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.