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Duloxetine Withdrawal: Symptoms, Timeline, and Treatment

Duloxetine, an FDA-approved generic antidepressant prescription medication sold under the brand name Cymbalta, is commonly used for the treatment of mental health issues such as major depressive disorder and generalized anxiety disorder,  diabetic neuropathy and associated nerve pain, fibromyalgia, chronic musculoskeletal pain and chronic pain in the joints. 

Duloxetine belongs to a class of drugs called selective serotonin-norepinephrine reuptake inhibitors (SSNRIs). Like other medications that can affect the chemistry of the brain such as SSRIs, duloxetine is commonly associated with some withdrawal symptoms. 

Duloxetine withdrawal is so common that nearly half of all patients may experience symptoms when discontinuing use of the medication.

Who is likely to experience symptoms of duloxetine withdrawal?

The risk of experiencing Cymbalta withdrawal symptoms associated with serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine or venlafaxine varies depending on how long a patient has been using the drug, what dose of the medication they take, and their unique medical history. 

Patients who have been taking duloxetine for at least four weeks are considered to be at risk of experiencing withdrawal symptoms due to the way the drug acts on the receptors of serotonin and norepinephrine in the brain. 

While many patients experience withdrawal symptoms when discontinuing the use of duloxetine, most patients are not aware that these symptoms can occur unless their doctor informs them. This is because unlike medications that can cause an obvious physical dependence, such as central nervous system stimulants or opioid pain medications, SNRIs like duloxetine act on the chemicals in the brain. 

If you’ve been taking duloxetine for more than four weeks, you will need to gradually reduce your dose of the medication under the medical advice of a healthcare professional in order to prevent or minimize withdrawal symptoms, also known as Cymbalta discontinuation syndrome. 

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What are the symptoms of duloxetine withdrawal?

Like other medications that affect the balance of neurotransmitters and chemicals in the brain, duloxetine is associated with a number of different withdrawal symptoms. 

Other medications that are also classified as SNRIs, like duloxetine, are also commonly associated with withdrawal symptoms. 

Symptoms of duloxetine withdrawal and SNRI withdrawal may include:

  • Nausea

  • Dizziness

  • Muscle spasms or tremors

  • Headache

  • Irritability

  • Vomiting

  • Anxiety

  • Insomnia

  • Drowsiness or fatigue

  • Increased sweating

  • Tingling or prickling shock sensations

  • Electric shock-like sensations called brain zaps

  • Seizures

  • Depression

  • Confusion

What is the timeline for duloxetine withdrawal?

Each person’s chances of experiencing duloxetine withdrawal are slightly different and will vary depending on the person’s age, the condition being treated, the dosage of the medication, and how long they have been taking the drug. 

A review of six different studies of patients discontinuing the use of duloxetine found that 44.3 percent of people stopping use of the drug experienced withdrawal symptoms, while nearly 23 percent of people taking the placebo experienced withdrawal symptoms. 

Symptoms of duloxetine withdrawal typically appear within two to four days of stopping use of the drug, and 65 percent of participants in the study reported that their withdrawal symptoms ended within a week of when they began. 

However, some patients may experience symptoms for up to a few weeks. Most symptoms of duloxetine withdrawal were reported to be mild or moderate.

What treatment is available for duloxetine withdrawal?

Tapering the dose of duloxetine, a strategy which involves gradually reducing your dose of the medication over time instead of abrupt discontinuation or quitting "cold turkey," may be helpful for minimizing the symptoms of duloxetine withdrawal that a patient experiences. 

However, studies show that tapering alone may not completely stop withdrawal symptoms from appearing. If you or a loved one decide to taper down your dose of the drug in order to prevent withdrawal symptoms, you can expect to taper the medication under the guidance of a medical professional for at least two weeks. 

Most patients will not need to take additional medications in order to resolve symptoms resulting from duloxetine withdrawal, and inpatient treatment is uncommon. However, duloxetine is associated with severe withdrawal symptoms, so discontinuation of the drug should only occur under the supervision of a doctor. 

Patients may find comfort in seeking support through an online group of people going through similar experiences or from family and friends.

Summary

Duloxetine has a well-documented history of causing significant withdrawal symptoms in some patients. Studies have shown that nearly half of patients discontinuing use of the drug will experience side effects of duloxetine withdrawal. 

The most common duloxetine withdrawal effects include headache, nausea, and dizziness, but most patients find that their symptoms are mild to moderate and resolve within a week. Other adverse effects of duloxetine include changes in blood pressure, suicidal thoughts, mood swings, and dry mouth. Rare cases may develop a deadly condition called serotonin syndrome. Talk to your doctor to see if duloxetine is right for you. 

Sources:

https://pubmed.ncbi.nlm.nih.gov/16266753/ 

https://www.webmd.com/drugs/2/drug-91490-2114/duloxetine-oral/duloxetine-sprinkle-capsule-oral/details 

https://www.karger.com/Article/FullText/491524

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