Cymbalta/Duloxetine and Sodium Levels?

[Xina535]

I came across people complaining that while taking Cymbalta, they started twitching. I then read that it can cause twitching because it reduces your sodium levels.

Anyone know anything about that?

Since end of April, I've been taking 60mg of Cymbalta (generic Duloxetine, made by Lilly). It took away my panic and anxiety, but gave me TERRIBLE constipation. I took the constipation side effect. No other side effects. No change in twitching though either.

On Aug 5th, I missed 2 doses of Cymbalta. I wrote about it on here. I felt SO horrible! I felt like I was hit by a truck! I was dizzy, feverish, trembling, fatigued AND I started getting diarreah (that lasted over a month). With the diarreah, I exploded in a "different style" of twitches that I've never experienced before. All over my lower body, constant, very very fine where I could see everything move around, but I could not feel it, but some I could feel. Soon, that different style of twitches moved all over my body. My tongue started twitching more.

During the month I had diarreah, I had taken electrolyte drinks, but nothing improved. Now that the diarreah has gone, the twitching is still the same.

Now, does that case sound anything like my sodium levels are too low? That they are so low that my body is twitching like this, despite electrolyte replacement?

Why did I not get this explosive twitching from end of April to beginning of August? Could it really have been those 2 missed doses that threw everything out of whack?

This is really my last string of hope that I am hanging on to. I am really losing it. My right hand keeps missing letters. During the training I gave today, I purposely did not write on the white board. Every time I pick up anything, I have to concentrate so I don't drop it.

[misterjuanperalta]

Any drug that targets neurological areas may produce neurological symptoms, even twitching.

[Xina535]

Yea, but why would I not expierence that from end of April to beginning August? Wouldn't I have had the side effects the medicine would give me within like the first month (at the latest)?

[Yuliasir]

Xina, when I was taking SSRIs, I got increase in my twitches which lasted for all the course and for about 4-6 weeks after proper weaning off the drug. Since that I never ever had such bouts of twitching anf neuro pain as I had on rexetine. So it is expected to have neurological symptoms throught all treatment course and for a certain period after it.

[Xina535]

Ok this is comforting.

Have you heard of this sodium-stealing property of Cymbalta or and other SSRI?

[Yuliasir]

nope, but it is still possible. My psychiatrist was objecting that SSRI could increase twitching but another one told me it was many times reported, it is also mentioned in the side effects in some countries.

[Xina535]

Coming back to Cymbalta:

My psychiatrist said that Cymbalta is stored in the brain where it controls dopamine and seratonin, and it can affect movement (since movement is controlled by the brain). Although it is rare, it can therefore cause twitching and jerking.

So - this made me think:

If my twitching was being caused by my brain due to Cymbalta and/or anxiety affects, and NOT due to lower motor neurons (in MND), then is this a good thing?

I am not 100% sure, but I believe my twitching stops when I sleep. When I wake up, for the first few minutes, I do not twitch. After waking and moving a bit, then they are full blown. I am not sure if I twitch in my sleep. I want my husband to check for me. If I do not twitch in my sleep, could this mean that the motor activity in my brain has stopped? If that is true, then is it true that really, my twitching is being controlled from my brain and not from lower motor neuron damage?

I am not asking anyone to know the answers, but I would like to see if anyone has opinions or references. I tried searching but the searches come up with twitching that starts when going to sleep (like the hypnic jerks - which is not what I am talking about).

Also, when I smoke marijuana, my twitching stops (most of the time). That is the only other time I know that my twitching stops. So in MND or if due to lower motor neuro damage, I am not sure that marijuana could stop twitching, but perhaps, it can stop the part of the brain controlling movement (if twitching was coming from brain signals). Making sense?

[RIno468]

You don't have an MND - so let's get that out of the way immediately.

Your twitches would not be stopping (in sleep or with MJ use) if you had an MND - with an MND for as long as you have been twitching, there would be OBVIOUS signs that something was sinister going on.

I am willing to bet that a bulk of your twitches are caused by anxiety.

you probably have a baseline level for twitching (say 100 pops per day) and that part of your twitching may be due to something physically wrong with you (NOT MND)

But a bulk of them are caused by you worrying about your baseline pops. You say you don't believe you twitch when you sleep ( you are relaxed) and you say don't twitch when youre on marijuana ( again relaxed) so this leads evidence to my assumption.

[Xina535]

thank you for the input.

I do have other things wrong. I am seeing my hand surgeon tomorrow morning for my right hand shakiness, clumsiness, etc. I had a ganglion removed in January, so I am hoping something didn't heal right. But what is happening in my hand (along with twitches) is very much like what happened with my left shoulder (abnormal EMG, clinical weakness). The clumsiness and unable to control in my left arm is very much what my right hand is doing. I STILL have no real explanation to what happened in my left shoulder and it is STILL not back to normal (constant twitching, still heavy, fatigued, shaky). So the twitching is not the only thing happening, technically.

And since the missed dose of Cymbalta, the twitches that happened were a totally different style than any of my twitching ever. Way more, way more widespread, constant in several places, and very very fine, to the point where I could see but not feel them (in the 2 years I had been twitching prior to that, none of this happened). Plus, new twitching place = tongue.

[RIno468]

I was not aware of your abnormal EMG on your shoulder.

That changes things significantly - Can you tell me what your EMG said exactly ? (the conclusion)

or if its too long can you link me to it if you posted previous

[Xina535]

This was the post where I first started experiencing the troubles in my shoulder/arm:
viewtopic.php?f=4&t=21329

Then this was the abnormal EMG, results are in there (red/black text post on the first page):
viewtopic.php?f=4&t=21521

My arm is not much better since then. I still have lots of pain and everything is still heavy.
I had another EMG, a follow-up one, still was not totally clean:
14-July:
"No denervation activity, scattered dispersions, predominantly "normkonfigurierte" (?) biphasic potentials with no evidence of neurogenic damage."

[Xina535]

also, today when I woke up, my head and left arm were shaking back and forth (like how my body reacted to Amytriptaline, which is why I stopped that med). Maybe I need to reduce my Cymbalta dose?

Going to the urgent care center tonight for my right hand and my left shoulder. I have pains in both that nothing is helping. My hand surgeon was not able to see me today and he will be out on vacation for the next 3 weeks.

[RIno468]

Interesting.

I would definitely be as worried as you are. I am sorry for downplaying your symptoms - I know there was something wrong but I always put *** off the table for you but abnormal EMG's can be scary. After reading your posts you have every right to be scared.

Have you ever been to an *** specialized dr?

[Xina535]

No I haven't. According to the neuros here, there's no need. And to see one I need a referral from a neuro. And their appts are 1 year out. I hope to see one when I go to the U.S. In April/May in NC.

And thanks for making me freak out more!

I decided to reduce my Cymbalta to 30mg from 60. I can't be waking up with tremors like that, I'll panic. It tells me I'm taking too much. Hopefully that is why the twitches all over are exploding ....they are all over, constant. And they are even like so small that they make just a flash wave.

[misterjuanperalta]

RIno, she doesn't need to be worried because she already is. I agree a more in-depth evaluation would be recommended. That, of course, does not mean it's MND.

On a side note, Stephen W. Hawking was not discouraged by his disease. He found a way to accept, move on, make the best of life and contribute much to the scientific community.

Xina, please try to calm down and focus on ways to overcome your fears and whatever life throws at you. You know better than anyone here what I mean.

Regards