Savella to Cymbalta - Serotonin Syndrome?

Update: I realized that since I take Lexapro already, I’m scared to add Cymbalta on top of that - the doc said I should take more Cymbalta as I come off of the Savella. However, I’m really worried about Serotonin Syndrome.

I’m wondering if anyone has gone from Savella to Cymbalta?

Today was the first day of this change. I have a plan to stop one and start the other with a gradual dose change over three weeks. It was developed by my psychiatrist. (I need to stop Savella as I’m unable to urinate properly while taking it.)

In the morning today I felt fantastic but towards afternoon I became extremely depressed. A coworker made a comment and I began crying and experienced a rapid decline in mood. I feel like a different person, the crying has barely stopped for 6 hours. My poor eyes feel full of salt.

I would like to know if you have experienced issues changing from Savella to Cymbalta? Or was it an easy change?



I will call the dr tomorrow to discuss. I hope I’m feeling more stable. My heart is racing which is not unusual but combined with crying its no fun!

Just thought I would post an update - by switching back to the original dose of Savella I’m feeling human again.

I don’t think the shrink knows what he is doing… I’m taking Savella, Lexapro and Cymbalta (he wants me to add a greater dose of Cymbalta as I come off Savella). I’m afraid of suffering from Seratonin syndrome!!

I am not taking any more Cymbalta until I can get a second opinion. It screwed me up so bad I felt suicidal. I also found out he Savella gave me a UTI since I can’t urinate properly. I’m on antibiotics and hope they work soon.

Hi Honey, I just found this post. It's definitely the changes in the medications that are making you feel awful. I'm so sorry! I go through the same thing all the time, even without changing medicines--and it's extremely miserable.

**I just had the Serotonin Syndrome talk with my Psych last week**

Lexapro is a full serotonin medicine (SSRI), and Savella and Cymbalta are SNRI's -- part serotonin, part norepinephrine. Cymbalta is 50/50 even between the two, Savella is 3:1 norepinephrine, so that brings the serotonin level even lower.

This isn't an uncommon combination of medications, and it's usually necessary when moving from one to another. You need to overlap them to avoid withdrawal symptoms, and as long as you are decreasing one medication while starting the other, it's still basically the same amount of serotonin. Lexapro and eventually Cymbalta is a common combination, their mechanisms are different, and the probability of serotonin toxicity is low.

You just have to follow the doctor's directions--- Like Jillian said, you can't just stop one. Decrease the Savella as he said, but don't just stop it. You will have even worse side effects and withdrawal symptoms. Or stay where you are until you can talk to him.

My doctor said that there are a lot of symptoms of Serotonin Syndrome, but the things he told me to watch for the most, what concerns him the most, are:

  • Chattering Teeth
  • Severe Muscle Twitches
  • Uncontrolled Shivering
  • Pounding Heart

Right now, I'm on Effexor, Savella, and Viibryd. I'm decreasing the Effexor to stop it due to horrible side effects for years, and increasing the Savella at the same time. The Viibryd stays the same. He told me I'd basically have to overdose to cause a dangerous level of serotonin toxicity during this change-over.

I haven't done Savella to Cymbalta, but many many other SSRI's and SNRI's--I've been on 3 Serotonin anti-depressants maintenance at once, with a few other goodies mixed in (anti-seizure meds for mood stabilization, benzodiazepines, etc).
I did have one Psych hand me 7 prescriptions at my first visit, and send me on my way with no instructions! (quack) -- Luckily, in all the years I've been on anti-depressant cocktails, I've never had Serotonin Syndrome.


PS: (Cymbalta is known to cause Urinary Retention ....)

Don't worry yourself sick over the weekend---if you feel off, GO TO THE EMERGENCY ROOM, or try to call your doctor, and next week talk to him about your meds !



**DISCLAIMER: I have no medical training whatsoever, I've been taking Psych meds for 20+ years, I'm really nosy, and ask too many questions!

Sunny, my doc told me that it is very, very difficult to take enough antidepressants to develop serotonin syndrome. You would basically have to overdose. Also, the symptoms are very acute so you would get very sick very quickly according to him. Changing meds is always difficult. Hang in there. Hugs. MB

How do you like Viibryd? He wants me to try it.

What sort of reaction do you have to Effexor?

I’ve been on so many psych meds it’s crazy. Actually, I must be crazy! LOL

Thanks for sending all this great information!

I haven’t but maybe it would be better if you started the switch on your day off? Then it would less harsh on your work atmosphere?. I hope you make it through the switch!

Renie, what wide effects do you experiance with Effexor?

Good idea - thanks I’m so overwhelmed that I can’t think properly.

Thanks for the encouragement. Thank goodness the brain zaps have stopped.

I remember once forgetting to bring my meds on vacation. I developed an awful migraine, brain zaps, etc.

When do you usually take your meds? The reason why is because it may be easier on your system if you switch to taking them at night. That way for the most part you are asleep when our body starts to do the switch. Will write more if I think of any suggestions. Yeah and so thought about another comment. Do you have another doctor you can get a second opinion from? I would see about staying on your former one till you get that 2nd opinion and then start the switch…

I take some in am and some in pm. I am going to ask my new PCP what he thinks so thanks for the suggestion!

OMG, Jillian. That takes my breath away. I can't believe that a doctor would be dumb enough to do that to you. I only know about tapering off and how disastrous it is because I stopped taking Paxil all of a sudden due to no insurance. It was hideous. I felt suicidal all of the time. It was one of the darkest times of my life and it lasted for months. You are right, some of those drugs are incredibly dangerous if you don't taper off them properly. Did you suffer any long-term effects from it, once you'd more or less recovered?

I would tend to agree with your brother. You nearly lost your life due to an incompetent decision on your doctor's part. How awful. And how needless.

Wow, this was a great post! Chock full of information.

I agree that it's much more possible to end up with bad side effects from just stopping one anti-depressant med than to get seratonin syndrome. I've been on and off anti-depressants for years and never had the latter but most definitely had the former from stopping a drug cold. NOT a good idea at all.

Sunny, how are you making out today? I hope like heck that you're feeling better! I have to apologize because I initially thought this just an issue of getting used to your new drug. But it sounds like you've switched back. So you still have to contend with the urinary retention issue, then, right? Is your doc looking into other possible meds?

As someone else said, switching meds is difficult. Not all meds are gonna be for you. Some people here love Lexapro but it did nothing for me, whereas Effexor has been great. I guess it really does depend upon your chemical make up.

Keep trying, Sunny! Something will work out for you. It might just take a while to find the right combination.

I use Effexor and I like it a lot. It's helped me substantially with depression. Well, I must admit that the recent increase in pain and the addition of my period really made the past few weeks challenging. But overall, it's been great for me. And I've had no side effects either. I do find that I'm more patient and think things thru more thoroughly (difficult for someone with ADD) and don't just open my mouth at the drop of a hat. And it helps with the depression component.

I hope it works as well for you!

Well, now I’m wondering why I am feeling bad even though this occurred a week ago. It’s as if the chemicals in my brain just won’t go back to normal. I’m not changing any meds until I see someone who knows how to prescribe them properly.

I’m sleeping all the time, have these awful suicidal images in my brain, can’t work and can barely drive. Any ideas?

Sunflower have you called someone? I think that would be the best advice I could give you. Keep your chin up beautiful.



I was on Savella and they took me off of it and put me on Cymbola. It took me three weeks plus a prescription of Nexium for it to work. It really did a number on my stomach. And, I had headaches so bad at first, but then they went away. I was on 20mg at first, and after the 3 weeks they increased the dosage up to 60 mg a day. I've been on it now for a year, and I can tell when I don't take it. It's expensive, a 90 day supply is $139.00, my insurance only pays $50 of it. Gracious of them, don't you think? My doctor told me some people have problems with the drug, they have urinary track infections. It helpsme a lot with the pain. We had to argue with the insurance company that the Cymbolta was for my fibromylgia, it was not for my depression. Wish u the best. Take care.

Hi Sunflower I took Cymbalta for about 2yrs and I got off of it because it made me depressed and no emotions and I hated that. Something bad could happen and i was like Oh well. I weaned myself off because if you go off it cold turkey you will have terrible side effects. That is my opinion of Cymbalta it may be alright for you just keep notes on how u feel so you will know how it affects you.