Duloxetine (Cymbalta) Side Effects & Withdrawal

We have received so many complaints about duloxetine (Cymbalta) side effects that we have lost count. Far more disturbing are the number of people who tell us how hard it is to discontinue this drug.

Decades ago, doctors did not know a lot about how to stop this medicine. They might have told patients taking a drug like Cymbalta that anxiety, irritability or strange sensations after stopping the drug, were due to their underlying psychological problem returning. Now we know it is probably withdrawal from the medicine.

Researchers have found that

“Withdrawal symptoms occurred after discontinuation of any type of SNRI [serotonin-noradrenaline reuptake inhibitor]” (Psychotherapy and Psychosomatics, July 17, 2018).

As a result, they concluded:

“Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.”

The History of Cymbalta:

The FDA originally approved Cymbalta in 2004 for treating major depression. It is officially an SNRI-type antidepressant. In doctorspeak, that means it is a serotonin-norepinehprine reuptake inhibitor and is somewhat similar to other antidepressants such as Effexor (venlafaxine) and Pristiq (desvenlafaxine).

The FDA also approved Cymbalta to treat nerve pain associated with diabetes in 2004. In 2007 the drug got a green light for anxiety and in 2008 the FDA agreed that it could ease the discomfort associated with fibromyalgia. The agency also approved this drug to treat musculoskeletal pain associated with arthritis and lower back pain in 2010.

In other words, here was a drug that could relieve your blues and your aches and pains. And the drug company that makes Cymbalta (Lilly) marketed this medicine as a good way to deal with chronic low back pain and osteoarthritis. Perhaps you have seen the commercials on TV promoting the pain relieving power of the drug with the slogan “Cymbalta can help.” It sounds almost too good to be true.

Ah…and there is the rub. Although there is a long list of serious side effects mentioned during the commercial, the video images seem quite reassuring and trump the scary message the FDA requires for this medication. So, let’s set the record straight. Here, without the visual distraction found in ads, is a list of potential complications associated with this medication.

Duloxetine (Cymbalta) Side Effects:

People have reported a very wide range of side effects, including:

• Nausea, stomach pain, constipation, diarrhea, decreased appetite, vomiting
• Dry mouth
• Insomnia, anxiety, tremor
• Dizziness, fatigue, sleepiness
• Sweating, hot flashes
• Blurred vision
• Headache
• Sexual dysfunction, lowered libido, erection difficulties, lack of orgasm
• Liver damage
• Serious skin reactions, rash, hives (requires immediate MD assistance!)
• Glaucoma
• Irregular heart rhythms
• Bleeding problems
• Blood pressure problems
• Interaction with other drugs (leading to serotonin syndrome, among other reactions)
• Pneumonia
• Seizures
• Depressed mood, suicidal thoughts and behavior, suicide

Such a long list of side effects makes your eyes glaze over after the top 3 or 4. That is why we have included stories from real people so you can better understand what these complications feel like.

Stopping Duloxetine (Cymbalta):

Even though such side effects are scary, there is another problem with Cymbalta. When people try to stop taking this drug they frequently report unpleasant withdrawal symptoms.

A reader recently sent us this question about stopping duloxetine (Cymbalta):

Q. I have been taking duloxetine DR capsules (Cymbalta) twice daily for acute anxiety for a year. No one warned me about the negative sexual side effects of the medication.

I stopped taking it cold turkey five days ago. I have strange hot flashes that make my face turn red and feel warm. I have also had other problems, including loud tinnitus and dizziness. It’s all strange, but I’m trying to fight my way through. Do you have any advice on stopping duloxetine?

A. Physicians prescribing duloxetine or many other antidepressants should warn patients about sexual side effects. These can include lower libido and inability to achieve orgasm. A black box in the prescribing information also warns about suicidal thoughts and behaviors.

Many people find it challenging to get off duloxetine. The FDA lists discontinuation symptoms such as dizziness, headache, nausea, diarrhea, irritability, vomiting, insomnia and anxiety. It suggests a “gradual reduction in dosage,” but offers no real guidance.

In our eGuide to Dealing with Depression, readers offer their detailed stories about how they were able to lower their dose a bit at a time to get off Cymbalta and other antidepressants and anti-anxiety medicines. This online resource is available under the Health eGuides tab.

Even Short Exposure May Trigger Withdrawal Symptoms:

Most prescribers probably acknowledge that discontinuing duloxetine could trigger unpleasant withdrawal symptoms for some patients. How many remains somewhat uncertain.

What is likely rejected, though, is the idea that this discontinuation syndrome could occur after a short exposure. This reader shares a surprising story:

Q. My psychiatrist prescribed duloxetine last month for depression. I had to stop after five days because I couldn’t sleep. My muscles hurt and clenching my jaw gave me a non-stop headache. I felt terrible.

It’s been over three weeks since I stopped and am still having withdrawal symptoms. I can’t even shake my headache. I won’t try this class of antidepressants again.

A. Duloxetine (Cymbalta) is not the only antidepressant that can trigger unpleasant withdrawal symptoms upon stopping suddenly. Many people report sweating, nausea, headaches and worst of all, dizziness. Some describe a sensation like having their head in a blender.

People differ in their susceptibility to such withdrawal symptoms. Most prescribers would doubt that such a short exposure would result in a discontinuation syndrome, but we have heard from others like you.

To learn more about various strategies to treat depression and ways to reduce the impact of stopping antidepressants, you may wish to read our eGuide to Dealing with Depression or listen to our interview: Show 1315: Are We Medicating Normal Emotions?

What Does the FDA Report About Duloxetine Withdrawal?

An organization (QuarterWatch) that monitors the FDA’s database of serious adverse drug events noted that:

“We observed a signal for serious drug withdrawal symptoms associated with duloxetine (CYMBALTA), a widely used antidepressant that is also approved to treat arthritis and back pain, anxiety, and fibromyalgia. In the first quarter of 2012 the FDA received 48 case reports of drug withdrawal identifying duloxetine as the suspect drug. They described a wide spectrum of withdrawal effects that began when the patients stopped the drug, including blackouts, suicidal thoughts, tremor, and nausea. Several cases involved hospitalization.

“Probing deeper into the scientific record for duloxetine we found that withdrawal symptoms were reported in 44-50% of patients abruptly discontinuing duloxetine at the end of clinical studies for depression, and more than half of this total did not resolve within a week or two. In addition, we identified a serious breakdown at both the FDA and the manufacturer, Eli Lilly and Company, in providing adequate warnings and instructions about how to manage this common adverse effect.”

Doctors have taken to calling this “discontinuation syndrome.” These clinical words do not do justice to what it is like to stop antidepressants like Cymbalta, Effexor (venlafaxine), Paxil (paroxetine), Pristiq (desvenlafaxine) or Zoloft (sertraline) suddenly.

Sudden Withdrawal Symptoms

• Brain “zaps” (electric shock-like sensations in the brain)
• Dizziness, light-headedness, vertigo, feeling faint
• Headaches
• Anxiety, irritability, hostility
• Nausea, diarrhea, digestive upset
• Tremor, hands shaking, nerve tingles, strange sensations
• Fatigue, tiredness, lack of energy
• Visual disturbances

Again, a list of symptoms does not do this problem justice. Below you will read some stories from people who have posted their comments to this website. We would love to hear your story, positive or negative. Share your experience with Cymbalta or any other antidepressant below.

Should you wish to learn more about dealing with depression through some other strategies, we offer our eGuide to Dealing with Depression. You will also find a whole chapter on prescribing mistakes doctors make when treating depression and fibromyalgia in our book, Top Screwups Doctors Make and How to Avoid Them.

Cymbalta Withdrawal Stories from Readers

D.G. shares a tragic story:

“My lovely young daughter-in law, who was about to celebrate her 29th birthday, was prescribed Cymbalta, Klonopin, and Ambien and has committed suicide.

“She told her physician and her therapist that she’d had thoughts of suicide but no one took her seriously. She suffered from depression, as well as an eating disorder, and had very low body weight. She also used alcohol.

“Please remind your readers of the potentially disastrous effects these chemicals can cause when taken carelessly or in combination with alcohol.”

This from P.J.:

“I have been on Prozac over the last 20 years off and on and it finally stopped working. The last time I took it about 2 years ago I was taking the generic from Barr – the blue and white capsule. I was feeling as if I were in the deepest dark hole there ever was.

“My doctor put me on Cymbalta from which I had a lot of side effects such as palpitations, feeling constant dread, panic attacks, sweats, lightheadedness and general feeling of not being well.

“She added Abilify which put me over the edge. I was in the worst depression I have ever been in. Finally after living like this for several months, I asked to be put back on Prozac. I was taking the generic from Sandoz. When the prescription ran out I ended up on the big blue and white capsules from Barr.

“Over the last couple of weeks it has been constant crying spells, arguing with everyone and feeling pretty low. I talked to my doctor and she wrote the prescription for Sandoz only generic. The blue and white capsules are like taking a placebo. My doctor said she had had other patients who complained of the same thing and she had to write prescriptions for a certain generic or name brand.”

R.P. says:

“I took Cymbalta for 3 days and thought I’d go nuts. I’m off it now and refuse to try any other drug like this. My main complaint was extreme hot flashes that estrogen wouldn’t help. I thought I’d be given Prozac, but was given Cymbalta instead. It was a rough 3 days and I stopped it last night. I am extremely tired yet cannot sleep at night. I think I was sweating even worse and my legs started feeling like I had Lyme disease again. And to be honest, within those 3 days of taking it, I didn’t contemplate suicide, but I had this crappy attitude of ‘who would care?'”

Nancy relates how hard it was to get off Cymbalta:

“It took me 18 months to get off Cymbalta, with no doctor’s help. I can hardly believe that doctors have no exit strategy for this dangerous drug. I had to find this out on my own from reading and as soon as I weaned off that – about a month, the tinnitus that had occurred decreased almost completely. No doctor told me this.”

J.K. shares a parent perspective:

“My daughter experienced severe side effects when trying to come off Cymbalta – she had nausea, vomiting, lost peripheral vision for 24-48 hours, had shaking, etc. This was while she was doing a clinical in a hospital for college. Had she known she would have stayed on it until after clinical. I called the manufacturer and they acted like there were no such side effects from withdrawal.

“She too took apart the capsules and it took awhile, but finally she is free from that drug. I think it is a crime that the manufacturers don’t publish more detailed information concerning withdrawal. They could even make money selling a one month or two month step down prescription so individuals aren’t taking the capsules apart themselves.”

P.C. tells what it is like to switch around from one drug to another:

“I just turned 52 today. I went on a very low dose of Zoloft about 8 years ago to treat generalized anxiety disorder. It really did help for a long time. I recently have been pretty depressed (however I can cover it up really well) and my psychiatrist switched me to Effexor which was terrible for me. Now I’m trying Cymbalta which has not done anything either except make me feel more anxious and headachy and weird.”

“I am a registered nurse and I do not understand what the long term effects of these meds are and I am concerned. I really want to get off and see what I can do naturally for myself.”

K.T. tells what it is like to try to stop duloxetine (Cymbalta):

“Getting off Cymbalta is challenging but not impossible. I, too, experienced the light-headedness, dizziness, and ‘brain zaps.’ I described it as being able to ‘hear my eyes move.’ It sounded like the light sabers on Star Wars. Very strange and disconcerting.

“The key is to do it very very slowly. Take the capsules apart and begin by removing 5 or 10 of the tiny balls inside. Do this for a week or so, then slowly increase the amount you remove each week or two as you can tolerate it.

“Your doctor will probably be no help at all. Mine wasn’t. He instructed me to wean off over a two to three week period and I almost lost my mind. I did it myself over about a YEAR or more. Be patient. I am completely off now and feeling GOOD.”

Karen’s story:

“I was prescribed Cymbalta ‘off-label’ to manage fibromyalgia pain When I stopped taking it because it wasn’t delivering on the promised effect of reducing my pain, I became so horribly depressed that I required hospitalization as I had become SUICIDAL!

“I will NEVER take another anti-depressant for an off-label purpose….such as Elavil/amitriptyline as a ‘sleep aid’ which is very commonly prescribed.

“I believe it should be criminal to prescribe ANY drug for a purpose other than the one it was approved to treat.”

R.H. and erectile dysfunction:

“I’m a 76 year old man, and my libido was very low. Taking Cymbalta for peripheral neuropathy added ED as a side effect of the drug. I had a testosterone blood test; it was 1/3 what the minimum should be. So I’m taking Androgel to raise testosterone levels and it is magic. I have great libido now and am working on minimizing the Cymbalta pills. In the meantime I have been prescribed Cialis for the ED. Each pill solves the sex problem for a couple of days.”

M.O. on stopping Cymbalta:

“I have the exact symptoms as everyone else and it’s been a week. I only took Cymbalta for 2 months, but the side effects from stopping it are horrible. Neither my doctor nor anyone else told me about side effects. I did read the insert. Most of the time the listed side effects of meds don’t bother me, so I figured no problem.

“From reading other posts on this website and on other sites, the drug seems to affect every person the same way. I would never have taken it for my neck pain if I had known about the likelihood of side effects. The worst part for me is the dizziness, the brain zings and the sudden burst of tears for no reason. I would never take this drug again. I think the FDA needs to do longer studies on all drugs and be honest with their findings and that doctors should be honest and tell their patients what really happens when you take Cymbalta.”

What Is Your Story?

Please add your own experience below in the comment section. You can also read about our hero, Dr. Heather Ashton. She was one of the first physicians to appreciate how challenging it can be to try and recover from benzodiazepine dependence and withdraw gradually from antidepressants. Her “Ashton Manual” is valued all over the world. Here is a link to her “Guidelines for Withdrawal of Antidepressant Drugs.” 

You can also learn more about a variety of strategies in our eGuide to Dealing with Depression in the Health eGuides section of this website. No one should ever discontinue any medication without the supervision of the prescribing physician! This can be a long and difficult process.