Why Cymbalta Makes Me Nervous

Okay, so by now you know there is an issue with my meds at the moment.  This post is partly for anyone who is interested in Cymbalta and partly to help organise my thoughts for the doctor tomorrow (today).

Firstly, of course, there is the whole serotonin syndrome thing:

If you have some or all of the following symptoms you may have something called serotonin syndrome: feeling confused, feeling restless, sweating, shaking, shivering, hallucinations, sudden jerks in your muscles or a fast heartbeat.

It then continues with the following symptoms; which may or may not also be symptoms of serotonin syndrome or not.

• stick neck or jaw muscles (lockjaw)
• fits or seizures
• mood of excitement, over-activity and uninhibited behaviour
• aggression or anger especially after starting or stopping taking this medicine.

You may need urgent medical attention.

But wait!  There’s more!  (And I don’t mean a free set of steak-knives.)

Glaucoma:  I don’t have glaucoma, that I know of.  (I really need to get that tested.)  But my Mum does.  And my brother.  I am nervous about taking a medication that could cause it.

Liver damage or failure:  Okay, noone really lines up to ask for this one.  I wouldn’t be too concerned at the moment normally as I do not drink (still breastfeeding S4 and F1) and as far as I know, my liver is pretty healthy (despite it all.)  However, elsewhere it talks about skin rash as a sign of a sick liver.  Go to the Accident and Emergency of your nearest hospital if you have itching, skin rash or hives.  I have had the most horrendous skin rash.  It started on Sunday 5th August.  It lasted until a few weeks ago.  (Coincidentally when I stopped taking my old meds?)  All over my legs, my arms and the trunk of my body.  It was so itchy that I couldn’t sleep and it often had me in tears.  Now my legs and chest are covered in scars.  I still have itchy, broken skin on my abdomen.  I don’t normally get rashes like that.  It was just too hard for me to get to a doctor about it.  It also says flu symptoms are a sign.  I thought I was fighting another seasonal bug, but maybe that is not what the recurring aches and fevers were about.

And, actually, it IS concerning to be taking something daily that puts your liver into such a tenuous situation that a big night out could wipe it out.  Not that I get big nights out.

Suicidal tendencies: I am not suicidal.  But suicide is a real and rather nasty side effect of some medications for some people.  I am a suicide-survivor, thank you Aropax.  I know that I am so glad I survived, not just because I am here now, but because in that moment that I stopped taking the pills, I won the war.  I do not want to go there again, and I am petrified to have that control taken from me.

Restless Legs:  @#%^ restless legs!  Restless legs drive me crazy.  It came on in a big way when I was pregnant with H6 and has got worse since.  I do not need to take something that has this as a possible side-effect!

Of course, there is the usual list of a thousand possible side-effects, the ones we are all used to seeing.  Of these, there are a few that bother me:

• sleeping issues – drowsiness or insomnia or weird dreams.  Take your pick.  They are all there, and I get them all.  Yick.
• anxiety/confusion – isn’t this part of what we are treating?
• and many, many more, but these are all the mild and short-lived ones, and generally speaking, I don’t bother with them if they don’t bother with me.

You know, in my gut, I just know this is not for me.

Serotonin Sickness

Have you heard of this?

I have just had the strange misfortune to find out a little about it.  It makes me wonder, why, when I have been on SSRIs for the better part of the time since 1993 (Wow.  Nearly 20 years.) noone has felt the need to discuss this with me previously.

So the story goes something like this.  I was in the stage that I term my pre-crash “euphoria”, for want of a better term.  It is this stage that has made me wonder about whether I might have a low level bi-polar illness.  I was upset, because I know that there is a crash coming, even ‘though there appears to be nothing wrong, and there is nothing I can do about it.

I had an appointment with my new psychologist during this time.  (When I say “new” I mean she is new on the team this year.  8 months is new when compared to 19 years.)

She asked me to describe what happens.

Firstly, I start to get more energy.  This is a good thing, because I spend so much time flat.  This extra energy and the things that I can achieve with it give me an excitement, a renewed vigour.

The next stage, the energy starts to get out of hand.  I start to stay up late at night (typically to 1 or 2am) doing stuff.  At first this is great because I get so much done.  Sometimes even housework!

But then the insomnia hits.  I am tired.  Exhausted.  And yet, I still cannot go to bed.  If I do, then I can’t sleep.  I am no longer excited and energetic, I am just plain agitated.  And cranky.  In the past I have generally blamed the insomnia for this.

During this stage, it also becomes increasingly difficult to take my medication.  I will go for weeks only taking it sporadically, if at all.

Finally, I crash.  I edge closer and closer to that cliff until finally over I go down into the whirlpool.  I hit the depression spiral, and well, you know about that, I am sure.

It has taken me a long time to figure a lot of this out.  The cycle is so long, it is hard to remember details from time to time.  This time, I was able to talk about it with someone who could ask probing questions.  This was her take on events:

I get a build up of SSRI in my system.  The side-effects get out of hand.  Being well in tune with my body, I am unable to take my meds (my body wants to avoid any more of the “poison”).  However, while I am detoxing from the side-effects, I am not getting the therapeutic benefits that I do need, and therefore end up crashing.

I had never heard of this concept of the build-up in the system causing negative side-effects over time.  (Fortunately for me, my psychologist has worked in hospital teams for many years and has been part of the medication programme.)

So I had to head back to the GP for a med-review.  My psych had suggested getting a referral to a psychiatrist for this, but to be honest, I didn’t know if I could cope with the multiple doctors (and the babysitting required), so I was happy when my GP decided to do it himself.

Sort of happy, anyway.

He has prescribed an SNRI for me.  I am really not sure about it.  My concerns about the new medication are a whole separate post.

Back to the serotonin sickness.

As I read through the PIS for the new medication (Cymbalta), amongst all the other alarm bells ringing, I notice this:

If you have some or all of the following symptoms you may have something called serotonin syndrome: feeling confused, feeling restless, sweating, shaking, shivering, hallucinations, sudden jerks in your muscles or a fast heartbeat.

It then continues with the following symptoms; the poor punctuation left me unsure if they are also symptoms of serotonin syndrome or not.

• stick neck or jaw muscles (lockjaw)
• fits or seizures
• mood of excitement, over-activity and uninhibited behaviour
• aggression or anger especially after starting or stopping taking this medicine.

You may need urgent medical attention.

Now, I looked at that list and thought for about thirty seconds.  Then I read the list more slowly.

• feeling confused – well that is part of depression and anxiety, isn’t it?  It certainly is for me when I am suffering insomnia.
• feeling restless – well that is certainly part of the pre-crash euphoria
• sweating – yes, well.  The night-sweats of late have been awful.
• shivering – just figured that this combined with the sweating meant I was feverish and fighting a bug
• shaking – uh-huh, uh-huh.  Thought I was tired from the insomnia
• hallucinations – well not terribly; just that seeing things move out of the corner of your eye thing.  Doesn’t everyone get that when they are over-tired?
• sudden jerks in your muscles – not often, but I get a bit tic-y occasionally.  Like last Saturday.  And then there is the restless leg syndrome…
• fast heartbeat – oh, again, like Saturday.
• stiff neck and jaw – Here’s the thing.  I was in a car accident in 1993 and did considerable soft-tissue damage to my neck.  It flares up from time to time.  Like recently…
• lock-jaw – well, not lately.  But I spent a fair bit of time being treated for it – since I have been on Lexapro.
• fits and seizures – you mean there is something on here that I haven’t had lately?
• excitement, over-activity and uninhibited behaviour – um, excitement and over-activity… isn’t that how I described the euphoria?  (Not uninhibited behaviour, ‘though.  Apparently, that is how we know I am not bipolar.)
• aggression or anger – and I thought it was just progesterone!

I did a little snooping on the internet.  I don’t like to self-diagnose, or use the internet as a doctor, but there is enough to make me think. Enough to make me cross that no medical professional has told me about it, especially when I have discussed and questioned the way I was feeling.

You know, people die from this?