Cymbalta: Uses, Side Effects, Dosage, and More

Published March 6th, 2021 by Erik Rivera
Fact Checked by
Camille Freking
Medically Reviewed:
Dr. Gerardo Sison
Updated Date: Mar 18th, 2021

Cymbalta is a popular prescription drug that can be used to treat both mental health conditions and physical health conditions. While the conditions may not seem related at first glance, Cymbalta affects neurotransmitters in the brain that play a role in how the brain, body, and nerves communicate with each other. 

If you are one of millions of Americans suffering from common conditions like major depressive disorder, diabetic neuropathy, generalized anxiety disorder, chronic low back pain, or fibromyalgia, Cymbalta may be able to help relieve some of your symptoms.

What is Cymbalta?

Cymbalta is a brand-name prescription medication that is also available as a generic drug called duloxetine. Cymbalta is part of a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs), which are commonly used for the treatment of mental health conditions like depression and anxiety. 

The U.S. Food and Drug Administration (FDA) approved Cymbalta for the treatment of major depressive disorder in 2004, and it quickly became one of the most popular antidepressants on the market. Cymbalta should be stored at room temperature to keep its integrity. 

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What is Cymbalta used to treat?

Cymbalta was initially approved by the FDA for the treatment of major depressive disorder, also known as clinical depression. Since its initial approval, the FDA has also cleared Cymbalta for the treatment of a number of other conditions, including generalized anxiety disorder, chronic muscle or joint pain, fibromyalgia, and diabetic neuropathy. 

Clinical Depression/Major Depressive Disorder

Major depressive disorder, also known as clinical depression, is a type of severe depression that is characterized by intense and persistent feelings of sadness that occur over an extended period of time (at least two weeks or more). 

People experiencing major depressive disorder not only struggle with mental and emotional symptoms, but they also experience physical symptoms such as changes in appetite or sleep that can impact their quality of life. As a result, patients suffering from clinical depression often lose interest in activities that they previously enjoyed or struggle to carry out daily chores and activities. Some people also experience suicidal thoughts or behaviors. 

Common symptoms of major depressive disorder include:

  • Feeling sad or empty

  • Loss of interest in activities that were previously enjoyed

  • Difficulty concentrating

  • Low energy levels

  • Mood swings

  • Restlessness

  • Feelings of worthlessness, guilt, hopelessness, or helplessness

  • Sleeping and eating more or less than usual

  • Suicidal thoughts or behaviors

Generalized Anxiety Disorder

Anxiety is a natural part of life. Everyone experiences anxiety from time to time in response to stress, fear, or apprehension about certain events. While experiencing occasional anxiety is normal, anxiety can become a problem when the feelings become extreme, persistent, and disruptive. 

Patients who meet certain criteria for six months or more may be diagnosed with an anxiety disorder. Generalized anxiety disorder (GAD) is characterized by feelings of extreme anxiety that are not linked to a clearly identifiable cause. People who have GAD commonly experience symptoms like an increased heart rate, trouble concentrating,  rapid breathing, restlessness, and difficulty falling asleep.  Some people with GAD also experience an acute form of anxiety called a panic attack in which they may experience symptoms like dizziness, shortness of breath, dry mouth, restlessness, distress, fear, sweating, chills or hot flashes, apprehension and worry, numbness or tingling.

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Fibromyalgia

Fibromyalgia is a chronic condition characterized by unexplainable musculoskeletal pain that occurs throughout the body. While chronic pain is the most well known symptom of fibromyalgia, other symptoms commonly include sleep issues, mood issues, memory issues, and fatigue. 

Fibromyalgia often co-occurs with other problems like tension headaches, irritable bowel syndrome (IBS), anxiety, temporomandibular joint (TMJ) disorder, and depression. 

Researchers have not yet identified a clear cause for fibromyalgia, but they believe that the condition may result from improper processing of pain signals in the brain, which causes amplified feelings of pain throughout the body. Some people start to experience symptoms of fibromyalgia after a physical trauma or significant psychological stress.

Diabetic Neuropathy

People with diabetes who are unable to control their blood sugar levels may experience a type of nerve damage known as diabetic neuropathy. When uncontrolled for an extended period of time, high blood sugar can cause injury to the nerves in the body. 

Diabetic nerve pain is often experienced in the legs and feet. Other symptoms associated with diabetic neuropathy can include digestive issues, bladder problems, vision problems, and erectile dysfunction. 

How does Cymbalta work?

Serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta work to balance the brain chemistry by increasing levels of the neurotransmitters serotonin and norepinephrine. Serotonin and norepinephrine are critical in helping the brain to send messages back and forth, and adequate amounts of these chemicals in the brain are associated with an improved and stable mood. 

Additionally, these neurotransmitters may also play a role in the transmission of pain signals in the central nervous system and brain. When taking Cymbalta, patients who are currently suffering from depression or anxiety may notice an improved mood, a reduction in physical symptoms, and an increased interest in doing hobbies that they used to enjoy. 

These mood stabilizing effects are also potentially beneficial for people who experience depression and anxiety as a byproduct of other medical conditions, such as fibromyalgia. 

How do I know what dose of Cymbalta to take?

The right dose of Cymbalta for you will vary depending on your age, which form of the medication you take,  and what medical condition is being treated. Patients may need to adjust their dose several times under a doctor’s supervision in order to find the right dose to manage their symptoms. 

The standard treatment dose of Cymbalta for adults suffering from major depressive disorder starts at 40 mg per day, taken as one 20 mg release capsule twice per day. Some patients may eventually have their dose increased to 60 mg per day in the form of a 30 mg capsule taken twice a day or a 60 mg capsule taken once per day. Patients being treated for major depressive disorder should not take a dose of more than 120 mg per day.  

When used to treat generalized anxiety disorder in adults, Cymbalta is given at a starting dose of 60 mg taken once per day. Your daily dose for generalized anxiety disorder should not exceed 120 mg per day. Adults over the age of 65 may need to take a lower dose of the medication in order to determine how Cymbalta affects them before increasing their dose of the drug. Children may start Cymbalta at a dose of 30 mg per day before increasing to 60 mg per day, with a maximum of 120 mg per day. 

When used to treat fibromyalgia or diabetic neuropathy, most patients take Cymbalta at a dose of 60 mg once per day. There is no evidence to support that taking a dose higher than 60 mg per day yields any additional benefit or lowers the amount of pain a patient experiences.

The exact dosage of Cymbalta will be determined in collaboration with a healthcare provider. Cymbalta should only be used with a prescription. If you had a missed dose, do not take extra medicine to make up for it. If you are approaching the time for your time for the next dose, take it as usual. 

Does Cymbalta cause withdrawal symptoms?

Cymbalta is known to cause withdrawal symptoms in patients who take the medication for at least six weeks and discontinue or lower their dose abruptly. Withdrawal from Cymbalta can be a common occurrence. 

While gradually tapering down your dose may help, some patients may still experience withdrawal symptoms even when gradually discontinuing the medication as directed. 

However, withdrawing from Cymbalta under a doctor’s medical attention is typically recommended. 

Symptoms of Cymbalta withdrawal include:

  • Nausea

  • Dizziness

  • Muscle spasms or tremors

  • Headache

  • Drowsiness or fatigue

  • Increased sweating

  • Irritability

  • Insomnia

  • Electrical shock sensations

  • Depressive symptoms

  • Vomiting

  • Vivid nightmares

  • Paresthesias

  • Seizures

  • Feelings of anxiety

  • Malaise

Are there any side effects of Cymbalta I should be aware of?

Possible side effects associated with Cymbalta are typically characterized as either common or less common. Common side effects associated with Cymbalta include:

  • Dry mouth

  • Vomiting

  • Constipation

  • Diarrhea

  • Indigestion

  • Weight loss

  • Nausea

  • Headache

  • Abdominal pain

  • Tremors

  • Headache

  • Loss of appetite

  • Tiredness or sleepiness

  • Excessive sweating

  • Dizziness

Less common adverse effects that may occur in long-term users of Cymbalta include:

  • Seizures

  • Dangerously low blood pressure

  • Liver disease

  • Serotonin syndrome

  • This may not be a complete list of side effects.

Are there any risks associated with Cymbalta?

The two main risks associated with use of Cymbalta are the potential for physical dependence and an increased risk of suicidal thoughts and behavior in children, adolescents, and young adults suffering from major depressive disorder. 

Due to the potential for an increase in suicidal thoughts and behaviors, patients who have been diagnosed with major depressive disorder will need to be closely monitored while using the medication. 

Cymbalta is more likely to cause physical dependence than other drugs in its class. “Cymbalta Withdrawal Syndrome” is a term coined by medical professionals to describe the symptoms that are most commonly experienced when use of the medication is discontinued. 

While addiction to Cymbalta is unlikely, it is possible, and misuse of the drug does occur. Patients using Cymbalta to manage chronic pain are the most likely to abuse the drug, as they may take increasingly higher doses as their bodies begin to adjust to the medication. 

Signs of Cymbalta abuse include:

  • Slurred speech

  • Decreased appetite

  • Changes in sleep patterns

  • Noticeable weight loss

  • Financial problems

  • Lying about symptoms to get additional prescriptions

  • Bloodshot eyes

  • Sudden changes in hygiene and physical appearance

Who should not take Cymbalta?

Cymbalta has the potential to cause serious drug interactions in people taking medications known as monoamine oxidase inhibitors (MAOIs) or Mellaril (thioridazine). 

The use of other medications that affect the levels of serotonin in the brain, including SSRIs, SNRIs, lithium, tramadol, linezolid, sumatriptan, hydromorphone, phenelzine, and St. John’s Wort, should not take Cymbalta due to the increased risk of serotonin syndrome. 

People who experience an allergic reaction to Cymbalta or its active ingredient, duloxetine, should not take the medication.  

People with certain medical issues, including uncontrolled narrow-angle glaucoma should not use Cymbalta. 

People who have personal or family history of any of the following conditions should provide their doctors with a complete medical history prior to using Cymbalta:

  • Alcoholism or heavy drinking

  • Personal or family history of suicide attempts

  • Liver problems

  • Kidney or liver problems

  • Low or high blood pressure

  • Glaucoma (angle-closure type)

  • Personal or family history of bipolar disorder

  • Seizures

  • Taking nonsteroidal anti-inflammatory drugs (NSAIDS)

Adults over the age of 65 have an increased risk of experiencing serious side effects while taking Cymbalta, including bleeding and loss of coordination. People who experience a loss of coordination are also at an increased risk of falling. 

Summary

Cymbalta is a popular prescription medication with many applications for both mental and physical health issues. Cymbalta is commonly used for the treatment of major depressive disorder, generalized anxiety disorder, fibromyalgia, and diabetic neuropathy. Common side effects of Cymbalta include digestive upset, lightheadedness, dry mouth, and fatigue. 

Cymbalta is available in both brand name and generic forms and can be purchased at a discount using a pharmacy discount card from USA Rx.

Sources:

https://www.health.harvard.edu/a_to_z/major-depression-a-to-z 

https://www.drugs.com/dosage/cymbalta.html 

https://www.webmd.com/drugs/2/drug-91491/cymbalta-oral/details

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