# Post-op sympathetic overdrive? **URL:** \ **Category:** General\ **Created:** [August 19, 2026, 12:29pm UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049 "2026-08-19T12:29:25Z")\ **Posts on this page:** 6\ **Page:** 3
**Author:** ![Emerald](https://avatars.discourse-cdn.com/v4/letter/e/bbce88/32.png) [@Emerald](https://forum.livingwitheagle.org/u/Emerald)\ **Post date:** [September 10, 2026, 7:48pm UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049/42 "2026-09-10T19:48:58Z")
Hi Harry again, I think @Chrickychricky is unaware that you had a bad experience with Agomelatine so it wouldn’t be a good idea to use Prozac in your case as they both (Agomelatine and Prozac) have the same mechanism of action i.e. 5-HT2C receptor antagonism. Blocking this receptor disinhibits and increases the release of both noradrenaline and dopamine in the prefrontal cortex. The other problem with Prozac is that it is a potent inhibitor of the liver enzyme CYP2D6. It is this enzyme that is needed to breakdown duloxetine in the liver. So you could end up with higher levels of duloxetine in the blood with all sorts or consequences. In Australia you have compounding pharmacies. As duloxetine comes in capsule form, they can use a bead-counting method to reduce the dose very slowly for example 10% of the dose every few weeks. There are other methods but they would depend on what medication your doctor intends giving you afterwards. In any case I would do your own research and discuss any medication plan with a pharmacist. ---
**Author:** ![Harry](https://avatars.discourse-cdn.com/v4/letter/h/f6c823/32.png) [@Harry](https://forum.livingwitheagle.org/u/Harry)\ **Post date:** [September 11, 2026, 11:22am UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049/43 "2026-09-11T11:22:34Z")
@Emerald thank you, thank you, thank you. I have been on the duloxetine for 2 years to help with the neck pain… honestly I didn’t ever feel it helped, but was told by multiple pain doctors it was a good idea. Until my POTS specialist said ‘No’! With everything happening pre surgery and the decline with the IJC it fell down the list of priorities. I just don’t understand how I could weather the duloxetine taper while already being in overdrive- I do however understand it is making the adrenaline metabolism problematic. The GPs idea was to get onto Zoloft after a time without Duloxetine post ween. But I wonder from your awesome articles if Lexapro would be a better option. I am having problems finding an available Rehabilitation Specialist that understands such matters. But hopefully I find one. My feeling is to hold all meds until I have a better specialist opinion. If only you were my doctor @Emerald! ---
**Author:** ![Chrickychricky](https://yyz1.discourse-cdn.com/flex027/user_avatar/forum.livingwitheagle.org/chrickychricky/32/15581_2.png) [@Chrickychricky](https://forum.livingwitheagle.org/u/Chrickychricky)\ **Post date:** [September 11, 2026, 1:40pm UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049/44 "2026-09-11T13:40:20Z")
@Harry What dose of duloxetine are you on? ---
**Author:** ![Chrickychricky](https://yyz1.discourse-cdn.com/flex027/user_avatar/forum.livingwitheagle.org/chrickychricky/32/15581_2.png) [@Chrickychricky](https://forum.livingwitheagle.org/u/Chrickychricky)\ **Post date:** [September 11, 2026, 1:42pm UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049/45 "2026-09-11T13:42:32Z")
@Harry sorry, I saw it is 30mg. ---
**Author:** ![Emerald](https://avatars.discourse-cdn.com/v4/letter/e/bbce88/32.png) [@Emerald](https://forum.livingwitheagle.org/u/Emerald)\ **Post date:** [September 11, 2026, 4:32pm UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049/46 "2026-09-11T16:32:55Z")
Hi Harry, If I was you I would go with the Lexapro not with Zoloft. The only problem is you are going to have to wait a while until you are on a much lower dose. I know 30mg duloxetine is not a very high dose, but it is obviously high enough in your case to cause problems. The major problem in the cross-taper switch to Lexapro is that both medications are metabolised by CYP2D6. So that’s why it would be best to wait until you are on a lower dose of duloxetine before the switch starts to be on the safe side. The other reason is that Lexapro is a weak CYP2D6 inhibitor (i.e. it inhibits the enzyme that the drugs needs to be metabolised). Normally this wouldn’t be a problem but in someone that is obviously sensitive to noradrenaline, it has to be taken into account. Other than the long term calming down of the fight/flight response by Lexapro there are other advantages of Lexapro over Zoloft. Zoloft can cause a moderate increase in dopamine which in sensitive people can cause a wired jitteriness, a burst of nervous energy and an increase in heart rate 🫩 that “normally” abates after a few weeks but in some people can continue on after 6 weeks!! (my son has been through that too!!🫩 ). Your experience with agomelatine which also increases dopamine is another reason to skip the Zoloft. Zoloft can also cause GI upsets in some people as well. So as far as tolerability lexapro is less likely to have the possible side effects that zoloft could have in your case but the first few weeks are going to be delicate in the cross taper. You may require a low dose benzodiazepine like Seresta 10mg but you may not especially if the noradrenaline levels are starting to come down due to the decrease in duloxetine dose. There is a study that was done using Zoloft for people with POTS. The conclusion was : Sertraline had a modest pressor effect in POTS patients, but this did not translate into a reduced heart rate or improved symptoms. [Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: A randomized, crossover trial](https://journals.sagepub.com/doi/10.1177/0269881113512911) As far as your neck pain goes, lexapro like zoloft is not going to directly improve the pain. You need to be aware that your neck pain may increase. However given you would be in a better place as far as the level of stress hormones, like noradrenaline in your brain, you are less likely to contract your neck muscles thus increasing the pain. Hope you can find a suitable rehabilitation therapist/ doctor or hospital pharmacist ? who can guide you through this period. Best regards Emerald ---
**Author:** ![Jules](https://yyz1.discourse-cdn.com/flex027/user_avatar/forum.livingwitheagle.org/jules/32/404_2.png) [@Jules](https://forum.livingwitheagle.org/u/Jules)\ **Post date:** [September 11, 2026, 6:09pm UTC](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049/47 "2026-09-11T18:09:28Z")
Thanks for that info @Emerald 🤗 [Previous page](https://forum.livingwitheagle.org/t/post-op-sympathetic-overdrive/24049.md?page=2)