Hey everyone. I'd appreciate help deciding if I should reinstate or not.

I've been on Duloxetine for 4 years. I've mostly been taking it every 2 days (not recommended, I know). I've been tapering since February, and my most recent dose was 7.5mg. sexual side effects have been getting worse while tapering. I've been very inconsistent lately, taking my 7.5mg dose in intervals between 2 and 4 days lately (again, not recommended, I know). This led to a bout of severe emotional blunting. I spoke to my GP (He knows about PSSD), who strongly advised that I quit cold turkey from here. It's been 8 days since my last dose, and my only withdrawal symptom is pain. Random pains in my body, around 3/10 in severity. Sexual numbing has also been slowly worsening.

7.5mg is around 50% receptor occupancy, so not really a low dose. I've been reading about protracted withdrawal, and I've seen lots of cases where acute withdrawal is mild, but severe protracted withdrawal develops months later. I don't wanna risk that, so I'm thinking of reinstating.

On the other hand, I've put my body through so much with the fluctuating dose intervals, and I've already had over a week of starting to adjust to the absence of the drug. I don't know what I could be risking by reinstating. I could make the emotional blunting or sexual numbing much worse, or take longer to recover.

If I do reinstate, I would probably do a 1-2mg daily dose. It's a risk either way, so any thoughts or advice would be appreciated.

Welcome to the forum!

 

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40 minutes ago, bjossa said:

I've been on Duloxetine for 4 years. I've mostly been taking it every 2 days (not recommended, I know). I've been tapering since February, and my most recent dose was 7.5mg. sexual side effects have been getting worse while tapering. I've been very inconsistent lately, taking my 7.5mg dose in intervals between 2 and 4 days lately (again, not recommended, I know). This led to a bout of severe emotional blunting. I spoke to my GP (He knows about PSSD), who strongly advised that I quit cold turkey from here. It's been 8 days since my last dose, and my only withdrawal symptom is pain. Random pains in my body, around 3/10 in severity. Sexual numbing has also been slowly worsening.

Sorry to read how tough things have been for you. As you note, dosing inconsistently is a very bad idea. If your symptoms were worsening during your taper it is likley due to going too fast. Generally you need to taper no more than 10% a month and that is often too fast for those with very sensitive nervous systems. Holding to let things settle down is best. We suggest rating your symptoms out of 10, 10 being the worse 1 being mild, if they come in consitently 1-3/10 then this is your WD normal baseline from which you gauge your taper.

Tapering Information

 

43 minutes ago, bjossa said:

.5mg is around 50% receptor occupancy, so not really a low dose. I've been reading about protracted withdrawal, and I've seen lots of cases where acute withdrawal is mild, but severe protracted withdrawal develops months later. I don't wanna risk that, so I'm thinking of reinstating.

No you are right 7.5mg is a very large dose. We suggest tapering right down to 0.01mg before stopping.

I think RI is a good idea. It is your choice of course.

51 minutes ago, bjossa said:

If I do reinstate, I would probably do a 1-2mg daily dose. It's a risk either way, so any thoughts or advice would be appreciated.

As you have only been off 8 days you might want to just go back to your 7.5mg dose or perhaps half that dose. However you may wish trying a lower dose around 10% of your last dose to safe. It is up to choose what you think it best. Have a read: Reinstating an Antidepressant

If you need help working out how to make up smaller doses take a read here, we can help you if you need more assistance: Tapering Capsules That Contain Beads

In the mean time this is what I would do if I were you:

 

-Stay Hydrated 

 

-Eat a good clean whole food diet, avoiding processed foods and sugars.

 

-Stay away from caffeine, alcohol and antihistamines and any other psychoactive substances.

 

Supplements are to be avoided initially, as they often irritate our nervous systems. Try to get your nutrition through food.

 

Down the line, you may wish to introduce Fish Oil and Magnesium. Those who can tolerate them have found them calming to the nervous system. Be careful try one at a time and start low and see how you get on should you choose to try them.

 

A daily walk is very important as much as you can manage, if you can manage it. Gets you your fresh air and Vitamin D does wonders for your mind!

 

You are very welcome here and I hope you find the site supportive.

Do you really think that the worsening sexual symptoms could be a result of tapering too fast? Because I haven't had any withdrawal issues from tapering too fast. Strangely, while I was tapering, the sexual numbing would subside for a while after taking a dose, and then get worse over time until the next dose. I was thinking this is more of a PSSD indicator.

I'm worried about reinstating, because it could make PSSD symptoms worse. I've read cases of people only developing PSSD after going on and off their SSRI the second time.

55 minutes ago, bjossa said:

Do you really think that the worsening sexual symptoms could be a result of tapering too fast?

Certainly possible.

55 minutes ago, bjossa said:

Strangely, while I was tapering, the sexual numbing would subside for a while after taking a dose, and then get worse over time until the next dose.

They could be from being on the drugs themselves. I had this. When I stopped they stopped.

56 minutes ago, bjossa said:

I was thinking this is more of a PSSD indicator.

There are no indicators as to who would get sexual dysfunction after stopping an SSRI.

56 minutes ago, bjossa said:

I'm worried about reinstating, because it could make PSSD symptoms worse. I've read cases of people only developing PSSD after going on and off their SSRI the second time.

I would try to not label sexual dysfunction as PSSD, there is a lot of fear in the community about this term. I know some have these issues for a long time after stopping, however that can be true of all symptoms, so for me I tend to just think of sexual dysfunction as a symptom of WD rather than a seperate thing in of itself.

As with all of this we can't know if restarting the drug will make you worse or not, however you have been off a short time so the risks are much lower. If you try a low dose the risks are further mitigated.

I don't agree with saying that long-lasting sexual side effects are a symptom of withdrawal. There are many cases of people who tapered very slowly, and still developed severe PSSD, emotional blunting, and anhedonia.

In my case, sexual symptoms only got worse when I started tapering, which is a common occurrence for people who end up with long-lasting sexual issues

13 hours ago, bjossa said:

I don't agree with saying that long-lasting sexual side effects are a symptom of withdrawal.

That is ok, you don't have to agree.

13 hours ago, bjossa said:

There are many cases of people who tapered very slowly, and still developed severe PSSD, emotional blunting, and anhedonia.

Correct, I have seen many still have WD after stopping from a slow taper, who knows why, it is still WD.

I will say often when I see people who have bad WD after a taper they often come off too high a dose, or have tapered though WD symptoms or have a long history of kindling before they started their taper. Having at least some WD post taper is actually pretty common. https://www.survivingantidepressants.org/forums/topic/23081-are-we-there-yet-how-long-is-withdrawal-going-to-take/#findComment-492502

16 hours ago, bjossa said:

I don't agree with saying that long-lasting sexual side effects are a symptom of withdrawal.

Adele Framer, who started Surviving Antidepressants, stated openly that she had complete sexual dysfunction for the first 6.5 years of her 9 year withdrawal journey. It did resolve for her.

Personally, after taking it for 4 years, if you had no issues on the medication, I'd reinstate at a very low dose. Try to get stable, and then taper very slowly without skipping doses and rocking the boat. If you stay off, nobody knows how long those issues you mentioned will stay with you. Could be some days, weeks, months... Or years. Tapering for 5 months isn't too much time compared to the time on the medication.

I took escitalopram for 10+ years and never had sexual issues until I "rocked the boat". Tapered lowering and then skipping doses originally for a year with my psych, but I didn't feel anything off. Took antibiotics months later for h pylori, reinstated after 10 months free at minimum dose, reacted badly and fast tapered 3 months later in a week to "fix it". PSSD developed after 4 months off this fast taper, so by this time it was already too late to fix it. Still lasting to this day 8 months later, but the times I tapered correctly or reinstated, I had no issues when it comes to sexual functioning.

Edited July 14Jul 14 by ALonelySoul12