Doing a cross taper that my psychiatrist says is fine, but still worried.

[Bearsfan0909]

I’m tapering off of 60mg of Cymbalta onto Zoloft. Went down to 50, 30, now 20mg of Cymbalta with bad withdrawal symptoms, mainly irritability and depression. Started Zoloft at 25mg yesterday. So currently I am on 20mg Cymbalta and 25mg Zoloft. I will stop the Cymbalta in about a week.

Right now I just feel funny. I feel jazzed up and tense. I know taking combos of these drugs can cause serotonin syndrome, and I’m freaked out about that.

Can anyone shed some insight? Would it be unlikely for the lowest doses of both these drugs to cause it? Would it have already happened since this is the second night I’ve taken both? Just super worried, and I know that can be anxiety, but still feel pretty odd.

[Paxiled]

There are different opinions on this.  Mine is that one should successfully complete tapering off of a medication before starting another because when you're doing what you're doing, you're on two drugs at the same time and can't tell what are the start-up side effects of the new drug and what are the withdrawal effects of the old.  Withdrawals are very individual, as are side effects of starting a new drug -- people are just very different and the same person can have wildly different experiences from even very similar meds.  I didn't make this up -- I learned it by doing my own research several years ago when I had a bad problem going and my psychiatrist wasn't being at all responsive (or even making sense).  But most psychiatrists have general tapers they use on everyone -- it's just easier for them to do that, far easier than having to spend the time to follow up with each patient to see how it it going.  Often as well patients don't tell their psychiatrists they're having a problem.  When my current psychiatrist took me off Celexa she wanted to start me on a new med as she tapered me off the old, but I told you no way and she agreed readily to do it my way -- she really didn't care that much as long as things went well.  The class of meds Cymbalta is in are all some of the most difficult to stop taking for the most people, especially Effexor, and so it just makes sense to me to make sure you've successfully stopped a drug before moving on.  After all, you're not going to be on that drug anymore anyway, you are going to stop taking it, and there's really no reason to rush onto a new drug.  Serotonin syndrome is very rare, and so probably not the most important factor here, but you know, that's small consolation to those very few people who get it.  Your Zoloft dose is quite low, though, so it's not the most likely problem.  That is if you get a bad withdrawal from the taper off Cymbalta that lasts a while.  When that happens, the way to fix it is to go back on the last dose at which you felt fine and taper off more slowly at a pace that suits you, not a pace that suits someone else or suits your psychiatrist.  The time to stop the Cymbalta is the time to stop it -- not a preset time but the time it seems you're brain is adapting well and you're ready to see how that turns out.  Bad withdrawals, particular the ones where you get new emotional problems you never had before, can start after you completely stop a med and even weeks afterward, and again, the fix is to go back on it and try again.  You can't do that if you're now on Zoloft, which is not just a different drug but a whole different class of drug.  Now, this is my opinion --doctors do it other ways, as you're seeing.  It's up to you to choose what you feel is best because most doctors want to push the speed of this stuff because most people do okay and they're trying to see as many patients as they can within the constraints of insurance company policies and their own preset determination of how much money they intend to make each year.  But again, you get to choose, not them.  Now, you've already started on the path your psychiatrist believes in, and hopefully if you continue you'll do fine.  I just believe in playing it safe when it comes to medicine given this isn't a life and death situation.  You no doubt have your own opinions.  Whatever you choose to do, I hope it works out exactly how you wish it to.

[Bearsfan0909]

Wow, what an answer! First of all, thanks so much for taking the time to write this out.

I think, as of now, my opinion is this. When I was simply on cymbalta I basically felt as if it was a life or death situation so far in 2018. I developed severe OCD due to life changes I believe, and everyday was very hard to live. I was on Zoloft for 10 years before, and felt great. It was only due to body issues and my mother getting involved as I was still under 18, that I got switched to cymbalta without me really caring as I was feeling fine anyways and just listened to the "adults". Well, as I've grown up a good bit now I've obviously learned what works for me, I've taken control of that and decided to get back to a medicine that worked with me. So, I think, since the risk of serotonin syndrome seems pretty low, I will slow up this taper a bit. I was thinking of taking 20mg for only 6 days then stopping because of my worry of serotonin syndrome, but I'll actually go back to what my doc recommended. I'll take that for a week - or longer - then take it every other day for a while.

And I'll play it by ear, but my doc says that taking Zoloft as I'm coming off should help, so I'll listen to him on that one especially since I did well on that before with no side effects coming on or off.  And also he sees over 1300 patients and I just switched to him as he is one of the most regarded psychiatrists in my area, and he says he's only had 2 or so cases of serotonin syndrome. And my previous psychiatrist said he had never seen one case in his 40 years of practice. So I will take solace in that, and slow up a bit.

And if I run into more severe problems I will modify a bit and go back to what you said.

Thanks again.