Cymbalta's 9th Circle of Hell - A Very Personal Account

I was diagnosed with Bipolar I, mixed moods and ultra-rapid cycling in 2000. Not a good combination. Consequently, I spent 3+ years trying a dizzying array of prescription cocktails, which resulted in an ultimate prescription for Cymbalta. Apart from a very short stint on Effexor, Cymbalta was the only SNRI I had tried. For more than 3 years, I was a relatively stable, albeit maxing out on a daily dose of 120 mg. of the anti-depressant.

As a result of a series of events irrelevant here, I decided to eliminate Cymbalta from my daily cocktail mix.

I did what I could to soften the blow by halving my dose for several days before I took the last capsule. I was not overly concerned about nixing the Cymbalta, as I had read the available literature on the withdrawal side effects and - as they were principally physical, - I concluded I could weather whatever I encountered.

That was fine as far as it went. You see, apart from an increase in depression, mania or anxiety (all of which I handled well enough with my other medication trials), Eli Lilly "forgot" to mention some of the more interesting side effects. (That said, I must admit that I may have exacerbated my situation by sleeping as little as possible in order to push me towards mania and away from depression.)

Days 1 - : Nothing remarkable.

Day 7: Abrupt increase in vivid, lucid dreams; but as I'd experienced that on other meds, I wasn't alarmed).

Days 8 and 9: More and more vivid with difficulty awakening and staying awake; more alarming, I began to confuse dream time with awake time.

Day 10: I entered the gate to the 9th Circle of Hell. I tried to stay awake all night, but eventually fell asleep; within a minute, serial ultra-vivid dreams until daybreak. When the sun appeared through my windows and I tried, vainly, to awaken. I opened my realize, vaguely sensing that I was awake, but immediately fell into a frenzy of exhausting dreams.

This continued from 9 a.m. until 3 p.m., when I finally was able to sit up and stay "awake."

Though perhaps awake, I was hopelessly disoriented - unable to see or feel any separation between what was inside and what was outside my mind.

I tried to telephone family and friends to objectify my experiences, but no one was available. This is where I started to lose it.

Familiar things around me - my room, its contents, my body, even my thoughts lost familiarity and substance; I was unable to perceive any distinction between "me" and "not me." As I became more and more unable to discern between objective reality and subjective dream time, (a functional definition of psychosis), my anxiety - already off the scale from the Cymbalta withdrawal - combined with my dissociation from reality and my vicious mood swings to produce the most hellish version of psychosis I might ever have imagined. I became unable to use my cell phone; so confused was I that it made no sense to me. I was too terrified to leave my room. I was utterly isolated from anyone or anything but "myself."

With only a few hours of sleep spanning more than a week, I physical and mental exhaustion overtook me; serial REM sleep left no room for deeper and dream-free restorative sleep. But the notion that if I fell asleep again, I would never "awaken" terrorized me. I was certain that should I lie down, I would never again awaken, or if I did, I would never again individuate, with any assurance, dreaming from from not dreaming.

There I was, sitting in a corner of Dante's 9th Circle of Hell.

As I felt myself slipping deeper into irreversible psychosis, I focused every ounce of my will to remember and to do any routine that might objectify my existence, convince me that I was awake, that I still possessed the ability to control my thoughts and govern my actions. This slowed my apparent inexorable slide into irretrievable psychosis; but I was miles and miles from sanity.

Serendipitously (perhaps), my daughter and a close friend (a brilliant psychologist with an encyclopedic knowledge of psychiatric meds) telephoned me. Not ten minutes later, my daughter arrived, while my friend - telephonically, yet effectively - illuminated the cause of and the cure for SNRI withdrawal - those troublesome details Eli Lilly kept to itself. Happily, I learned, all psychotic symptoms would resolve once Cymbalta again imbued my mind with its pharmaceutical patina. of sanity. Once again a Cymbaltite, at the time of this writing, my mind is still loopy and distressingly disoriented.

I am, it seems, doomed for life to Cymbalta's power of redemption.

A $245 Billion Doctor's Bill

AP, July 21, 2009: "WASHINGTON -- House Democrats want to give doctors a $245 billion sweetener that helps ensure their critical support for a health care overhaul bill. Next up: Trying to explain how they could do it without breaking President Barack Obama's promise that health legislation won't increase the federal deficit."

While there is little empirical data from which to infer a professional ideological bias on the part of physicians as a whole – or even the more distilled versions found among the AMA leadership (see, e.g. Goldman, “Factors Related to Physicians' Medical and Political Attitudes: A Documentation of Intraprofessional Variations,” Lee Goldman, Journal of Health and Social Behavior, Vol. 15, No. 3 (Sep., 1974), pp. 177-187), $245 billion dollars apparently can buy (or lease) their support of one of the most ambitious and radical pieces of legislation ever to be feverishly cobbled together by a Democratic Congress, itself glued together by unequal measures of cupidity and ideology. Still, we could hope that one of the brightest and best educated segments of the population might have perused the 1,000+ pages of the metamorphosing bill in order to apprehend its draconian ramifications. Once again, money is the great equalizer.