Cymbalta: Does it Make You Gain Weight?
Dr. Angel Rivera
Millions of Americans suffer from common mental health conditions like major depressive disorder and generalized anxiety disorder, but many of these same individuals also suffer from conditions that cause chronic pain like fibromyalgia and diabetic neuropathy. For individuals suffering from multiple conditions, it is possible to find relief with just one prescription medication: Cymbalta. Like other drugs in its class, Cymbalta is highly effective at treating mental health disorders, but it does come with side effects. There is one major question everyone wants answered about Cymbalta: does it make you gain weight?
What is Cymbalta?
Cymbalta is a prescription medication that is also sold under the generic name of its active ingredient duloxetine. The drug belongs to a class of medications called selective serotonin and norepinephrine reuptake inhibitor antidepressants (SNRIs); this class of drugs is commonly used to treat depression and anxiety as they prevent the reuptake of serotonin in the central nervous system. Cymbalta has been an extremely popular medication since it was approved by the U.S. Food and Drug Administration (FDA) to treat depression in August 2004. Approximately 16.5 million prescriptions were written for Cymbalta in 2017, which makes it the 46th most commonly prescribed medication in the United States and one of the most popular antidepressants. Cymbalta should be stored at room temperature to keep its integrity.
What is Cymbalta Used to Treat?
Cymbalta was first approved by the FDA in 2004 for the treatment of clinical depression. Since that time, the FDA has also approved Cymbalta for the treatment of numerous other conditions, including general anxiety disorder (GAD) in adults and children who are at least seven years old, diabetic neuropathy, and fibromyalgia. A brief explanation of each of these conditions and their associated symptoms is provided below.
Clinical Depression/Major Depressive Disorder
Clinical depression, or major depressive disorder, is said to occur when a patient experiences persistent and intense feelings of sadness that last for a minimum of two weeks or more. Major depressive disorder can impact every aspect of a person’s life, from emotional symptoms that impact mood and behavior to physical symptoms that cause changes to appetite and sleep. It is common for patients with clinical depression to lose interest in doing activities that they once enjoyed, have difficulty carrying out daily tasks, or have suicidal thoughts and tendencies. The following symptoms are associated with clinical depression:
- Feeling sad, empty, or tearful
- Nervous energy
- Feelings of moving or thinking in slow motion
- Lost of interest in activities you used to enjoy
- Difficult concentrating and low energy
- Mood Swings
- Feelings of worthlessness, guilt, hopelessness, or helplessness
- Sleeping and eating more or less than usual
- Suicidal thoughts or behaviors
General Anxiety Disorder
When our bodies experience stress, we naturally develop fear or apprehension about what is to come, which is called anxiety. Anxiety is commonly experienced by all people at various points in their lives, but sometimes, it becomes so pervasive and intense that it becomes a mental health condition. Anxiety is defined as a mental health issue when the feelings are extreme, last longer than six months, and interfere with your life. Generalized anxiety disorder is one of the most common disorders and is characterized by unexplainable anxiety or panic that has no obvious source. Symptoms of generalized anxiety often include an increased heart rate, rapid breathing, restlessness, trouble concentrating, and difficulty falling asleep.
Patients with diabetes who are unable to control their high blood sugar often experience diabetic neuropathy, a type of nerve damage caused by the long term effects of high blood sugar. When left uncontrolled for extended periods of time, high blood sugar can cause injury to the nerves in the body. Diabetic neuropathy is most commonly experienced in the legs and feet; however, symptoms can also include digestive issues, urinary tract problems, or problems with the heart or blood vessels.
Fibromyalgia is a chronic condition in which patients experience unexplainable widespread musculoskeletal pain. Fibromyalgia symptoms include unexplained pain that spreads throughout the body, memory issues, mood issues, tension headaches, fatigue, sleep issues, temporomandibular joint (TMJ) disorders, irritable bowel syndrome (IBS), anxiety, and depression. The cause of fibromyalgia is currently unknown, but researchers think that the pain may result from improper processing of pain signals in the brain, which causes the body to amplify sensations of pain. It is common for people to begin to experience fibromyalgia symptoms for the first time after a physical trauma or significant psychological stress, but in other cases, symptoms may slowly build over time.
You can also take Cymbalta to treat other types of chronic musculoskeletal pain, such as that associated with arthritis, back pain, and diabetic peripheral neuropathic pain. Make sure you seek medical advice of a doctor before you start.
What Dosage of Cymbalta Should I Take?
The proper dose of Cymbalta for each patient is determined based on the patient’s age, the condition being treated, and other underlying health conditions that the patient may have. Like other SSNRIs, the dose of Cymbalta a patient is prescribed may need to be adjusted several times before it is just right. When treating clinical depression, most adults start with an initial dose of 40 mg per day, taken as one 20 mg release capsule twice per day. Over time, your doctor may choose to adjust your dose to 60 mg, given either as one 30 mg capsule twice per day or one 60 mg capsule taken once daily. The daily maximum dosage for clinical depression should not exceed 120 mg per day.
Adults with generalized anxiety disorder typically start with an initial dose of one 60 mg Cymbalta capsule per day. The maximum daily dose of Cymbalta when used to treat generalized anxiety disorder is 120 mg per day. Older adults may need to start with an initial dose of 30 mg and assess the effects before considering an increase to 60 mg once per daily at their doctor’s discretion, as older adults are more likely to experience side effects of the medication. Children taking Cymbalta will start at an initial dose of 30 mg per day before increasing to 60 mg per day, with a maximum dose of 120 mg per day.
When taken for the treatment of diabetic peripheral neuropathy or fibromyalgia, the maintenance dose of Cymbalta is typically 60 mg taken once per day. There is no evidence to support that taking a dose higher than 60 mg per day yields any additional benefit to the patient.
If you had a missed dose, do not take an extra dose of Cymbalta to make up for it. If you are approaching the time for your time for the next dose, take it as usual.
Does Cymbalta Make You Gain Weight?
Unlike other antidepressants, which are sometimes associated with unwanted weight gain, Cymbalta is more likely to cause weight loss, particularly when used for shorter periods of time. A recent study found that patients treated with Cymbalta experienced weight loss after short term treatment with the drug lasting eight to nine weeks. When taken for longer periods of time, such as 26, 34, and 52 weeks some patients reported modest weight gain while taking Cymbalta. However, overall, the medication was found to have minimal effects on weight for the majority of patients when compared to the placebo. Therefore, patients taking Cymbalta are likely to experience weight loss during the first weeks of taking the medication but may experience a modest weight gain of approximately 2.5 pounds after one year of taking the medication. Overall, effects on weight are considered negligible.
Are There Any Side Effects Associated With Cymbalta?
Possible side effects associated with Cymbalta generally fall into two categories: common and less common. Common side effects associated with Cymbalta include:
- Dry mouth
- Low blood pressure
- Weight loss
- Excessive sweating
- Eye pain
- Muscle weakness
- Loss of appetite
- Tiredness or sleepiness
- Bruising easily
- Abdominal pain or stomach pain
- Skin rash
Less common adverse effects that may occur in long-term users of Cymbalta include:
- Liver disease or damage in individuals who mix the medication with alcohol
- Frequent Urination
- Sexual dysfunction
Are There Any Risks Associated With Cymbalta?
Cymbalta use is associated with several risks, but the most prominent is the increased risk of suicidal thoughts, and behavior in children, adolescents, and young adults suffering from clinical depression. Younger patients suffering from clinical depression should be closely monitored while taking Cymbalta for suicidality.
Cymbalta also has a high likelihood, compared to other serotonin-norepinephrine reuptake inhibitors, of causing physical dependence. The term “Cymbalta Withdrawal Syndrome” was coined by healthcare professionals to describe the condition symptoms associated with withdrawal from the drug. Symptoms of Cymbalta withdrawal include:
- Insomnia (trouble sleeping)
- Muscle spasms or tremors
- Depressive symptoms
- Feelings of anxiety
- Vivid nightmares
- Drowsiness or fatigue
- Increased sweating
- Electrical shock sensations
It is unusual for patients to become addicted to Cymbalta, but it is possible, and the drug can be misused. In order to avoid the uncomfortable withdrawal symptoms associated with Cymbalta Withdrawal Syndrome, some people begin taking increasingly high doses of the medication. Signs of Cymbalta abuse include:
- Slurred speech
- Bloodshot eyes
- Noticeable weight loss
- Sudden unusual changes in hygiene and physical appearance
- Decreased appetite
- Lying about symptoms to get additional prescriptions
- Financial problems
- Changes in sleep patterns
Possible drug interactions may result from combining Cymbalta with prescription or over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, SSRIs like fluoxetine or paroxetine, monoamine oxidase inhibitors (MAOIs), St. John's Wort, tramadol, linezolid, ciprofloxacin, thioridazine, quinidine, propafenone, fluvoxamine, flecainide, buspirone, blood thinners, amphetamines, tryptophan, triptans, tricyclic antidepressants, and methylene blue.
Cymbalta should generally not be combined with other serotonin-affecting drugs, especially in the treatment of major depressive disorder, due to the possibility of serotonin syndrome. Some symptoms of serotonin syndrome include loss of muscle coordination, excessive sweating, headache, shivering, goose bumps, and more. Serious side effects that can be life threatening include high fever, seizures, irregular heartbeat, and unconsciousness.
Starting Cymbalta should be discussed with a healthcare provider especially in the case of breastfeeding (as it can pass into breast milk), narrow angle glaucoma, psychiatric disorders such as bipolar disorder that involve manic episodes, a history of liver damage, liver problems, or liver injury, or have a history of high blood pressure.