Posted by bleauberry on November 10, 2007, at 19:31:50
In reply to weaning from cymbalta to start zoloft, posted by meAgain on November 4, 2007, at 23:15:18
I have seen clinical studies at pubmed, and I have done it myself, where one ssri or snri was tapered to another. While decreasing the dose of one, start very low doses of the new one. By low, I mean cut the tablet into small custom chunks, or dump out capsules to count the beads or to divide powder into piles...don't just take whatever the smallest size you can get at the pharmacy is. Too much risk of serotonin syndrome or adverse effects when combining two meds that do similar things.
That's how I've done it anyway. In the clinical studies I saw they simply stopped one and started the new one the next day. While you are lowering the dosage of one drug, start introducing the new one. Reduce the old one at a more aggressive rate than the rate of introducing the new one. In other words, get off the old one as fast as you can tolerate, but don't be in the same hurry to get the new one up to desired dose. Go more cautious with it. Even just having a little bit of it in there will buffer things a lot and make the transition smoother. Too much though and you could feel lousy. If ever in doubt, back off for a few days to stabilize and then resume.
The most common protocol though is to wash out the old drug for at least a week or two before starting a new one. In my experience if you do careful cross-tapering, that is not necessary and only causes avoidable suffering.
Regardless, don't get your hopes too high. I mean, yes, cross tapering does reduce the side effects of withdrawal. But you also have the new side effects of the new med mixed in. It is a strange transition with new feelings you haven't felt before. But, the overall discomfort for me was distinctly less than just stopping a med completely before starting another.
I cross tapered off cymbalta onto lexapro with not much discomfort at all. On another go of cymbalta I cross tapered off of it onto zoloft with dramatic relief evident even on the first day of introducing zoloft (in terms of anxiety relief).
poster:bleauberry
thread:793369
URL: http://www.dr-bob.org/babble/wdrawl/20070929/msgs/794329.html