A randomised, placebo-controlled, double-blinded trial of duloxetine in the treatment of general fatigue in CFS, 2014, Arnold et al. Cymbalta

My GP tried to get me on Cymbalta several years ago and I remember she was very unhappy when I refused to take it - I've never regretted that refusal. My research suggested it was one of the worst drugs for prolonged withdrawal problems, was incredibly addictive, and had enormous numbers of side effects.

https://rxisk.org/top_100_reactions/duloxetine/

https://davidhealy.org/a-symbolta-of-sorts/

 

Cymbalta is commonly prescribed for management of neuropathic pain, so it's not surprising to me that it would reduce "pain" in ME/CFS and with less pain one might be able to sleep better, hence less fatigue. Probably little useful to treat the core pathology in ME/CFS though. And yes, Cymbalta has withdrawal problems, but if there is a treatment that works I would be on it for life and wouldn't need to withdraw from it, so I never understood this argument.

 

I was prescribed Cymbalta. It was a horrible experience. I found it almost impossible to stop due to withdrawals. 18 months! The worst symptom for me was a short intense feeling of only what I could describe as vertigo. Suppose that's what some people describe as 'brain zaps'. Constantly feeling travel sick.

I'm at a point now, of desperation but personally I wouldn't do it again. That's only my experience but I would caution anyone who would consider Cymbalta, be aware.

 

I've tried it among a list a SSRIs and SNRIs I've tortured myself with in attempts to get better. I've always been completely clobbered by side effects even at minimal doses. No benefits.

I would agree but....

It isn't unknown to get to the optimal dose of drugs like this, have some improvement in pain, sleep, etc., but then find the drug stops working for you. A situation can develop where you simply cannot tolerate any increase in dose, the current dose doesn't work and you have great difficulty weaning off it.

This happened to a friend with ME. Admittedly it wasn't Cymbalta, but it was a drug I had tried and couldn't tolerate. I was quite envious at first but then it stopped working for and she went through hell trying to get off it.

It's not really advisable to keep taking a drug that doesn't help you anymore, as any side effects that may have been worth it are now an additional burden. It might also increase the likelihood of problems with drug interactions or complications further down the line.

 

I won't take any antidepressants of the newer variety (SSRI, etc). I tapered off Paxil too fast and it provoked a type of mania (not meeting the threshold of mania, but still very weird and disconcerting to those around me and me, also), according to a shrink I consulted.

I have primarily fibromyalgia pain or some sort of initially thought to be auto-i
immune disorder induced pain. Don't need anything that is stimulative mentally.

Edit: Dr. Leslie Arnold has done many clinical trials with this drug. Ad nauseum?

 

All of the other findings they they are claiming are "statistically significant" don't survive corrections for multiple comparisons (meaning if there is an effect, that effect is weak).

 

sci-hub: https://sci-hub.tw/https://www.sciencedirect.com/science/article/abs/pii/S0033318214001935?via%3Dihub

With just one treatment group that is receiving 'flexible dosing', I would be worried about the efficacy of blinding. I would think this would call for a dose-response design.

Maybe more importantly, I thought antidepressants were a well-known dead-end in ME/CFS? Other than for the important use of treating depressed patients' depression; and maybe insomnia, or possibly pain, depending on the particular drug. Goodness knows how many patients have received various antidepressants over the years so I have to think we would have gotten on to it one of them was particularly effective.

 

Not necessarily a dead end—TCAs can modulate T cells— see this thread

https://www.s4me.info/threads/an-in...ne-and-nortriptyline-2019-conroy-et-al.13031/

 

They probebly are right but looking at the wrong substance.

 

I wish such a lifelong treatment could be found! In my experience, our bodies change and can become intolerant of drugs over time even if they still work to some extent. As we age some are more risky as well. I have yet to find more than a couple of drugs I can take long term (so far) and not find in the end I am better off without them, despite a good start and often a few years of usefulness.

also, as I understand it (and from unreferenced websites) drugs like this deplete vitamin and minerals which we need, often for the very problem they treat. So they can cause problems that way long term.

After decades of being pushed drugs, particularly anti-depressants in the early years, I now try to take as little as possible. I wouldn’t take anything for “fatigue “ as I agree, there is no understanding of the mode of action or cause of this nebulous symptom. Also I can cope with it more easily than pain, or POTS symptoms, which are more difficult.

after greatly reducing gabapentin and having a very hard time with the withdrawal I wouldn’t touch Cymbalta, personally. I just hope my pain stays manageable and I don’t have to try more drugs.

 

Which begs the question, what is the right substance? Or more appropriately, how would we find out what the right substance is?

 

Looking at what happened with the animals after the mysterious chronic infection was brought in I would say look at the neurotransmitter achetylcholine and receptors.

As the allosteric a7nicotine achetylcholine receptor modulator was the med to treat the animals with and it also saved my live and still helps me I would say start there. It not only eases the pain within 10 minutes but also calms my brain.

 

old thread about this trial https://forums.phoenixrising.me/thr...led-double-blinded-trial-of-duloxetine.35478/


they carefully picked 60 patients out of 600 over 6 years

 

I think these "experts" are just making it up as they go along. How many people have ever had levels of neurotransmitters measured? Most people would assume that the brain is somehow involved in cases of depression, so how are neurotransmitter levels measured in the brain? And if this measurement could actually be done reliably, I wonder who decides what levels of neurotransmitters are proof of good mental health or poor mental health, what mix of levels is good or bad, and whenever people in medicine, conventional or alternative, start talking about balance I always suspect they are talking bollocks because they rarely, if ever, mention what they are balancing with what.

 

A short article on the subject of "Cymbalta Discontinuation Syndrome" under the heading of "Pain Management", written by an MD :

Link : https://www.healthcentral.com/article/cymbalta-discontinuation-syndrome

 

I tried stopping venlafaxine abruptly and had an awful discontinuation syndrome so I had to reinstate some of the dose. Interestingly I stopped duloxetine abruptly as well and didn't have any problems. As far as I know these drugs have similar structure so (just a suggestion) I might have adapted to duloxetine by taking venlafaxine. Or maybe it matters that I was taking venlafaxine just 2 months but duloxetine for a whole year. Anyway, duloxetine didn't help with fatigue.