[35F] Experiencing fatigue, emotional lability, and headaches post-Duloxetine discontinuation

Question

With these symptoms, I have already had a Dr. Appointment and ran some labs. My labs came back with low Vitamin D low of 21, Low TSH with reflex to free t4 as 0.411, High B12 of 1543, Hemoglobin 11.4, High platelets at 432 and low monocytes as 3.9. I have been supplements with B12.

Patient Description

A 35-year-old female has been experiencing significant fatigue, uncontrollable emotions, irritability, and daily constant headaches in the forehead area since stopping Duloxetine about a week ago. The patient describes the emotional lability as being triggered by songs, leading to spontaneous crying, and a heightened irritability towards family members. This emotional state is described as being most intense in the afternoons. Additionally, the patient reports heart palpitations described as a fluttering sensation, occurring when lying down or sitting and changing the direction of gaze, accompanied by a small head rush. The palpitations and head rushes are described as having a severity of 2 out of 10. The patient also experiences tingling and warmth in the fingertips. The patient has been using a nicotine vape for over 6 months, with an average of 10 puffs or less a day. The medical history includes chronic back pain in the lumbar region due to multiple motor vehicle accidents since 2010. Current medications include Celebrex, ferrous sulfate, lamotrigine, with Tizanidine and Buspar taken as needed. The patient has stopped taking Duloxetine, which was previously part of their medication regimen, about a week ago.

Show More

Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions could potentially explain your symptoms:

  • Duloxetine Withdrawal: Duloxetine (Cymbalta) is an antidepressant medication that can cause withdrawal symptoms if stopped abruptly. These symptoms can include fatigue, headaches, irritability, and mood swings. It's generally recommended to taper off this medication under the supervision of a healthcare provider to minimize withdrawal symptoms.

  • Anxiety or Stress: Anxiety can cause a variety of physical symptoms, including fatigue, headaches, heart palpitations, and emotional instability. It can also exacerbate the symptoms of medication withdrawal.

  • Thyroid Disorders: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can cause fatigue and mood changes. Hyperthyroidism can also cause heart palpitations.

  • Anemia: Low hemoglobin levels can cause fatigue, headaches, and heart palpitations.

What you can do

  1. Consult with your healthcare provider: It's important to discuss your symptoms with your healthcare provider, especially since they started after you stopped taking duloxetine. They can provide guidance on managing withdrawal symptoms and can assess whether there might be another underlying cause for your symptoms.

  2. Monitor your symptoms: Keep track of your symptoms and any potential triggers. This can help your healthcare provider in their assessment.

  3. Practice good sleep hygiene: Make sure you're getting enough sleep and maintaining a consistent sleep schedule. This can help with fatigue and mood changes.

  4. Stay hydrated and maintain a balanced diet: This can help with fatigue and general well-being.

  5. Limit nicotine: Nicotine can cause or exacerbate heart palpitations. Consider cutting back on or quitting your nicotine vape.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe headache or a headache that is different from your usual headaches
  • Severe heart palpitations or chest pain
  • Difficulty breathing
  • Severe mood changes, such as feeling extremely depressed or having thoughts of harming yourself

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

Show More

2
 Hugs
9
 Comments

Save

9 mo ago

People Also Ask

What are common withdrawal symptoms from stopping Duloxetine?

Common withdrawal symptoms from stopping Duloxetine can include fatigue, headaches, irritability, mood swings, dizziness, and flu-like symptoms. It's important to taper off the medication under medical supervision to minimize these effects.

Can anxiety cause physical symptoms like heart palpitations and headaches?

Yes, anxiety can cause a variety of physical symptoms, including heart palpitations, headaches, fatigue, and emotional instability. These symptoms can be exacerbated by stress or changes in medication.

How can nicotine use affect heart palpitations?

Nicotine use can increase heart rate and blood pressure, potentially leading to heart palpitations. Reducing or quitting nicotine use may help alleviate these symptoms.

What are the symptoms of thyroid disorders that might overlap with my current condition?

Thyroid disorders can cause symptoms such as fatigue, mood changes, heart palpitations, and changes in weight. Hyperthyroidism may lead to increased heart rate and anxiety, while hypothyroidism can cause fatigue and depression.

Preview

Post

9 Comments

Leo#3962

9 mo ago

One of my friends is a primary care doc and has seen many of the symptoms you're describing when a patient abruptly stops an antidepressant medication like Duloxetine. The better approach is to gradually taper to reduce side effects.

I'm not sure if less than 10 puffs of vape is enough to explain your other symptoms but perhaps you're extra sensitive. Also the slightly low TSH is unlikely to explain much of what's going on.

1
 Hugs
Reply
Owner

Anonymous#5257

9 mo ago

My doctor did com to the conclusion that I'm having duloxetine withdraws. And these sx came up even after tapering. I was at 160 mg a day and then went down to 60 for a month. Then I started tapering 60 every 2 days for a few weeks until I took it out of my prescriptions. I'll never use antidepressants again. And my doctor seen with my lab results is that with low TSH and Low vitamind D. He is running tests for Graves disease.

1
 Hugs
Reply

Leo#3962

9 mo ago

I see. Did you feel like the duloxetine was helpful when you did take it? Sorry to hear about these pretty severe withdrawal symptoms and hopefully the lamotrigine alone works for you as a mood stabilizer.

Let me know if your Graves disease workup shows and I can ask my PCP friend what the standard of care is if you'd like a second opinion

1
 Hugs
Reply
Owner

Anonymous#5257

9 mo ago

I was taking the duloxetine more for a thereupeutic medicine for chronic back pain. I chose to quit because the long term effects that can possibly happen to your body. And I hope the lamotrigine does help with my mood issues. And yea I would definitely be interested in a second opinion. My doctor said High platelets and low monocytes isn't a concern. But that doesn't sound good to me.

2
 Hugs
Reply

Leo#3962

9 mo ago

The platelets are little on the higher end but some ranges say 150k-450k is normal so your doctor probably didn't think it was necessary to do much at your level. Also, the range for monocytes is typically 3-7 so again you are somewhat low but not in a range that warrants worry

1
 Hugs
Reply
Owner

Anonymous#5257

9 mo ago

That's what he kind of said. I understand but, I want to know if there's a way to fix those numbers, or if anemia could cause this or know why these numbers are like this so I can be proactive in my health. So it's hard to not worry. You know what I mean?

1
 Hugs
Reply

Leo#3962

8 mo ago

Yeah I totally hear you. Have you had anemia or any blood problems before? Otherwise would probably just be something to check up on in 6 months to a year.

1
 Hugs
Reply
Owner

Anonymous#5257

8 mo ago

Oh yea. I have issues with anemia. I'm taking iron now and I'm adding Vitamin D.

1
 Hugs
Reply

Leo#3962

8 mo ago

Did you end up getting any insights into potential Graves disease and your lab test questions?

1
 Hugs
Reply

Share your feedback

All Stories

Experiencing symptoms?

Our AI will conduct a medical interview and assess what might be happening. You can also make a post afterwards.

Share your feedback