Cymbalta is a popular drug used to treat depression and anxiety. Of 381 million prescriptions for antidepressants in 2018, over 26 million were for Cymbalta. Notably, this is up by 45% from 18 million in 2013.1, 2, 3
The drug was initially approved for short-term use, typically lasting eight weeks. However, with new indications and more people seeking treatment for depression, long-term use has become widespread.
Between 2011 and 2014, one in eight Americans aged 12 years and older took antidepressants in the last 30 days. Among them, 25% took these drugs for a decade or longer.4
Cymbalta is the brand name of an antidepressant drug called duloxetine. It is available only with a doctor’s prescription. Other brand-name drugs that contain duloxetine are Irenka and Drizalma Sprinkle.
The United States Food and Drug Administration (FDA) approved Cymbalta to treat moderate-to-severe depression (major depression) in 2004. In the same year, it received approval for the treatment of nerve pain due to diabetes.
Cymbalta comes in the form of delayed-release oral capsules. Each capsule contains either 20 mg, 30 mg, or 60 mg of duloxetine. Delayed-release formulations release the medication only after they have reached the intestines. This protects the drug against inactivation by stomach fluids.
Street names for Cymbalta have not been documented. The lack of street names suggests that the drug isn’t popular as an illegal drug on the streets.
Alarmingly, some online vendors claim to provide Cymbalta without a prescription. The public is advised never to buy any prescription drugs from such vendors, as you can’t be sure what is inside the medicine. Moreover, it can be challenging to differentiate between registered and illegal online pharmacies.
Duloxetine is a member of a group of drugs known as serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are sometimes called selective serotonin-norepinephrine reuptake inhibitors (SSNRIs).
Examples of drugs in the SNRI class are:
Venlafaxine (Effexor, Effexor XR)
Desvenlafaxine (Khedezla, Pristiq)
SNRIs block reabsorption of two essential brain chemicals (neurotransmitters) by nerves. They are serotonin and norepinephrine. That way, SNRIs increase the levels of these neurotransmitters in the space between the nerves. More serotonin and epinephrine means that nerves can communicate better with each other.
SNRIs are used to treat depression, anxiety, and chronic pain due to diabetes or other conditions.
Like other SNRIs, Cymbalta helps restore the balance of serotonin and epinephrine in the brain. It increases the levels of another critical neurotransmitter– dopamine. Mental disorders are thought to occur due to an imbalance of these neurotransmitters.
Dopamine regulates memory, attention, and movements. Notably, dopamine may also play a crucial role in addiction. That’s why some think Cymbalta may cause an addiction.
Which causes persistent low moods, sleep problems, and low energy levels. Major depression affects over 17 million US adults aged 18 years or older.6
GAD causes excessive and unreasonable worry that lasts at least six months. Approximately 6.8 million adults in the US have GAD in a given year.7
Diabetic neuropathy causes pain, tingling, numbness, and weakness in the hands or feet. It occurs when high blood glucose levels damage your nerves.
It causes diffuse pain that affects every part of your body. No one knows the exact cause of fibromyalgia. That said, certain factors may increase the risk. These include Injury, genetic factors, and arthritis.
The FDA approved Cymbalta to treat long-term pain in the bones and muscles in 2010. Duloxetine is the only antidepressant approved for chronic pain treatment in the US.8
A physician may prescribe a drug for conditions other than approved by the FDA. Such type of practice is known as “off-label” use. The non-FDA approved uses of Cymbalta include:
Cancer treatments can damage nerves that lie outside the brain and spinal cord. CIPN causes a tingling sensation, pain, numbness, and increased sensitivity to high or low temperatures. Besides, some with CIPN may also have problems while writing or handling small objects.
SUI causes involuntary leakage of urine. It usually occurs when one sneezes, laughs, exercises, or stands up. One in three women in the US has SUI at least once in their lifetime.9
Duloxetine is not a controlled substance. Therefore, Cymbalta does not fall into any of the drug schedules. The Drug Enforcement Administration (DEA) classifies drugs into five schedules based on their abuse potential. The DEA does not consider Cymbalta a drug of abuse.
The DEA does not consider Cymbalta to be a drug of abuse. However, Cymbalta carries a risk of abuse and overdose.
Cymbalta does not cause euphoria like other addictive drugs. It can be one of the reasons why the drug is not considered addictive. However, Cymbalta lifts your mood and helps you calm down during stressful situations.
Yes. The risk of abuse is high if you have a history of drug abuse. People may abuse Cymbalta to experience stimulant and dissociative effects. Interestingly, many consider prescription drugs, such as Cymbalta, a safer alternative to street drugs.
Abuse means taking a drug in ways other than recommended. It can be anything from taking higher than the usual doses or more frequently than recommended. Cymbalta abuse is rare, but doing so can cause serious consequences.
A common way people abuse Cymbalta is by crushing or chewing the delayed-release capsules. Some people may open the capsules and mix the contents with food or liquids.
Animal studies show that using Cymbalta during pregnancy affects the fetus. Likewise, using the drug in the third trimester can cause complications in newborns. Some of these complications may require hospitalization and breathing assistance.
The newborns can have one or more of the following problems.
Bluish discoloration of the skin due to low oxygen levels in the blood
Low blood sugar levels
Unusual changes in body temperature
Increased or decreased muscle tone
Doctors do not recommend the use of Cymbalta in any trimester of pregnancy. Nonetheless, they may prescribe the drug if the benefits outweigh the potential risks.
Duloxetine is present in breast milk. It is not clear how the drug in the mother’s milk affects a baby. Thus, Cymbalta should be avoided by mothers who are nursing a child. A physician’s assistance should be sought for any concerns related to taking Cymbalta during pregnancy or while breastfeeding.
Duloxetine, the active drug in Cymbalta, is not considered addictive. But, whether or not a substance is addictive depends on many factors. Examples include an individual’s susceptibility to addiction, drug use behavior, and the drug’s ability to cause a “high.”
There are five key features of addiction. If a drug meets most of the five criteria, it may be considered addictive.10
An individual takes a drug to experience feelings of pleasure or high. It is the most common motive for initiating the addictive process. Other reasons could be a distraction from uncomfortable feelings, pain and stress relief, or coping with loneliness.
Cymbalta users have not reported addictive highs or any pleasurable feelings. That said, some users say they get amphetamine-like effects when they consume high doses of the drug. While the stimulant effects might be a motive for some users, it is rare and unlikely to cause addiction.
When addicted to a drug, a significant amount of time will be spent by the user to acquire and use the drug. Such preoccupation can affect their relationships and performance at work.
Recurring thoughts about drug use and its effects will be present. For example, a heavy smoker will probably report thinking about smoking many times a day. Seeing another person smoke or meeting friends may trigger the desire to smoke.
Cymbalta is unlikely to trigger addictive desires. Thus, the risk of addiction is small.
Tolerance develops when high doses of a drug are needed to achieve the effects that lower doses once provided. Those with depression may develop tolerance to Cymbalta. It is not clear if tolerance can lead to addiction in Cymbalta users.
Discontinuing Cymbalta can cause undesirable effects. Severe withdrawal happens when large doses are taken for prolonged periods. The risk of withdrawal is also high if you suddenly stop taking the drug. Cymbalta may cause withdrawal in short-term users.
Many addicted people continue taking drugs despite the harmful consequences. For example, long-term heavy drinkers fail to control their drinking habits even if it causes significant health problems.
Compulsive use, a hallmark of addiction, is not seen in those taking Cymbalta.
It may be concluded that Cymbalta is not addictive. That said, withdrawal is a significant issue in many users, which needs specialized medical care.
When used properly, the risk of fatal effects is low with Cymbalta. Rarely, the drug may cause life-threatening complications.
Duloxetine has been in the market for over 15 years. During this period, the American Association of Poison Control Centers reported only one death.11
A 2013 study reported the death of a 54-year old male taking Cymbalta for depression. The same study also reported behavioral changes and suicidal ideation in a 28-year old female.12
The FDA approves a drug only after it has passed several safety tests in humans and animals. Nonetheless, some medications have a higher risk of fatal complications compared to others.
Cymbalta can increase the risk of suicidal behaviors in people younger than 24. The drug can make depression worse, especially in the first few weeks of treatment. For this reason, the FDA requires Cymbalta to have a Black Box Warning (or boxed warning). A Black Box Warning informs doctors and users about the potentially dangerous effects of prescription medication.
It is imperative to consult a physician immediately while taking Cymbalta if you have suicidal thoughts or the symptoms of depression become worse.
High blood pressure
Difficulty falling or staying asleep
Consult a physician immediately if any of these symptoms arise:
Suicidal thoughts or attempts
The symptoms of serotonin syndrome. Serotonin syndrome occurs when there is too much serotonin in the body. It is a potentially life-threatening condition. Cymbalta overdose or mixing another antidepressant can cause serotonin syndrome. Symptoms include agitation, hallucinations, fever, sweating, and shivering.
Allergic reactions. Cymbalta may cause potentially fatal allergic reactions. Symptoms of an allergy include purple skin rashes, swollen tongue or face, blisters, and skin peeling.
Seizures. Cymbalta may trigger seizures if there is a history of seizures in the past.
Long-term use at doses between 80 and 120 mg per day is safe and unlikely to cause serious side effects.13 Nonetheless, some may have:
High blood cholesterol levels
Painful skin infection
There is limited information on duloxetine overdose and fatalities. The number of deaths has considerably increased since the drug became available in 2004. In 2004, only one death was reported. However, the number of fatalities climbed to 5 in 2005, 11 in 2006, and 14 in 2007.15
In 2013, there were 3,428 cases of duloxetine poisoning. This is according to the American Association of Poison Control Centers (AAPCC).16
A 2016 Annual Report of AAPCC’s National Poison Data System (NPDS) reported 4952 cases of poisoning involving duloxetine and other substances. Among them, 1714 cases involved duloxetine only, and death occurred in only one case.11
Taking about 1000 mg of duloxetine can cause death.17 This amount of drug is present in about seventeen 60-mg capsules, and can cause these symptoms:
Fast heart rate
Too low or too high blood pressure
Seek emergency medical care if a possible overdose has occurred. Call a doctor or the American Association of Poison Control Centers at 1-800-222-1222. Call 911 for severe symptoms.
No antidote for Cymbalta overdose is available. Cyproheptadine (Periactin) may help relieve serotonin syndrome.
In the emergency room, the doctor will first check breathing, heart function, and vital signs. They can also test a blood sample to check if other drugs have been ingested.
Treatments can include:
Cooling measures for serotonin syndrome
Maintenance of airway
Oxygen therapy and breathing machine (ventilator) to support breathing
Cleaning the stomach by inserting a tube through the mouth. This is known as gastric lavage. Gastric lavage is useful only if performed within a short period after ingestion.
Activated charcoal to prevent the drug from reaching the bloodstream
Severe cases often need treatment at an intensive care unit (ICU).
Abrupt discontinuation (or gradual dose reduction) causes unwanted effects called withdrawal symptoms. Withdrawal typically occurs when the drug levels in blood fall below 90% of the initial levels.
The half-life of duloxetine is about twelve hours. Thus, withdrawal symptoms will begin approximately 60 hours after the last dose. Cymbalta withdrawal may cause three types of undesirable symptoms. Some of these symptoms can be so severe that one may need to retake the drug.
Withdrawal usually lasts six weeks. Rarely, it may persist for several months or even longer.
These include symptoms not present before using Cymbalta, reducing the dose, or stopping the drug. The new symptoms appear 36 to 96 hours after the last dose. They typically go away on their own within 6 weeks.
Fast heart rate
Electric shock sensations
Rebound symptoms appear 36 to 96 hours after you have taken the last dose. They are associated with the original illness rather than the effects of Cymbalta. For example, if an individual is taking the drug for depression, their depression can become worse.
Common rebound symptoms are:
Most of these problems resolve within six weeks.
Persistent post-withdrawal disorders appear about six weeks after the last dose and can persist for several months. Persistent post-withdrawal disorders are similar to rebound symptoms. However, they are more severe.
Always consult a physician before stopping Cymbalta. The doctor will assess your condition and ask you to reduce the dose gradually.
There is no standard guideline on dose reduction (tapering). That said, most experts recommend tapering over two to six weeks.
Stopping antidepressants like Cymbalta is a step-by-step process. Consider the following to reduce the risk of severe withdrawal.
Consulting a doctor about how you are feeling and if you are ready to start tapering is the best recourse. A significant life event that might cause stress may delay tapering. The duration of tapering depends on the current dose, duration of use, and symptoms.
Tracking emotions is a great way to identify feelings. Keeping a mood journal to check how mood changes with tapering is a good idea, rating mood on a scale of one to ten every day. It is advised to notify the physician if there are any significant changes.
Talk therapy (psychotherapy) helps an individual stick to the treatment plan. It also helps replace their negative thoughts about drug use with positive ones. That way, psychotherapy reduces the odds of relapse and improves treatment outcomes.
A strong support network goes a long way towards helping cope with withdrawal. Besides talking to a doctor, sharing feelings with a relative or close friend is very helpful. Those who are the most intimate are often the first people who notice an individual’s mental problems. Reach out to an addiction treatment center to find out how they can help.