Cymbalta discontinuation re-triggered my apnea?

[absurdlyTired]

I described my situation in a thread viewtopic/t178037/How-to-best-get-help.html?start=15.

One detail I didn't mention was that I completed a gradual wean off Cymbalta on 9/1/19. Since then, I have been questioning my decision due to increasing depression and some anxiety. I kept telling myself that I should give it another month without it, and that I can always start back up again if I really need to.

I thought there was a chance that my abdominal discomfort and waves of nausea were also due to some kind of Cymbalta discontinuation. But on 12/15/19 my transitional apnea (can't fall asleep because I just stop breathing) started up again after 6 years.

I'm a complete mess, and don't know if I should just go back on Cymbalta. Could it hurt? Could going off of it have triggered my severe condition I find myself in?

NOTE: I realize I sound insane right now. I haven't been sleeping, and I'm on the verge of a panic attack. My head is full of fog. I'm a shell of my self.

[Julie]

Hi - did you go off the med with your MD, or on your own? It can take quite a while to do it properly without consequences and I think you should talk to him/her re this but be careful (unless he's a real 'sleep' doctor as well) about asking for Cpap advice at the same time as they may be tempted to give it and/or advice on both without necessarily understanding the connection, if any. I can't tell you (obviously) to go back on the Cymbalta... but possibly something in the interim while you're still 'detoxing' from it might bridge the gap. I will say that I don't know if it 'retriggered' your apnea so much as re-exposed it (might have been just knocking you out enough to hide it).

The abdominal stuff may still be aerophagia and nothing to do with the Cymbalta, but then again nausea is not a typical OSA problem, so both things could have coincided but you won't know until you get your Cpap working well again.

I''m sorry you feel so lousy and do understand, but I think it's important to not give up now (of all times, after all) on Cpap til you talk to your MD about the other thing.

Not to be a scold, but it is usually better to stick to one thread even if individual issues are different, so we can follow your whole story and try to help.

[absurdlyTired]

Hi - did you go off the med with your MD, or on your own? It can take quite a while to do it properly without consequences and I think you should talk to him/her re this but be careful (unless he's a real 'sleep' doctor as well) about asking for Cpap advice at the same time as they may be tempted to give it and/or advice on both without necessarily understanding the connection, if any. I can't tell you (obviously) to go back on the Cymbalta... but possibly something in the interim while you're still 'detoxing' from it might bridge the gap. I will say that I don't know if it 'retriggered' your apnea so much as re-exposed it (might have been just knocking you out enough to hide it).

I had weaned off it over a period of 8 weeks. It was tough (and my second time doing so), but I'm now completely regretting it.

I'm considering starting to take Cymbalta again tonight. I have to wait for an appointment from a sleep doc, and in the meantime, I'm unable to sleep or tolerate my masks and ASV/CPAP devices. I feel as thought I might be losing my mind. I'm feeling very, very unwell and hoping that the Cymbalta can at least take the edge off my emotional pain. I've lost 7 pounds in the past 2 weeks of extreme transition apnea.

Anyway, my concern now is that if I start Cymbalta (which take a month or so to really kick in) tonight, will I meet up with my sleep doc in a week or so only to have him tell me to get off immediately?

It can't hurt, right? I understand that SSRIs might have some negative effects on REM sleep. But at this point, there is no sleep happening.

[Julie]

No one here with a brain would advise you whether or not to restart or take any prescribed medication so you're on your own here, but IF I were you and had spent so much time and trouble going off it, I personally would see my GP or someone and ask for some milder med that you could try overnight to just keep the depression at bay and not (have to) go back on the other thing. You may even want to go to the ER if you feel that bad, but I'd be so careful about taking anything beyond a temp fix until you do see your psych or sleep doctor again... have you ever tried e.g. a small (1 mg ) dose of melatonin about half an hour before bed (not for depression as such, but to help keep you asleep)? I break those in half and still need time to 'wake up' properly the next day... though others do 3 mg, 5, 10 (not recommended!) etc. And maybe try a small swig of Diovol for your stomach (it seems to cover everything!).

[greatunclebill]

Cymbalta is not SSRI. Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) used for treating depression, anxiety disorder, and pain. I take it and have no adverse issues with sleep apnea from it. no reputable doctor would tell you to discontinue immediately. call the doctor that ordered it and tell him you quit and what a mess you've made of it.

[Julie]

He didn't make a mess, just followed the doctor's suggestion for weaning... and is scheduled to see the doctor very soon... but he feels like crap now.

[Chris8243]

This is my personal advice, NOT MEDICAL ADVICE.

1) TODAY: Call the MD who prescribed the Cymbalta, he or she definitely needs to get involved. Immediately. Going off an antidepressant and then falling apart needs to be adressed. TODAY. Explain urgency to whoever answers the phone so you can at least talk to the RN if not the DOC and explain the current situation. I think you need to ramp up on the Cymbalta similarly to how you had to wean off (but not exactly the same). No idea of dosages or timelines, but pretty sure you shouldn't go back to your full dose in one day.

2) Also call the sleep doctor! Definitely tell them what's going on. But they shouldn't give you "advice" about Cymbalta unless they talk to the prescribing doctor.

3) Get both doctors in communication so they can help you as a team - by calling each office & asking them to send your records to the other one. I don't know where you live or how easy or complicated that may be for you, in my situation it would be easy. I have a great Primary Care doctor who wants copies of everything whenever I see someone else so he has a clear picture of me and my issues. He is not the one who prescribed my antidepressant or anxiety meds, nor did he prescribe my CPAP but he knows about both.

As a person who also suffers from depression and anxiety, I haven't seen a correlation between my mood and my AHI. Good mood doesn't mean good night with CPAP or vice-versa. If I'm in a bad place and can't sleep, it's not because of CPAP.

PS - you don't sound insane, you sound worried and unsure what to do.

[absurdlyTired]

Thanks everyone!

I'm in a rough situation because:

a) As of now, I have no sleep doctor. The last time I saw my sleep doc was more than 5 years ago, so they won't talk to me without a referral from my primary. My primary has submitted a referral through their referral department, and after a hour on the phone it seems like they might not get around to contacting my sleep doc for up to a week. Then I need to make an apppointment (ugh).

b) I'm in MA, and keeping a primary care physician is a full-time job. I go through a new one about once every 6 months to 1 year. Anyone accepting new patients is here temporarily, and will move on shortly. Then, you need to go through the whole process of finding a new one. The original prescribing doc for the Cymbalta is 3 doctors ago. In fact, I have not yet even seen my current primary - only the nurse practitioner.

So, for now - I started Cymbalta this morning. I can't work with my current machines and masks. They leak, hurt, and are unbearable.
I'm not sure what else I can do other than to wait for a call to make an appointment.

[Chris8243]

You sound better today! I'm curious how you were able to get the Cymbalta Rx refilled, any prescription I get is for one year max. I would have never been able to keep renewing if a doctor didn't ok it.

More importantly, I'm so glad to hear you've at least got the wheels in motion for the sleep doctor. Will your Primary Doc see you about the Cymbalta/depression? Do you have a counselor?

I live in rural northwest Wyoming, very scarcely popluated. I love it. But this is not the place to be if you are seriously ill. Or have a heart attack, how long would it take an ambulance to get to someone? And I've had my share of doctors retire or move away, feels like a revolving door. Right now I am really, really lucky that I have a great Primary Doc who isn't planning to go anywhere. He is easy to contact and usually can get same day appt. I do have to drive 2 hrs to see a specialist (my psychiatrist & my sleep doc) and wait for appointments, but they are good and I like them.

Another person on the forum recently said they lived north of Boston and didn't know where to go for a sleep specialist. Years ago when I lived in the Boston area, I thought there were major medical centers there. Are your doctors moving because they are in teaching hospitals? Do you know why so many leave? Several of my former docs sent letters explaining that they were leaving and recommendations for who else to go to, with instructions on how to get my medical records from them. Maybe I live in a fantasy world, but maybe it's just good to live in a small town.

[absurdlyTired]

You sound better today! I'm curious how you were able to get the Cymbalta Rx refilled, any prescription I get is for one year max. I would have never been able to keep renewing if a doctor didn't ok it.

I still had my pills from when I had weaned last (ending on 9/1/19).

Sounds like you have an amazing primary doc.

(My understanding of why primary doctors are impossible to keep here is that it's a very densely-populated area with many great hospitals and schools. So, there are plenty of primary jobs available. Once a doc has been able to put in some time here, however, they are often more able to go where they want and practice something other than primary care. Overall, however, my understanding is that primary care is not a desirable place for many new doctors, as it's not as profitable, resulting in a general shortage.)