Contents
WHEN TO WEIGHT OR COUNT
Since the beads are so small, once the dosage is in about the 20mg range, the scales can not resolve that small a weight. At that point, switch to the counting method https://healthwithoutantidepressants.com/counting/.
INTRODUCTION
After many years operating a Group on Facebook that currently has ~40,000 members, the operators of this site have documented a way to slowly wean off of this drug. We call it the GRADUAL TAPER Method. Multiple methods exist. This page documents the WEIGHT method using a small jeweler’s scale to weigh the beads you consume, rather than counting them.
The goal is to reduce the drug so that the bad symptoms of the reduction are minimized or eliminated. Using this method, you can reduce the bad side effects of discontinuation.
This site documents tapering recommendations of antidepressant experts such as Dr. Mark Horowitz, Dr. Anders Sorensen, Adele Framer, Dr. Peter Breggin, and Dr. Heather Ashton, who recommend a slow, steady, deliberate taper off psychoactive drugs in which each reduction gets smaller and smaller over the course of the taper. In the scientific world, this type of taper is called “hyperbolic”.
We suggest a Gradual Taper decreasing by 5% or less from the previous dose — not the original dose. Each dose reduction should be held for typically 14 days, allowing the brain and body time to adjust before the next dose reduction. Some other antidepressants may be reducible by 10%, but our “lived experience” over the last decade has demonstrated that a 10% reduction for Cymbalta/duloxetine is too fast for most people.
Many people report that 2.5 – 5% decreases, with a minimum of 14 days in between, produce great initial results. Due to the hyperbolic function of the drug, the lowest doses have the strongest effect, so as you get lower in dose you will likely need to do the following:
- Hold longer between dose reductions until your symptoms abate
and/or - Lower the percentage by which you reduce the dose
For more personalized options, please join the Facebook group Cymbalta Hurts Worse.
We have seen, over the last decade of tens of thousands of reports, that a gradual taper can greatly minimize the withdrawal symptoms and reduce the risk of developing protracted – bad, long-lasting – withdrawal.
The key is to listen to YOUR body, and let it tell you what the best rate is for you.
We are part of a grassroots movement to raise awareness about the dangers of ALL serotonin-affecting drugs; the benefits of nutrition, gut health, diet and other healthy lifestyle choices; and the need to look for the underlying root causes of anxiety, depression, pain and chronic pain-causing illnesses. For many people, this is the first time they will be exposed to information that is contrary to what our society is being told by the pharmaceutical industry and conventional medicine. We hope everyone will open their minds, expand their thinking, and begin their own research, starting with our files located on this site.
WEIGHING TOOLS REQUIRED
Details on each of these follows.
- Jewelry scale from Amazon or elsewhere online for about US $20
- Comes with tweezers and small tray
- Usually uses two AAA or AA batteries. Get spares!
- Paper plate and scissors to make pouring tray for replacing beads in capsules
- Silver foil for making capsule stander-upper so you can pour into it
- WEIGHING spreadsheet from Files section here
- Very small bowl to hold beads before weighing
- #1 or #0 gelatin capsules from amazon.com, non-enteric
- Your existing prescription of Cymbalta capsules
- Access to the online calculator at this site or a spreadsheet program for an Excel file
THE SCALE
You will need to buy a scale that goes down to 0.001 grams. They are typically called “jewelry scales.” The little “g” or “gm” after the number means GRAMS. Typical small scales can weigh up to 20gm, 50gm, or 100gm. We suggest the 20 gram models, as they are more accurate with small weights that we will be using.
We tested three scales, from about US $7 to $25. The two cheaper scales at the left that claim “professional” would not respond to small milligram changes at very low weights. They are NOT recommended.
Affordable Scale
Our favorite scale is the SmartWeigh GEM20. When tested, it was accurate down to around 50 beads. This appears to be the least expensive one that is adequate for our purposes.
This goes by MANY different names on a site like Amazon. It sells for $25-$50. ALL scales that LOOK like this one are very likely to be exactly the same, just sold by different people. Find the lowest priced one you can. Currently, in 06/2024, the best price is here at US$15.75:
https://www.amazon.com/Precision-Portable-Milligram-Jewellery-Calibration/dp/B0CWDJSYGH/ref=sr_1_4
This is not an affiliate link, we get no commission. If the link breaks, please let us know at info@healthwithoutantidepressants.com.
Things change on Amazon, so you may just have to search for “GEM20” or “GEM 20”.
The scale comes with two marginal batteries, so get some quality Energizer AA to replace them. Fresh batteries are critical for proper function. The bowl provided works well for the weighing. We don’t use the tweezers.
Once you get the scale, make sure to use fresh batteries and set it to read GRAMS.
Premium Scales
If you have more of a budget, these scales should also work well, as they have low maximum capacity and resolution to a claimed 0.001g:
US$65.48: ..https://www.amazon.com/Digital-Kitchen-Jewelry-Weighing-Accuracy/dp/B0BTN4H66R/ref=sr_1_248
Please update us with your experience with all of these scales at the Facebook group.
THE SMALL BOWL
We use a small bowl that I found in the kitchen. Anything similar will work. This is the easiest step of the process!
THE CAPSULES
You may not necessarily need capsules. When we were doing 60mg doses, we re-used the existing capsules, as they are Size 1 and easy to handle. So if you are on 60mg you likely will not need capsules, though they can be handy if you break some when opening.
We are now on a 20mg capsule from the pharmacy, and they are tiny, so we use the Size 1. On Amazon, search for “empty medicine capsules”. You cannot use “enteric” capsules, as the beads are already enteric coated. So do NOT get enteric capsules.
We like the size 1.
Capsules are basically all the same. Get the cheapest.
THE CALCULATOR
The weight spreadsheet calculator is online here in this site, CLICK HERE.
Later in this process, we will walk you through the use of the calculator!
THE VIDEO!
The following pictures and narrative give a detailed process to weigh. We also have a great video on the general weighing process here:
PREPARATION
Most scales that can measure milligrams display the weight in GRAMS with 4 digits, 0.000. Often sold as .001 scales. Set your scale to GRAMS! Then make sure it is showing Grams. Scales that have a maximum capacity of 20 grams or less will work the best.
CALIBRATE THE SCALE
Turn on the scale. Make sure the table is solid and does not jiggle. We are weighing THOUSANDTHS of a gram, so the scale is very sensitive. Let the scale warm up a bit.
Hold the Power button until it says CAL.
It now says CAL, so let off the button.
Wait a little bit, and it will display 10.000.
That is the weight it is requesting being placed on it. Put one of the two weights on the scale.
In a few seconds, it will recognize that and request the second weight to be put on for a total of 20g. Place the second weight on with the first and wait.
In a few seconds, it will show “PASS”. If not, read your instructions and try again.
Congratulations, you are ready to go!
BUILD the CAPSULE STAND
We use a piece of aluminum foil to hold the capsule bottom upright so I can pour into it.
Take a complete empty capsule and form the foil around it. This may take a few times to get it to stand up.
Just work the foil as best you can to get something similar. Our first one was a crumpled mess, and it worked for a year.
FOLD YOUR POURING PLATE
First thought to putting the beads back in the empty capsule is usually a funnel. Tried it and did not work for us. So we folded a paper plate and have used it for a long while very happily.
Start with a paper plate. Use a cheap one, the “grease resistant” work best. Too thick is hard to work with.
Cut off the crinkled part:
Fold it in half, and press down the fold with something hard.
Draw something like half a heart shape on it while folded:
Cut it out. Does not have to be perfect, at all.
Unfold it and pinch in the center part on the top of the “heart”:
Pull it together, fold at the center, and press it down to make this backstop for the beads. This prevents them from rolling off the back!
Should look something like this. Does not have to be exact.
Now, cut off the very tip of the point, while folded. This allows the beads to roll into the cap.
Should look about like this:
Congratulation, you have all the required tools.
SETUP YOUR CALCULATOR
Go to the
on this site and choose the Weighing Online Calculator or Excel Spreadsheet. They both produce the same results. Once fully populated, PRINT the results if online, as the online calculator will not retain your settings!
WEIGHT AVERAGE PROCESS
Turn on your scale and place the tray provided with the scale on the scale and hit TARE. Should show 0.000g. Make sure you are in GRAMS mode.
First, we need to get the average weight of a capsule of your current prescription by weighing the contents of three capsules. We will add those measures and then divide by three to get the average for one cap.
Note that the WEIGHT milligrams has NOTHING to do with the DOSAGE milligrams. Two different things! We will only be dealing with the WEIGHT milligrams as we weigh.
Clear a working area on a hard, stable, table. Assemble all the gear from above. Take the clean small bowl and pour the contents of one of your three capsules into it. Pour into the tray on the scale and note the weight in the calculator.
Do this for the next three of your capsules and record their weights in the calculator.
On the Spreadsheet, note that only the light green cells can be filled in.
Select your taper rate, we suggest 5% is a good place to start. DO NOT think you can push this process. Starting too high only leads to wasted time in the end.
Select your taper period, and we suggest 14 days.
Once you have a calculator complete, print the first page or two and get ready to load.
DOING A BATCH
Note that in this example, we are doing 20mg capsules that are tiny. If you are doing 30 or 60mg capsules, they will be larger. When we did 60mg, we often re-used the capsules from the prescription. We did not need the empty caps, except in the beginning when I cracked a capsule or two twisting them apart. Once you get the hang of it, you won’t have an issue popping them open.
We already ran a few sheets, so this is typical of what you might see if you are starting a taper from 20mg. You numbers will vary from what you see here!
Our target today is 0.100g, which is 83% of the original dose. I squeeze the caps with my fingernails to get a grip and then twist to break the seal. You can see the indent. On a 60mg cap, it is not so deep.
Once the cap is twisted open, pour all of the contents into the little bowl.
This is the result of two weeks’ doses. ALL of the contents of the caps is in the bowl.
Now, setup an empty capsule bottom in the holder.
We open all of them first, so they are ready. The scale will timeout if you take too long, so we get everything ready up front.
The whole setup looks like this to get started.
Then, we use the tweezers in my right hand to push beads into the tray on the scale.
If we go over just a few thousandths (like 0.103 when we want 0.100), we will pick a few beads out with the tweezers. If we are too far over, we will pour some back in the bowl.
This is the goal, 0.100 of weight.
Remember, this weight HAS NOTHING TO DO WITH THE DOSE. While the weight and the dose are both measured in milligrams (mg), there is way less dose per weight. This 0.100mg weight (one hundred milligrams) only has ~0.017mg of actual medicine dosage.
Then I pour the beads into the pouring plate, held level or tilted back a bit. They sit nicely there…
See!
Now, I pour the beads into the capsule, holding my finger over the top of the cap against the paper to prevent them from running over. Only had one hand here, so I could take a picture.
The glorious result:
Place the top on the capsule and fell it click into place.
Voila! One finished cap.
These are the leftover beads from two weeks of doses.
OTHER METHODS
Counting the beads you consume is another approach that is used. Since this requires counting literally hundreds of beads that are tiny and have static, many find it very challenging.
Also, some compounding pharmacies will provide the counting service, though some are limited to the unacceptable conversion to a liquid. Bottom line, for this writer, the weight method makes the most sense.
Post your comments on Facebook!
Facebook Group Cymbalta Hurts Worse
https://www.facebook.com/groups/Cymbaltahurtsworse/
Best of luck in your GRADUAL TAPER!
NOTE ON LOW DOSAGES
SCALE ACCURACY
At very low doses of few beads, maybe in the range of 50 or so, the scale will not have the accuracy to measure correctly. At that point, you will have to start counting beads. Since there will be very few beads, the task is not horrendous.
EFFECTS AT LOW DOSES
Cymbalta/duloxetine has a nature of being effective in small doses and losing effectiveness at higher dosages. Note how the “Occupancy” (effectiveness) climbs really fast from 0 to 20mg in Dose, and slows from there.
https://www.nature.com/articles/s41380-021-01285-w.pdf
This also shows how questionable it is for doctors to prescribe doses beyond 60mg, which is also not recommended by the maker.
This explains why small changes at the end of your taper, when you are at just milligrams, or counting single beads, will have a great effect on your discontinuation symptoms.
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