QUESTION: Female in her 50s, who is unfortunately one of the supposedly 1% who is suffering from lasting side effects from Cymbalta use. She only used the meds for a few months and came off them in Spring of this year. Right now I have her on basics for pyrrole disorder and undermethylation (zinc, Sam-e, B-6, methylcobalamin, anti-inflammatories, fish oil, probiotics, Vit D). I am working on a homeopathic for her case as well. I didn’t know until the patient kept impressing upon me that all her symptoms (anxiety, suicidal thoughts, extreme dry mouth) started after dc Cymbalta. She does have a hx of depression though and is borderline pyrolluric).
ANSWER: Your plan is good. I’d consider the isopathic preparation as well, and neurofeedback. And while not a high percent, the SSNRI class has odd withdrawal symptoms associated with it. In addition to what you are doing I’d add:
1. ACh support: Phosphatidylcholine 1 gram BID-TID with food and if OK then 2 grams TID with food for 1 month, then ramp down to 1 gram QD-BID. Taurine is a key for Ach but also for support of the GABA complex and to decrease anxiety. And B-5 (pantothenic acid) is co-factor I use 500 mg QD to TID minimum for 1-2 months.
2. Support the neurotransmitters SSNRI affects (Tyrosine in the AM 500 – 3000 mg) and Tryptophan or 5HTP (1-4 grams Tryptophan or 200 – 600 mg 5HTP) in the evening. (Dose the P5P you are giving in the evening with the Serotonin support). Due to the anxiety I’d start with the serotonin side and then add the DOPA-NE support.
The timeline can be another 2-4 months until things really settle down, but should progressively improve.
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