My Husband is a Wreck After Taking Cymbalta as a Pain Treatment
Reader’s Question
My husband was put on Cymbalta last February by a pain doctor. He started at 30 mg, but by April he was up to 120 mg. Nine days later, he had seizures. The psychiatrist on rotation whom they then had him see had him back off the dose to 60 mg for a week, then from 60 mg to 30 mg for a week, and then tapered completely off. About a week or so later, the psychiatrist put him on citalopram starting at 20 mg and increasing to as high as 100 mg, but eventually to 80 mg by the end of April. By this point, he was having regular anxiety and panic attacks which I think were the result of the Cymbalta. And he began to have suicidal thoughts and paranoia, which I think were because of the citalopram. So now he’s on Effexor XR (venlafaxine). They want him up to 3 tablets of 37.5 mg, but he is now on two.
I’m wondering if things should ever have happened in this manner. My husband has never been depressed or had problems with anxiety or panic prior to being placed on Cymbalta. When we asked the psychiatrist if he could just come off all the meds to let his brain chemistry re-balance itself, he told us he must be deaf and swore he couldn’t have heard us ask that.
Any input on this would be appreciated.
Our Clinical Psychologist’s Reply
Q: Although Cymbalta (duloxetine) is primarily an antidepressant medicine in the class of Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs), it is also used frequently to treat pain associated with nerve disorders, pain associated with fibromyalgia, and chronic pain. Although a relatively rare occurrence, some patients can experience changes in mood, anxiety, panic, and restlessness after starting treatment with the drug, in which case its use is contraindicated. Because symptoms can worsen without the use of a different medicine, it’s not uncommon for physicians to recommend that someone not simply withdraw “cold turkey” from all such medications.
Citalopram (trade name Celexa) is also an antidepressant drug in the class known as Selective Serotonin Reuptake Inhibitors (SSRIs). It is not thought to inhibit the re-uptake of norepinephrine. Although again rare, some patients can experience some of the same disturbing effects on this drug that might have occurred with the use of the SSNRI.
Pain management — and regulation of brain chemistry — is not yet an exact science, and the state-of-the-art can unfortunately involve a substantial amount of trial and error. Unique patient characteristics can also complicate common practices in the administration of drugs. What jumps out at me more than anything in your report is the response you indicate you got from your treating physician when you sought to address these issues. It’s important that you believe your treatment provider understands your concerns, takes a variety of factors into account, and has the breadth of expertise necessary to sift through all the viable alternatives for patient care in order to find the best match for your needs. If you believe you’re not getting that kind of care from your present doctor(s), by all means, seek another opinion — but be careful not to self-direct treatment or tamper with existing treatment without the advice and counsel of a reputable doctor.
