Swapping meds

[Boombod]

I am currently taking escitalopram it isn’t working docs have changed my medication to duloxetine and said I can do a straight swap I always thought u taper off one then start another . If I have to taper does anyone know how to that and for how long I was on 15 mg I have been on 10 mg since tue I don’t know how long to stay on that and move down to 5 mg for how long ?

[LisaSnow FMA UK Volunteer]

I think it is better to follow the advice of your doctor and not others' experience or opinion from the internet. After all, your doctor knows your health better than any of us.

[Suze]

Hi. You might find it helpful if you search for the Facebook group called 'Cymbalta Hurts worse'. They teach the proper way to taper, following the Ashton protocol. Unfortunately, doctors have little to no idea how to do a safe taper, and it can cause awful withdrawal effects. Good luck. 🙂

[LisaSnow FMA UK Volunteer in reply to Suze]

Escitalopram is a serotonin reuptake inhibitor, whereas duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor. They are two different drugs that affect a brain modulatory pathway through slightly different mechanism. OP was asking about Escitalopram not Cymbalta, and doctors do know about the withdrawal side effects and tapering strategy (which isn't applicable in this case). On average, medical doctors see more patients in one week than what average pain patient see in five year. I am sure medical doctors have learned, seen and heard about the risks and side effects.

Just to add that Ashton protocol was developed to treat benzodiazepines abuse (a class of drug that is highly effective for anxiety but also highly addictive). Neither escitalopram nor duloxetine belongs to that class so even though sudden stopping of them could cause discomfort and tapering should be done under the supervision of the prescribing doctor, the degree of consequence is not comparable to that of benzodiazepines.

[Suze in reply to LisaSnow]

I am fully aware of what the OP was saying! However, all of these drugs DO have an effect on the brain, to some extent, and abruptly swapping to another medication (bridging) CAN (and frequently does) cause people to feel extremely unwell! There are 28k+ members in the group I mentioned. Very few of those people, have ever been told any correct way to taper by their doctor, and are now in PAWS (some of them have been, for 6+ years). Yes, I did know that the Ashton Protocol was developed for the prupose of weaning patients off of Benzo's. However, it has been adopted for tapering off of other medications too. Duloxetine (Cymbalta) being one of those medications. Oh, and yes, the FB group mentioned may be '...off the internet', but, it's a group for REAL patients, with real experiences, and many of them have Fibro. It's sad so many people are so dismissive of things that they don't feel are 'the norm', because Doctors are not always right. And ultimately, you either have a good Doctor, or a bad one. Only the OP will know which kind of Doctor she has. And I wish her all the very best.

[LisaSnow FMA UK Volunteer in reply to Suze]

I agree with you that all.of the drugs have effect on the brain and that is how they help pain sufferers to feel better. I encourage you to not be so pessimistic and assume anyone's doctor is "either" good or bad (Black and white thinking). We all wish others to feel better, but the fact is that none of us is qualified to instruct another HOW and WHAT to take for their symptoms. It is rather dangerous to assume you know what is medically best for a person on the internet, even more than his/her doctor.

[desquinn Partner Volunteer FMAUK Trustee]

Best to follow gp advice. Direct switch is an option under nice cks.nice.org.uk/topics/depr...

But as others said the GP will have lots of experience of this scenario and be able to support you

[Boombod]

Than you all for your advice