I saw Van Halen in concert. As it is with any event or trip planned in advance, I have concerns about the mood state I will be when I am actually experiencing the activity. It is seemingly impossible to predict what my mood state will be and whether my mood will be good enough so I can have some fun!

Since I was not drinking at the time I got the coveted duty of being the responsible driver for the group. In a way this is an honor. It gives me recognition of sorts that I am being victorious over alcohol, my arch nemesis of the psychoactive substances here on God's green earth.

The show was pretty good and I had killer time for sure. I liked the venue and lights. But don't be surprised if you hear a change in David Lee Roth's voice. It's starting to fade. No bueno!

I had some serious depression three days in a row leading up to the show. All sorts of negative self-talk was dominating my thoughts. The signs were pointing towards trouble ahead.

A Friday in the Bipolar Lives of Me

So this past Friday I am having a typical slow start to my morning (it can take an hour for me to "get up" each day). My usual not-so-great bipolar depression mood is present. Blah, dead countenance, not much hope. I say to myself, "Another gray day, what the hey!"

But this doesn't last long. Things quickly changed when I got a call from my Dad. He said someone just called him saying they have my wallet! Now I have some anxiety to go along with my mood.

Oh no, not again!

This at least the 6th time I've lost my wallet. The mere thought of having to notify all those institutions and creditors that have cards in the wallet does not do well for one's spirit. How many times has  this unfortunate experience happened to you?

Computer Calamity Creates Confused Countenance

I'd like to share with you a real life potentially problematic problem of powerful proportions that I faced just the other day. It is a modern age problem that, should it happen to you, will create intense feelings of helplessness that suck.

It's when your computer crashes! It happened to me Saturday afternoon. My laptop was attacked by a gang of renegade programs and evil code. They took over and rendered it useless!

Furthermore, this electronic mayhem was starting to activate my bipolar symptoms and mood-states. Not good. Head for the hills!

And the Depression Dragon Comes Calling

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Did you know that May is Mental Health Month. May was designated by Congress in 1949 as the month to raise awareness of mental health conditions and mental wellness for all. It has become apparent that mental health and wellness is essential for a person’s overall health. And we should remember that effective prevention, mitigation, and treatment of bipolar symptoms is possible. It is true that people can recover from mental disorders and live full and productive lives. This post is dedicated to the Mental Health Month of May.
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Well, leave it to my bipolar depression and its minions to interfere with a perfectly good out-of-town trip. I drove up to San Francisco last week to visit an old friend for a few days. We planned on catching up, hanging out, and discussing business ideas and whatnot (remember, I’m still unemployed yet semi-retired).

Depression Dragon Appears

The depression dragon came calling on the day I drove up to the Bay Area. I felt it descending upon me around 1030 that morn. The sky was gray. I was at my father’s house dropping off my dog before heading out to NorCal. Nothing against my father it just happened that way. Just sayin.
Also, I was very tired from staying up all night. I had spent the night busily reading and thinking about some things that my friend and I intended to discuss. 

It was exciting material, I was motivated, and so I kept on working through the wee hours of the night. Time flew by like it does when you become engaged in something you enjoy doing.

Funky Friday

I slept 18 hours straight on Friday, not getting up until 5 pm. It was one of my marathon depression slumbers. So much for talking shop that day. We’ll catch up this eve and tomorrow I thought.

But that was not to be the case. The bedeviling depression dragon had come home to roost for a time. He dwelled amongst me all evening. The feelings from ruminations over nonexistent yet “impending doom” kept me pinned on my back.

Saturday

I awoke Saturday at a reasonable hour with no relief from depression symptoms. As per all depressions to this extent I had diminished capabilities, limited cognitive functioning, and a pathetic level of self worth. I was not in a good state for having lively, engaging conversation about future possibilities.

Mother’s Day

The last day of my visit was on Mother’s Day. This didn’t help my poor mood matters because this day inevitably brings up memories of my mom, usually sad. She passed on January 2, 2010.

So, after a splendid lunch with my longtime friend and his family and a short nap I departed.

My thinking about the visit on the drive home was disappointment at first. I was disappointed I didn’t have the needed access to my mind during my trip. I was robbed of important things like memory recall, attention, and a fluid mind. Never mind executive functions like planning and strategizing.

Instead I was stuck with no go neurotransmitters, nasty neural network cobwebs, and gelatinous blobs of gray matter. It’s enough to make a Jewish mother say "oy."

Dragon Departure

After talking with my friend illegally on my cell phone while driving home I felt better. I told him I was disappointed and why. He acknowledged that and was glad I communicated the matter. He knows I fight this demonic dragon each day and I’m stronger on some days over others. This helped me relax.

I slept well Sunday night. The dragon left his roost during the night.

So as things would have it my mind and mood came back on Monday. There is still a little depression, but this much I can deal with.

The wackedness (new word, pronounced wa’ ked ness) of this bipolar depression of mine continues to amaze me. No sooner than when I get a grip and think recovery is moving forward, I find myself wallowing in the mire once again.

Final Analysis

So, was this experience a failure? Not by a long shot. I had a wonderful time hanging out with my friend and his family.

Regardless of the whims of serious depression we managed to discuss several issues and ideas. It just wasn’t to the depth and detail I was hoping for.

The work stuff and ideas will come as they do. I’m trying not to put unnecessary expectations on things. This just adds stress. And stress can very easily become a trigger for and aggravator of bipolar symptoms.

As I said to my good friend, “Sometimes you just got to be the tortoise in the race.” It takes time and patience when you are taking over the world.

So what are you in life? A tortoise or a hare?

My Bipolar Life in a Blog Post

Not including the intense, short-lived manic episodes and fleeting periods of normalcy, most of my life since my teenage years has been spent fighting bipolar depression.  

I was diagnosed with Bipolar Disorder in August 1997, while being held against my will in a psychiatric hospital by a 5150. A 5150 is a section of the California Welfare and Institution Code, which states a person is required to be hospitalized if they are considered to be a threat to themselves or someone else and/or are gravely disabled.  

I would say I may have been gravely disabled (whatever that means), certainly not a threat to anyone. Of course they didn't ask my opinion. 

I have been blessed to make it up to this point. It has taken brains, willpower, and help from above to make it. AND I get a lot of help from a good pdoc and psych meds, a good psychologist, supportive family, and understanding friends.  

Shortly after my 1997 manic episode I had a major depressive episode that lasted three years. By the time I got to a more "normal" state I had cleared up all the financial, social, and work-related messes I'd made. My "normal" state was probably more like dysthymia (a chronic, low-level depression that lasts for at least two years) that lasted until 2002.

By May 2002 I was doing well at work, it was spring, and I had a girlfriend.  No problems, right? Wrong.  

The girlfriend insisted there was nothing wrong with me and I did not need to take my meds. I argued for weeks that she was wrong. I had bipolar disorder and pretty much everyone knew it. So, to prove her wrong, I stopped taking my meds in May. Houston we have a problem.

Shortly thereafter we all know what happens. Since I was off my psych meds I went manic in a matter of days. This manic trip was more bizarre and damaging and exciting than my 1997 episode. I did some fun stuff, but also had delusions, anger, and the symptoms associated with unbridled mania: a flood of racing thoughts, tons of energy, little or no need for sleep, rapid speech.

I was Supermanic: faster than a pissed off bartender; more powerful than an upset badger; and able to escape from bad situations in a single bound. The depression dragon feared the sight of me. I felt invincible (a bad thing).

That fun ride landed me in the hospital twice that summer. The first was a 72 hr hold (another 5150). The second was voluntary, but I left early AMA (against medical advice). I was stabilized and I got bored so I left. Plus the head doctor was being a dick. He tried to get me committed for another two weeks. It was a nice try, but I beat him in mental health court.

Following the years of depression after Mania 2002 my symptoms began to recede by 2005. I was mostly stable from 2005 to 2010. I wouldn't say recovered - more like remission from most of my depression symptoms. 

In early January 2010 my mom died. I was devastated. I was drinking hard at this point. I was drowning my sorrow over my mother's death. And then my pdoc up and retired on me in March with no advanced notice.  

By May I'm a little hypomanic maybe (definitely). By late May to late June I found myself in a manic phase once again. But this time it's without a psychiatrist!

I couldn't work. I got approved to take all of June off for medical reasons. I ended up resigning for medical reasons in November 2011 and I haven't been back to work since. I'm calling it my retirement transition period. 

Anyway, there you have it. The cliff notes version of my life from when I was first diagnosed (1997) until now. It is my life during the time bipolar dominated all else, as it does now.

Present status. I live in a house with two dogs for roommates. Currently I am in a 17 month treatment resistant bipolar depression, with a splash of anxiety.  I am on meds and participate in one-on-one psychotherapy. Dogs, sun, blogging, family, friends, and faith continue to provide me strength and sense of purpose as I struggle to live with bipolar disorder. 

I hope you are blessed with the kinds of things that contribute to a stable bipolar existence. If you continue to struggle with the disorder please be patient and do not give up.  There is good reason to remain hopeful. Many people with bipolar learn to cope and live quality lives despite the demons and depression.

My Cymbalta Withdrawal - Review of the Trilogy

I've blogged about my ongoing withdrawal from the antidepressant Cymbalta since I started tapering doses on March 20. In that time I've written three posts sharing my experience with the most recent being "My Cymbalta Withdrawal - Return of the Mind."  

This post is a review and summary of the first segment on my journey to 0 mg/day so far. But with a twist. I am inserting characters and adding plot that represents the Star Wars series.  Why not, right?

The Trilogy

1.  Withdrawal Wars. In "Withdrawal Wars" we find our hero, Duke Taperwalker, at the very beginning of the discontinuation process when he went down from 120 mg per day to 100 mg per day. We come to find out through the master obi-one-clinician that he needs to clear himself of the toxic antidepressant before he can begin to clearly access the Life Force.

Duke had high hopes since he has made it off several psych meds without invoking the wrath of the Discontinuation Syndrome. He's thinking Cymbalta withdrawal will go smooth and last less than six weeks or two months max. Our protagonist is not aware of the evil biopsychoneuropharmacology that lurks in the not-so-distant future. 

2.  The Syndrome Strikes Back. In "The Syndrome Strikes Back" post we find Duke eating a little humble pie.  The withdrawal from Cymbalta took a turn for the worse. He has been overpowered by the Dark Side and is experiencing severe symptoms from the evil warlord Darth Depression.   

It started at the beginning of the second week when they dropped Duke's dose to 80 mg per day. The psychmed rebel fighter began experiencing severe depression, which became mild by the end of the week. During the third week the depression became severe again, but this time worse than the prior week! And the fourth week was like the third. 

Even though young Taperwalker stayed at 80 mg per day, he continues to experience attacks from Darth Depression.  

So, we leave our hero devastated and trapped by the intensity of withdrawal symptoms. The Syndrome has regrouped and attacked with ferocity.  What now?  Where will this perilous journey lead him?
    
3. Return of the Mind. In "Return of the Mind" we find Duke pleasantly surprised and thoroughly relieved by the remission of Darth Depression. However, drug recon data and recent Cymbalta withdrawal symptoms indicate this is going to be a long and arduous process.

The episode starts at a point where the withdrawal from Cymbalta took another big turn. This time for the better! It is near the end of fifth week and he remains at 80 mg per day. Duke has actually had as much as six days in a row with only mild depression!!
It looks like the kid might be stabilized with intermittent, mild depression. He has remained in communication with his rebel leader psychiatrist, Dr. G, on a weekly basis throughout this withdrawal process. 

At the end of the fifth week the Executive Council of the Psychmed Rebel Alliance was convened to decide what to do next. Even though it was not clear what direction Duke's withdrawal symptoms were heading, the recommendation was to stay at 80 mg/day for a few more days and see what happens. It turns out that was a good move!

It is now the end of the fifth week of this episodic battle to get off Cymbalta. Duke Taperwalker has defeated the Discontinuation Syndrome once again!  His mind is clearer and his mood is significantly better. The psychmed rebels are enjoying an extended period of peace between the dark and light sides of the disordered universe. There is hope once again in the Pharma Galaxy!

What's Up Cymbalta What's Up?

I have had better moods lately because we paused the campaign to rid my body of Cymbalta. I've been at 80 mg per day for over five weeks now.

My psychiatrist wants me to stay at 80 mg for an unspecified period of time, but I'm wanting to press on, but respect for her recommendation resulted in a compromise. I agreed I would stay at 80 mg per day for four weeks and at that time evaluate my progress to determine whether to lower my Cymbalta dose or not.

Bipolar Wellness Plan - A Roadmap to Emotional Stability

Well, I planned on getting this post out earlier but ran into production problems. Specifically, I picked a topic that was over my head. I was writing about developing a wellness strategy for long-term, successful management of bipolar disorder.

My plan was to write a three part series of posts around (1) creating a well thought out bipolar strategy, (2) writing a plan that addresses elements of the strategy, and (3) implementation assistance. It makes sense to me. In my prior life as an engineer this is how we tackled all sorts of large projects and programs. The steps I would take to execute a large project/program were like this:

Step One - Strategy. A strategy is a set of related activities and actions designed to achieve a specific goal or achieve multiple objectives. The strategy document defines the issues, wellness elements, and directs you toward action required to successfully implement the strategy. It represents the "big picture" about how one intends to address a significant problem or run a new program. The strategy usually articulates goal(s) and purpose.

Step Two - Planning. Planning transforms the strategy into a series of steps that are taken to live a more balanced, healthy life. It is your map to achieving your strategic goals and objectives. It transforms goals into specific objectives. For example, using the goal of reducing depression symptoms, an objective could be to get the right amount of sleep and maintain the same sleep schedule every day.

Step Three - Implementation. Implementations assistance is key to realizing the goals and objectives previously defined in the planning and strategic documents. Implementation guidance is necessary for executing your plan from Step 2. For this step we used things like schedules, status reports, logs, and other tools to stay on course with what has already been planned.

After a few hours of researching and writing I didn't find much about developing a strategy for managing bipolar disorder. Hmmmmm. Instead I found that elements of a wellness strategy were being incorporated into health and wellness plans. In fact, there are books, programs, and training to help us make these plans.  So, I regrouped and decided to write this post about developing a Bipolar Wellness Plan (The Plan).

Bipolar Wellness Plan

A Bipolar Wellness Plan can put you in control of managing the disorder by providing a clear picture of how to take action that moves you away from disorder and towards order. It will help you create an environment that supports and prepares you and those supporting you for challenges along the way.

I used a helpful template from the Black Dog Institute to create my own Bipolar Wellness Plan. The Institute calls the template "MY WELLBEING PLAN to manage my BIPOLAR DISORDER."  I recommend it for starting your own plan. 

There are other cool things online.  The Black Dog Institute also has this introduction slide show called Staying Well with a Stay Well Plan.  

The Plan addresses several key areas including activities to maintain wellness, identification of things that could trigger a relapse of bipolar symptoms; and specific action items to take in the event of a relapse. It also identifies your medical team by name and number, 24 hour emergency numbers, current medications, and a medication contingency procedure.

Ideally, the Bipolar Wellness Plan should be discussed collaboratively with one's health professionals and friends and family that support you. I ran mine by my mother and good friend. They gave it a thumbs up, I think.

A Look Inside

I want to look at three of the components addressed in the Black Dog template: maintaining wellness, triggers, and relapses. 

The maintaining wellness section of the plan points the person towards seven areas: physical activity, sleeping, eating, alcohol and drugs, pleasurable activities, issues related to treatment, and other activities.  

I think "other activities" should be expanded. There are a lot of other areas that can influence wellness like relationships, spiritual, physical health, hobbies, stress and so on. I wrote down friends, family, my faith, hiking, and reading.  I think I will expand on this area.  

Triggers are important to be aware of. Triggers are external factors (e.g., environmental, psychological) that can set off an episode of depression or mania in someone. Stress, alcohol use, and ruminating about negative things are big triggers for me.

The section on relapses was straightforward. Simply put down what things you do that would be considered evidence of relapse and early warning signs of problems. I wrote excessive sleep, anhedonia, slow thinking, and withdrawn behavior are evidence that depression has returned.

Now What?

So, now I have an "approved" Bipolar Wellness Plan that should keep me stable when I get out of this 19 month (so far!) depression. The template recommends carrying a copy of the plan with you and giving it to all your health professionals and support people. I haven't done this yet. I'll put it on my list of things to do.

I was going to put my mostly completed Plan in this post but it is too big.  So if you would like a copy of my completed Plan shoot me an email at bipolarblogguy@gmail.com.

Bipolar Depression Nags and Ninnies

I am going to present here commentary about my thinking on the subject of depression. It is based on my understanding of our culture's view of bipolar disorder and psychiatric disorders in general. I also make the distinction between bipolar depression and other forms of depression.

Bipolar Depression

It is good to remember that bipolar depression is different from other types of depression. From my understanding bipolar depression is more severe, longer lasting (chronic), and treatment resistant than major depression. Mild, moderate, or most situational depressions pales in contrast to the intensity and duration of a bipolar depression episode.

Bipolar depression is a severe form of depression that has a biological component to it. This means that there are actual, physiological changes that occur in the brain when experiencing severe depression. Changes include things like loss of neuron connectivity, low activity in regions of the brain associated with emotion, problems with specific neurotransmitters (e.g., Serotonin) and loss of brain mass in certain areas.

Severe depression goes way beyond how one feels. It also includes adverse impacts to a person's energy levels, motivation, thinking ability (especially concentration and memory), sleep, and sense of self worth.

Because I have Bipolar Disorder I experience severe depression essentially by definition.  And let me tell you it can be unbearably severe.  At one point last year I went into an extreme depression that required partial hospitalization in a two-week outpatient treatment program.  That was a first.

Nags

We all have nags in our lives.  People whom existence thrives on pointing out our problems and reminding you of how you could do this or that to improve.  

Whether it's your mother or a brother from another mother, nags kill mood, start rumination, and piss you off.  Sometimes you will have to tell them to talk to the hand.

Exercise nags.  Everyone is harping about how beneficial exercise is for fighting depression.  Are they excited for good reason?  Well, yes and no.  The problem is exercise is truly effective, but only for certain depressions.

Exercise is known to help people with mild or moderate depression.  It can make a significant impact towards a successful depression recovery in these cases.  Exercise keeps them happier than a flea in a doghouse.  However, this is not the case for recalcitrant bipolar depression.

I find myself doing more exercise as I my depression lifts.  This is the opposite of what is believed.  I exercise when I feel better, versus exercising to feel better as with milder forms of depression.

Exercise as a means to reduce the severity of bipolar depression is mostly poppycock.  This website says otherwise.  However, based on my experiences with this monster, I have consistently found that exercise just doesn't provide much therapeutic value to the severe forms of my bipolar depression.

Diet nags.  After exercise, diet is the most well intended recommendation I hear. In addition to restricting bad foods from your meals, diet in this context includes natural and synthetic supplements that are part of a person's daily intake.

As with exercise it is my conviction that diet has only a limited effect toward bipolar depression symptom relief.  While losing weight and avoiding bad foods is certainly a huge health benefit, the ability for diet to significantly alter mood does not seem to occur with me.

As I write this I am on a pretty crappy diet.  I eat only once or twice a day and usually late at night.  It's been like this for the last couple of years.  Interestingly, as my depression began to lift over the last couple of months I have had the same poor diet.  I try healthier eating from time-to-time, but really don't notice improvements when in the pit of a bipolar depression.  I have similar experiences with dietary supplements such as St. John's Wort, 5-HTP, peppermint, green tea, and others.  I even wonder how much help I'm getting from my current supplements: NAC, multivitamin, fish oil, aspirin, Benadryl, and Provigil.

I've had this diet for many moons now, including the time I've spent in this bipolar depression (21 months).  It may be different for others, but altering my diet on my diet does not noticeably improve my depression symptoms.

Snap Out Nags.  A common myth persists that people should be able to "snap out" of depression.  They think that depression is merely a result of someone wallowing in their grief or sadness.  They believe it can be cured simply with just positive thinking and adjusting one's attitude.

This is nonsense.  Depression is a serious medical condition arising from biological and environmental factors.  It is not a sign of weakness, laziness, or self-pity. 

Depression is a psychiatric disorder of the mind arising from changes in brain chemistry, neural networks, and function.  It is marked by prolonged periods of unexplained hopelessness, profound sadness, lethargy, guilt, and suicidal tendencies.

Ninnies

Ninnies are those people who are completely clueless when it comes to an understanding of mental wellness and psychiatric disorders.  This unawareness often leads them to stigmatize, discriminate, and reject the notion that mental disorders even exist - despite all of today's evidence showing otherwise.  

Further, misunderstanding is perpetuated by exaggeration, inaccuracies, and misrepresentations of mental disorders.  The two main sources for a lot of people's information is the main stream media and the entertainment industry.  News media, social media, and popular websites often present severe disorders in a simplistic, violent-ridden, and deranged manner. 

Since they have no experience with severe depression, Ninnies love to impart their wisdom for relief from what they consider is simply the case of the blues.  Although they have the best of intentions, their simplistic understanding of psychiatric disorders leads to giving suggestions and advice that sound more like accusations, condescension, and hogwash. 

"But you have so much to be happy about.  Look on the bright side"  They have no idea that depression symptoms include a strong and persistent flow of negative, distorted thoughts, where everything occurs dull, meaningless, grey, and blah.  Severe depression generates apathy where expressions of concern, excitement, and motivation are conspicuously absent.  It can also lead to anhedonia, where there is a lack of ability to experience pleasure. Although I am grateful and thankful for the good things in my life, in the state of severe depression they are seen in a distorted light where all things seem meaningless, of little value, and guilt-ridden.

My bipolar depressions lasts years. Those around me know this. So, when someone asks a simple "How are you?", I sometimes can not believe what I am hearing.  Of course I'm feeling bad, I'm not well.  Of course I end up telling a lie that I'm doing fine just to avoid any more discussion about my depressed state.  

When it comes to understanding, the folks that ask this question are  not paying attention or something.  MLK said it best: "Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will." - Martin Luther King, Jr.

And then there's "I know how you feel." For most people this is b.s. plain and simple. Unless you are one of the 2.6% of Americans with bipolar disorder, you will have no way to relate to the depths and duration of bipolar depression.

I'm going to stop this post/rant. Something spurred me to write this and I'm not sure what it is. Until next time, live long and prosper.

My Cymbalta Withdrawal - Return of the Mind

This is my third post regarding the continuing saga of my withdrawal from the SSRI antidepressant Cymbalta.  It may be helpful to read my earlier posts on this topic: (1) Bipolar Treatment Update - Cymbalta Wars and (2) My Cymbalta Withdrawal - The Syndrome Strikes Back. 

Background

I have been on Cymbalta for six years.  It was added to augment Wellbutrin, my primary antidepressant, and improve treatment of lingering depression symptoms.

Although it worked for several years, I have come to believe that Cymbalta is no longer effective for me as an antidepressant.  It's known that antidepressants can be effective for a period of time (months or years) and then stop working.

Poop Out
  
A loss of effectiveness during antidepressant therapy can occur with most antidepressants.  A sustained, effective response from antidepressant treatment is not always achievable.  

Unfortunately, it's not fully understood what causes this so-called "poop-out" effect, or why it occurs in some people and not in others.  This effect could relate to the disease itself, pharmacological effects, or a combination of the two. 

Tapering - The Slow Withdrawal

I began tapering down from 120 mg/day of Cymbalta (a very high dose) on 3/20.  I dropped to 100 mg/day for the first week without significant problems.  

But when I went down to 80 mg/day at the start of my second week all hell broke loose.  It felt like a depression alien life form came and infiltrated my mind.  Since then I have had many days with mostly severe depression.  Not good.

Status

Well, my withdrawal from Cymbalta took another big turn lately. This time for the better! My depression has began to lift again. The intensity of my symptoms really dropped and since last Tuesday I've had mostly mild depression!! I remain in communication with my psychiatrist throughout this withdrawal process. We almost went back up to 100 mg/day at the beginning of last week because things were so bleak. On Monday we decided to stay at 80 mg/day for a few more days and see what happens.  It turns out that was a good move!
By the Way 

Adverse withdrawal effects and the discontinuation syndrome from Cymbalta are real.  They can be devastating to a certain percentage of users.  If I recall correctly this figure is in the 10 to 20 percent range.  Withdrawal effects are mostly overlooked by Pharma.  Because of this patients get taken by surprise when they try to get off the drug and experience a debilitating withdrawal process instead.

There are numerous papers, articles, and web sites that specifically address Cymbalta's under reported withdrawal effects.  Cymbalta Withdrawal Forums is a site I found helpful.  It used by folks dedicated to rooting out and addressing the adverse effects that can arise while getting off of Cymbalta.  Cymbalta Attorney gives you direct access to lawyers specializing in Cymbalta withdrawal and injury cases.  I'm sure they'd take my money, but I think I'll pass.  Cymbaltawithdrawal.net is another site that addresses Cymbalta withdrawal only.  It's not a good site but thought I'd include it for no specific purpose anyway.  

What's Next?

I will discuss my situation via email with my pdoc tomorrow.  Since things have lifted for several days in a row now she may okay lowering my Cymbalta dose some.  

I'm leaning towards remaining at 80 mg/day for another week to be safe.  This stuff is dangerous!  Also, we need to figure out how what the next tapering dose will be.  

Another 20 mg/day reduction in dosage is an overall drop of 25 percent.  Hmmm.  Maybe a bit much?  

How much would you decrease the next dose?

My Cymbalta Withdrawal - The Syndrome Strikes Back

Man, this has been a really difficult post for me to write.  I have been going through severe withdrawal symptoms (a.k.a. discontinuation syndrome by the medical community) from Cymbalta.  

The depression symptoms I experience keep me from writing.  My mind is dull and slowed with significant cognitive impacts.  Concentration, working memory, and attention is really messed up.  

I'm getting the “impending doom” type of anxiety.  It comes and goes.  I struggle to fight the barrage of negative thoughts.  Those suckers make the depression seem permanent, like it will never subside.  Fatigue, hypersomnia, and anhedonia (lack of interest, motivation, pleasure from normally enjoyable activities) are pervasive when my depression symptoms are this strong. 

The Situation

I have mentioned before that I am in the process of getting off Cymbalta.  It is the second of my two antidepressants.  I have been on Cymbalta for around six years.  It was added to Wellbutrin, my primary antidepressant, to help relieve lingering depression symptoms.

Although it helped my bipolar depression for several years, Cymbalta is no longer effective for me as an antidepressant.  It's well known that antidepressants can be effective for a long period of time and then stop working.  Unfortunately, it's not fully understood what causes the so-called "poop-out" effect, or why it occurs in some people and not in others.

Withdrawal

I discussed going off of Cymbalta with my psychiatrist, Dr. G.  She agreed and planned for me to taper off 20 mg/day each week from 120 mg/day (starting point) to 60 mg/day.  We would evaluate things at 60 mg/day and proceed accordingly.   

1st week (3/20-3/26).  Lowered dose from 120 to 100 mg/day.  Not much change except a little nausea.  Depression was similar to the week prior.  Depression was mostly mild during the week with a couple of moderate depression states.  

2nd Week (3/27 – 4/2).  Dose lowered from 100 to 80 mg/day.  Mood started okay but depression became severe by the second day (3/28).  Depression is moderate to severe for about two and half days at the beginning and mostly moderate to mild for the rest of week.

3rd Week (4/2 – 4/8).  Stayed at 80 mg/day.  This week was worse than the prior week.  I was severely depressed for four days in a row.  Depression began lifting on Friday night (4/6).  Certain symptoms are becoming stronger, like sadness and worthlessness.  Yuck. 

Status

I’m near the end of my fourth week.  The dose remains at 80 mg/day.  Like the two weeks prior I continue to experience days of severe depression.  This time it was five straight days for most or all of the day.  Today is Sunday and it seems like it finally lifting again.  I’m going backwards!   

Now What?

I’m sure glad we stayed at 80 mg/day.  It’s very likely the withdrawal effects would be worse if I had continued to lower the dose.   

I will email my doctor Monday with an update.  I’m not sure what she will say.  She may want me to go back up to 100 mg/day.

I’m going to bring up the idea of taking Prozac to control these Cymbalta withdrawal symptoms.  I’ve read this online in forums and articles.

One article I read today reports that Benadryl (dipenhydramine) helps with withdrawal symtoms.  I just started taking that today.

Summing It Up

Well, withdrawal from Cymbalta is not going as I'd expected.  I thought it was going to be without problems since I tolerate antidepressants well overall and I successfully got off Abilify several months ago.

Now I’m not sure what’s going on.  I just keep moving along.  I feel like Frosty the snowman when I tell myself “I’ll be back again someday.”  I will keep you posted as this perilous journey to de-Cymbaltanize myself continues.

Ketamine for Bipolar Depression Treatment

The debate continues over the best way to treat bipolar depression.  To a large extent, most of the antidepressants prescribed for bipolar depression are suspect with respect to their efficacy and tolerability.  

Looming in the background are a handful of emerging psychiatric antidepressants that demonstrate efficacy and rapid response time (hours or days).  I touched on this subject in a December post about seven novel treatment medications for bipolar depression.  In a post from last month I wrote about another potentially awesome drug, scopolamine.  I even tried it!

Meanwhile, the emergent drug ketamine has been studied in the scientific literature for the treatment of mood disorders.  Most studies focused on relief from major depressive order with only a few evaluating bipolar depression treatment.

Ketamine is a very rapid (as fast as 40 minutes) treatment for bipolar depression with acknowledged short term efficacy.  While its overall safety profile and tolerability seem positive, concerns about a few side effects (e.g., hallucinations) seem to persist.

Drug Background

Ketamine is used routinely as an animal tranquilizer and an anesthetic for surgery.  Unfortunately, it's also infamous for being used routinely in the recreational drug scene.  So, it comes with a bad rap to begin with.

The media recently published some curious stories about using ketamine as an add-on antidepressant for "difficult-to-treat" depression.  At the end of January NPR did a story about a severely depressed person's ketamine experience.  

I thought it glossed over the serious adverse effects. Also, this is an account of the experience of only one person who is not bipolar.  Bipolar treatment experiences are highly variable among individuals and unique for each brain.  Check out the story and you be the judge.   

The scientific literature affirms ketamine is a rapid acting and effective antidepressant.  And although the drug is well tolerated overall, some side effects still cause concern.  Potentially serious side effects reported are hallucinations, increased blood pressure, confusion, and respiratory stress. 

This is only some general information about ketamine.  If you want more facts and information check out my ketamine hubpage.

Ketamine Studies
There are dozens of scientific studies of ketamine going back 40 years.  However, most of the early studies were done to assess ketamine for use as an anesthetic during surgery, not as an antidepressant.

Fortunately, within the last decade or so there have been a good number of  studies involving ketamine for treatment of major depression, treatment resistant depression, and bipolar depression.

A recently completed trial showed a rapid and significant improvement in mood when using ketamine for bipolar depression.  It demonstrated rapid and significant improvement in depressive symptoms for the 79% of participants that responded to ketamine infusion.  Improvements remained significant through day 3.  The most common side effect was dissociative symptoms that occurred only at 40 minutes post-dosing. 

A 2010 study of 18 individuals having treatment-resistant bipolar depression found ketamine produced robust (71% responded to treatment) and rapid (response within 40 minutes) antidepressant effects from a single intravenous dose.  The researchers found ketamines effect of improved moods remained significant through day 3.   

Research in 2010 showed that multiple doses (6 infusions over 12 days) of IV administered ketamine (0.5 mg/kg over 40 minutes) administered to 10 treatment resistant, depressed individuals was robust (90% met positive response criteria) and tolerable.  Psychotic symptoms (e.g., hallucinations) were minimal and side effects are reported as generally mild.  However, three participants (30%) experienced "significant but transient dissociative symptoms."  Eight people relapsed between 6 and 45 days after ending ketamine treatment.  One had only minimal depressive symptoms for over three months! 

A 2006 trial used ketamine for treatment-resistant major depression.  The placebo-controlled, randomized, double-blind crossover trial concluded that ketamine is a rapid (less than 2 hours response time) and robust antidepressant when administered as a single intravenous dose.  The 17 trial participants were diagnosed DSM-IV major depression (treatment resistant).  Results show that 71% met response criteria and 29% were in remission (no symptoms) when measured the following day.  Also, following the trial 35% maintained a positive response for at least 1 week. 

Even with over 10 years of research on ketamine for treatment of depression, further studies are still required to better understand proper therapeutic dosages, administration methods, side/withdrawal effects, and other relevant factors.  There needs to be more data with statistical relevance (e.g., larger sample sizes) analyzed for treatment efficacy, tolerability, and safety.

Findings

1. Ketamine has established itself as a novel, rapid, and robust antidepressant with seemingly unresolved tolerability concerns;
2. Further trials are needed to substantiate earlier findings from some of the smaller studies; 
3. Additional trials are needed to investigate the possibility of using ketamine for longer treatment duration.  Specifically, the long term treatment that may be needed for effective acute and chronic bipolar depression treatment in some individuals;  
4. Clinical trials data is needed to develop dosing guidelines and administration techniques; and
5. A couple of side effects are still a concern, but otherwise ketamine is tolerated well.

Conclusion There are no safe and effective antidepressants available that have the rapid and powerful onset like ketamine.  We have scientific studies of the drug's mood changing effects going back over a decade.  It's not like ketamine is new to the block.  I think it's time to accelerate the advancement of promising treatments like ketamine. 

I'm not optomistic about ketamine's future.  Research and clinical trials are taking way too long.  It's reputation as a recreational drug doesn't help matters.  Ketamine could very well end up stuck in limbo between initial lab studies and your medicine cabinet    So, would you consider particpating in a ketamine study?  I know I would!  Take care friends and take your meds.

Bipolar Treatment Update - Withdrawal Wars

Changes are underway with my treatment plan.  I'm getting off of my antidepressant Cymbalta (duloxetine).  I've been on the drug for over 5 years now.  The reason for withdrawal is not for side effects, but for efficacy and safety concerns.


Cymbalta  

I've determined Cymbalta is no longer helping my bipolar depression.  And I recently discovered there are serious adverse effects from taking both Cymbalta and Wellbutrin (bupropion) at the same time, which I do.

I used an online drug interaction checker tool from Medscape.  It said "Serious - Use Alternative duloxetine + bupropion duloxetine increases toxicity of bupropion by unspecified interaction mechanism. Serious - Use Alternative. May lower seizure threshold; keep bupropion dose as low as possible.  Oh, my.


Psych Meds

• Cymbalta:  Remove.  Starting 3/20/12 I am tapering from 120 mg/day to 60 mg/day over three weeks (20 mg decrease each week).  Evaluate, then continue tapering until 0 mg/day.

• Lamictal:  300 mg/day.  No change.

• Wellbutrin: 450 mg/day.  No change.

• Xanax: 0.9 mg/day. Slight increase in use.

• Abilify: Completed withdrawal in December 2011.

Supplements

NAC: 2000 mg/day, started two months ago. Not sure of response really.  Will continue during Cymbalta withdrawal; fish oil - 300 mg/day; multivitamin; aspirin; and caffeine.


Additional Information

• Psychotherapy.  My therapy sessions are going well.  I go once a month.  This therapy gives me a clearer sense of what's really going on with me and I receive helpful feedback and insight.
• Withdrawal effects.  I am concerned about possible adverse effects from Cymbalta withdrawal.
• Supplement interactions.  Possible adverse health effects from supplements with psych meds.  I need to figure this out myself.

Conclusion

I am continuing to actively manage my medication treatment. I have some alternative/novel antidepressants I am interested in trying after Cymbalta withdrawal.  However, the pdoc is not so hot on it.  Something about side effects and hallucinations or something.

I am fortunate.  Because of high tolerance to psych meds I am able to use them and stop them with minimal adverse effects.  But who knows with Cymbalta?  This could be a protracted, agonizing period in my life like it is for an unfortunate percentage of those who suffer severe (sometimes debilitating) withdrawal symptoms.

I don't expect that, but then again this could be just the beginning of my fight against adverse withdrawal effects.  Could this be the start of "Withdrawal Wars?"