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I know you're not doctors, but I certainly respect the obvious expertise of many on here. Here's the situation:

I started on Cymbalta 30mg, along with Abilify 1mg daily on Sept 15. Initially, things went well. I began doing things around the house, and saw some hope for the future. About 3 weeks in, anxiety reared its ugly head. After some debate, pdoc stopped the Abilify-no change in anxiety. So, we went back on Abilify 1mg daily and upped the Cymbalta to 40mg daily, against my better judgement. Anxiety soon went through the roof. I wanted off the Cymbalta and Abilify, maybe try Zoloft. Pdoc was pissed, said I wasnt giving it a fair shot. So she dropped the Cymbalta back to 30mg and upped the Abilify to 1mg BID. All this happened within about a 6 week period. I also have Xanax 0.25mg PRN, but was VERY sparing with that.

Within a couple of days, I felt the afternoon Abilify was increasing the anxiety, so I quit it, but still took the AM dose. I was also driving gdoc crazy, with frantic phone calls, office visits, and hysterical crying. He and pdoc talked, decided I am my own worst enemy, and told me I had to stop being a nurse and become a compliant patient. We kept the Cymbalta at 30mg, with plans to increase to a more therapeutic dose of 60mg, and back on the Abilify 1mg BID. Also, I was to be liberal with the Xanax. I complied, and began feeling just a smidge better, nothing to brag about.

This past Wed at pdoc visit, I meekly asked why we would want to delay the reuptake of Norepinephrine in my system, when I was already so full of Adrenaline. (Pdoc keeps saying, "Cymbalta is a good drug!"). Well much to my surprise, she said we could try Zoloft. I dropped to 20mg of Cymbalta that evening, and was to begin Zoloft 25mg daily the next morning. I took the 20mg of Cymbalta since Wed, but decided to wait until today to start the Zoloft as I was working and didnt want to have a bad reaction.

The VERY NEXT DAY after going down to Cymbalta 20mg, I felt at least 50% better anxiety-wise. I dont think it's psychological, because I was expecting maybe some withdrawal before things got better. I felt better Fri, as well.

Today I took the first Zoloft. Within an hour I began feeling foggy-headed and nervous. I can tolerate it, as long as I know these are start-up side effects. My questions are:

1. How likely is seratonin syndrome? Pdoc says highly unlikely, since I'm on low doses of both.

2. Is the response I'm feeling to the Zoloft unusual with a new drug? I'm also having skipped heart beats, which I get from time to time from anxiety, and I dont know if it's the Zoloft or my anxiety over all this.

All opinions and advice welcome!!!!


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When I took Zoloft I also felt increased anxiety from it to the point where I couldn't continue with it. I have some anxiety/heart weirdness too when I get anxious. My bpm can go up to like 120bpm if I'm having a freak out of something. I often feel a sink in my chest that feels like a skipped heart beat but I dunno really. The docs say I have no heart trouble, they say it's just the anxiety in me.

My pdoc says mixing SSRI's (like Zoloft) with SNRI's (Cymbalta) is a high risk situation for serotonin syndrome.

I am not quite clear on something, is your doctor tapering you from Cymbalta to Zoloft or is he "mixing them" if that makes any sense?

I would at least question your relationship with your pdoc. I could be totally wrong but you two seem to have some friction and/or communication problems with your pdoc. Good communication with your pdoc is a must for good treatment imo. Personally, as much as I would like to sometimes, I think I'm better off resisting the urge to make frantic and hysterical calls.

With my pdoc he knows I research meds allot so he lets me have a big say In the meds I would be interested in/more willing to try and tolerate. He is good in that sense that the will spend up to an hour with me discussing all kinds of stuff and we end up always coming to a nice agreement on what we should do treatment wise.

Good luck. Better Days are ahead :)

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Sorry I wasnt clear-I am tapering off the Cymbalta, from 30 to 20mg for a week, while the Zoloft kicks in. This cardiac weirdness scared the crap out of me today, it's better now, but I'm scared to take the Zoloft tomorrow. I guess I'll give it one more shot......I have a Mitral valve prolapse, and ectopics are nothing new. I have been repeatedly testsed and assured that they are benign. It just seems odd that I would have a bad ectopic day starting an hour after taking my first dose of Zoloft.......

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i'm sorry you're having a hard time switching around meds. i know it can be scary, especially when starting a new medication.

don't cut your zoloft in half. actually don't take any of your meds differently than you've been prescribed. if you are concerned for your heart, a visit to the ER might be a better way to determine if you're having heart problems. but please don't play doctor on your own, especially since you just started the Zoloft.

you may very well be experiencing some start-up side effects that will lessen in time. you may be having panic attacks, which again, might resolve in a few days. there's no way to know what Zoloft will be like for you this quickly. and there's no way to find out if a medication is right for you if you mess with it every time you get scared.

you're also coming off cymbalta, which can have all kinds of lovely side effects. these will also pass (even though it can be frightening, and horrible).

again, if you really are concerned for your heart, please go have that checked out right away, but TAKE YOUR MEDS. if the doctor checks you out and says stop taking Zoloft, then that's the time to do so.

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