A bottle of generic delayed-release Duloxetine (Cymbalta) 30 mg

From what we hear from readers of our syndicated newspaper column and visitors to this website, most patients are not warned about how to stop duloxetine (Cymbalta). Perhaps the prescriber assumes that they will need to take this antidepressant for the rest of their lives. Or perhaps there is a reluctance to mention anything negative about a new prescription. Whatever the motivation, a lot of people are not adequately warned that they must never stop duloxetine suddenly.

The Many “Indications” for Duloxetine:

The FDA originally gave Cymbalta the green light for treating major depression in 2004. The drug has also received FDA approval for nerve pain (neuropathy) triggered by diabetes. In addition, the FDA has granted duloxetine approval to treat anxiety, the discomfort of fibromyalgia and the musculoskeletal pain brought on by arthritis or lower back injury. It works by affecting the neurotransmitters serotonin and norepinephrine.

On the surface, duloxetine seems like an ideal drug. It will ease your pain and relieve any related depression. Not surprisingly, Cymbalta became very successful. Today, the generic duloxetine formulation is prescribed quite frequently.

Duloxetine Side Effects:

There is a long list of significant side effects associated with Cymbalta. You can find them at this link.

Powerful Stories from Readers:

Kent in Oregon has the worst of both worlds: Side Effects and Withdrawal Symptoms:

“I am a 50 year old college honors grad, U.S. Marine and a retired homicide detective. I began taking Cymbalta to combat the effects of stress and depression associated with my constant exposure to the worst society has to offer.

“I have been taking it for about 15 years and now have symptoms I would trade for those that put me on Cymbalta in the first place. Each time the Veteran’s Healthcare Administration has failed to send my refills in the mail, it takes just 48 hours for the most terrible withdrawal symptoms to reappear.

“I experience horrible shakiness, uncontrollable, inappropriate and sudden bursts of tears, irritability and snappy moodiness, appetite problems and more. The worst of all my withdrawal symptoms, however, are the electrical shorts or zapping sensations in my brain. It literally feels like it shoots across my head and makes my brain bounce and eyeballs wobble. I find that it progressively worsens day after day while I wait for VHA to do their job and send the next bottle of capsules.

“There are symptoms that I get from taking the capsules as well, including erectile dysfunction, appetite changes, severe dry mouth, and MAJOR tinnitus [ringing in the ears]. The worst two are massive anxiety and sweating anytime I am in public or have even the slightest thought of things that are stressful for me.

“As a cop, I always thought anxiety was something people made up and used to escape work, or some other unpleasant task. Now I know it’s very real and has completely destroyed my public life. Standing in ANY store checkout line is a guaranteed shirt-soaking, sweat-filled-eyeballs experience for me.

“At one time, I was an over-achiever and a rising star in my profession with national awards and recognition, but now I live alone, have lost my family, friends, my personal belongings and even my home. I’m now stuck on a drug my brain cannot live without in a system with no reasonable means for discontinuation whatsoever.”

Sweating is a recognized side effect of duloxetine, along with hot flashes.

Martha in Texas shared a similar experience:

“I’ve been on Cymbalta since 2010 for fibromyalgia. Stupid me! I’m the one who asked my doctor to put me on it, since I saw it advertised on TV. The commercial said that it helps with pain!

“I was tired of the hot flashes and my ears ringing! And feeling like I was a robot! I had a lot of ‘brain farts’ where my mind would stop with a blank and couldn’t get my words out. I decided it was time to get off of Cymbalta.

“Getting off Cymbalta is horrific! Like so many others, I too am experiencing light-headedness, dizziness, and brain zaps. I describe it…when my eyes move my hearing zings while my brain zaps. I’m so tired and can sleep 12 hours at a time. I just don’t feel like myself.

All of this is affecting my job performance. I really need help, and I don’t care what it takes. Somehow or other, I’m getting off this awful drug!”

How to Stop Duloxetine (Cymbalta):

First, and we cannot emphasize this enough, NEVER stop duloxetine on your own. This requires very careful medical supervision. The prescriber must be informed of any plans to stop this drug. That said, the official prescribing information does not provide health professionals or patients much detailed guidance on how to stop duloxetine (Cymbalta).

Official Prescribing Information:

The FDA requires the following wording in the package insert. This is the officially sanctioned information hammered out between the drug manufacturer and the Food and Drug Administration. See what you think:

“Discontinuation symptoms have been systematically evaluated in patients taking CYMBALTA. Following abrupt or tapered discontinuation in adult placebo-controlled clinical trials, the following symptoms occurred at 1% or greater and at a significantly higher rate in CYMBALTA-treated patients compared to those discontinuing from placebo: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis [excess sweating], and fatigue.

“During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric [bad] mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Although these events are generally self-limiting, some have been reported to be severe.

“Patients should be monitored for these symptoms when discontinuing treatment with CYMBALTA. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.7)].

2.7 Discontinuing CYMBALTA:

“Adverse reactions after discontinuation of CYMBALTA, after abrupt or tapered discontinuation, include: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible [see Warnings and Precautions (5.7)].”

FDA’s Guidance on How to Stop Duloxetine (Cymbalta)?

So, what do you make of the official prescribing information? Do you feel as if you might be caught on the cusp of a Catch 22 situation? The FDA and the company acknowledge that “intolerable symptoms” may occur upon “discontinuation of treatment” or even a “decrease in dose.” The solution: resume the previously prescribed dose. Then “continue decreasing the dose but at a more gradual rate.”

We did not find any actual guidance on how to stop duloxetine (Cymbalta) gradually. For one physician that might mean over a week. For another health professional, “gradual” might be interpreted as a month. But the company and the FDA seem to be very careful not to provide clear and concise recommendations. That means that physicians are pretty much on their own and that leaves patients vulnerable to all sorts of complications.

a bottle of Cymbalta 20 mg

Withdrawal Stories from Patients:

Cindy in Dickson, Tennessee went through hell:

“I have been on Cymbalta for about 2 years. I recently ran out and didn’t have the money to refill my prescription. It’s been 6 days. My body hurts, I feel like I’m sweating from inside, upset stomach, whooshing in my head and brain zaps.

“Yesterday, which would have been day 5, I could barely move. I was very sick to my stomach and throwing up. I was going to refill it today cause I had 1 refill left but it expired on 5/19 so I couldn’t refill it.”

Angela in Palo Alto, California, had a similar experience:

“I’ve been on Cymbalta for the past 6 years for depression. My new insurance would not pay for my meds without a prior auth. I’ve been waiting for a month for my Dr. to handle the paperwork.

I’ve been so sick. Headaches, sweating, thoughts of killing myself, hostility, crying, not sleeping, feeling of everyone around me is gonna die, can’t think clearly, the runs, chest hurting, wheezing, and so much more! I finally got my thoughts right for me to look up Rx discount today. I’ll be getting my meds tomorrow. Thank God!

JoAnne in New Market, Ontario, adds:

“I came off Cymbalta two weeks ago. Oh My God! I don’t mind pain, but this is sick.
I have nausea, runs, stomach pain and headache.

“Well at least I don’t have thoughts of suicide. One minute I am cold and the next hot and feverish. Some times light hurts my eyes. I have gas, burping and farting.

“Then I have moments of wanting to just break down and cry for no reason at all. Chills. I am having a bad moment now. I just want to go to bed and stay there until it all passes and God I hope this passes soon. Shortness of breath. Please tell me it will end soon.”

There is no way to predict how long withdrawal symptoms will persist for any given individual. Some people tell us that after several weeks of unbearable symptoms, things gradually begin to smooth out. Others tell us it takes months. That is why it is essential never to do this on your own or suddenly.

Nancy in Florida was taking a different antidepressant: citalopram (Celexa). Here is what she reports:

“I was on citalopram for many years. More than one doctor tried to tell me that there were no side effects if you quit. More than one time I tried to go off but would have major crying spells and irritability.

“I finally got off of it by taking 2/3 of a pill for one month, then 1/2 of a pill for 1 month, then 1/3 of a pill for 1 month, then 1/4 of a pill for 1 month. Then I went to 1/4 of a pill every other day for a month, then every third day, etc. It was an incredibly slow process but did not cause any problems.”

Kassandra in Arizona had physician support:

“I am currently on duloxetine for my extreme nerve pain related to sciatica. When I asked my doctor about the reported difficulty of stopping duloxetine, she said that she would put me on a different drug while I reduced the duloxetine, and that it would reduce the side effects. She also said that it can take months to get off it completely, and should not be rushed.”

How to stop duloxetine (Cymbalta) from “Hopeful” in Indiana:

“Getting off of Cymbalta was the hardest physical thing I’ve ever done in my life. Many doctors don’t realize how difficult it is or that you have to taper – mine did not.

“I found A LOT of help online — my withdrawals were so difficult, I’m not sure I would have survived if I had not found all the online resources and other people’s stories of how difficult getting off of it was and the techniques they used.

“What I did, safely and carefully, was actually open the capsules and count the beads in order to taper down. (Cold turkey is horrible and was simply not do-able for me!) This counting of the ‘beads’ was detailed in many places online.

“I went down VERY slowly and this greatly minimized the horrors of cold turkey. I think I took 3 solid months to go off of it completely. I took a LONG time to phase off this drug. Even then, I had bad side effects and my brain didn’t ‘heal’ completely for 9 months. I had bad memory problems, extreme difficulty with logical thinking, exhaustion, physical aches, and more. BUT I DID get better finally; it was just a very long, painful journey.

“Now I continue to experiment and research and have had successes with natural alternatives to a prescription antidepressant. I understand deeply how much antidepressants are needed for some people, but after my terrible experience with going off of Cymbalta, I hope to not use one again. (And the fact that the manufacturer doesn’t make a tapering dose/pack is unbelievable given the bad results of cold turkey.) I have much sympathy for you and urge you to search online regarding how to best go off Cymbalta. I wish you well. Hang in there – it can be done!”

We are grateful for “Hopeful” in Indiana for her guidance. Many visitors to our website have successfully tapered off duloxetine by removing a few pellets from the capsule each day. Some have gone so far as to remove only one a day for awhile until the body adjusts. Because duloxetine comes in a capsule with tiny pellets or beads containing the active drug, it is actually possible to lower the dose very gradually over a period of many months. If symptoms show up, a slight increase in the dose may suppress the discomfort.

An Alternate Approach from a Physician:

We were contacted by a board-certified family physician who specializes in pain and addiction. He reports that:

“The best way to stop this drug is to put the patient on fluoxetine (Prozac) for one to two weeks. You then stop the Prozac. Prozac is so long lasting that it gradually decreases blood levels slowly enough so that the discontinuation syndrome doesn’t happen.

“This is simple and inexpensive. It is important, as you say in your article, that people do not stop this medication [duloxetine] on their own. However, it is not necessary to go through the ‘Chinese water torture’ by such a prolonged and unnecessary tapering regimen.

“Since most physicians do not know this simple trick, it is up to the patient to ask their physician to use the simple method.”

Once again, we recommend this be supervised by a physician who is knowledgeable and sympathetic. Some people may be successful with the prolonged tapering regimen described by “Hopeful.” Others may find the fluoxetine substitution for duloxetine a helpful strategy under close medical supervision. Because each person responds differently, we hope that the health professional who assists in this process is patient and understanding.

Here are some links to other articles to consider:

Stopping Duloxetine (Cymbalta) Suddenly Flipped her Out

Stopping Cymbalta Suddenly Triggered Emotional Roller Coaster Ride

Stopping Cymbalta Suddenly Led to Disaster

Reader Enraged by Advice about Stopping Cymbalta

Share your own duloxetine (Cymbalta) story in the comment section below:

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  1. Anne J.

    I’m thankful to have found this article, and these comments. Other websites are quite a few years older and I needed to find some current commentary. I’m on day 16 of no Cymbalta, after having slowly tapered down from the max dose to the lowest dose over a couple of years. I think I may have reached my limit for tolerating the withdrawl. There is no need for me to go into what I am experiencing, because everything that is written here is what I am experiencing. I was actually handling the zaps, the screaming in my ears, the dizziness and sweating tolerably well, but these past few days have seen me hit an emotional low. I’m so angry and abrupt that I’m worried I will hurt relationships and my career. I’m starting to worry that this is my true personality and that duloxitine has just been masking the real me – but that simply can’t be true, I’m a really nice person. (I was on Effexor previously, Cymbalta was prescribed to me as a better alternative). At this moment I’m not sure what to do – it would crush me to give in – but I think I may have to try counting beads. Thanks to everyone for sharing your stories because it helps to know that I’m not alone and I’m not crazy.

  2. Evelyn

    I uses Dramamine to combat the withdrawal symptoms of Cymbalta.
    I was given generic Cymbalta for lower back pain. If I had known how hard it would be to stop taking it, I would have lived with the pain until my fusion surgery was approved. I did not take the Cymbalta while in the hospital and did not think I needed to take it anymore. A few days after returning home, I started to have many of the symptoms discribed by so many others. At first I thought my Vertigo had returned and went to my Primary Physician. He prescribed something for the dizziness and nausea. Neither worked. It wasn’t until I remembered an article about Cymbalta that I figured out what is actually was. I contacted my PC and we worked out a schedule to slowly reduce the dosage. The process would have taken at least six weeks and still was not 100% guaranteed. I did not want to wait that long. I realized the headaches, dizziness, nausea and other symptoms were very similar to how I felt when I was sea sick. I stopped taking the Cymbalta and replaced it with two Daytime Dramamine in the morning and two regular at bedtime. I did this for about three weeks and had no withdrawal symptoms. I stopped taking Dramamine two weeks ago and feel fine. I hope this information can help someone else.

  3. LSK

    I am a 57 year old female. I started taking Cymbalta 9 years ago for jaw pain (jaw migraine) after trying many other medicines. I believe the jaw pain was caused by an estrogen patch. This was the only patch that didn’t cause a migraine. Even after stopping the estrogen, the jaw pain lived on. I also had undiagnosed Celiac (all of my life) and Chronic Lyme Disease (37 years). So my medical issues are complicated. I have been having muscle spasms/cramps for most of those 9 years. Lately, the muscles issues are unbearable due to new Lyme treatments. Dead Lyme bugs can cause muscle spasm/cramps, so I thought nothing of it. I discovered that the Cymbalta was magnifying the spasm/cramps to a horrific level. So over the last 10 weeks, I have been weaning myself down.

    After this last treatment, I have not been able to take my lowest dose of 20mg Cymbalta due to spasms/cramps. I feel like my head is going to explode, and I am going to vomit, in addition to the Herx Reaction from the dead Lyme bugs. The withdrawal is so much better than muscle spasms/cramps side effects of the Cymbalta. Today, I found that Benadryl helps with the head issue. Very small snacks of protein help with the nausea. I might be able to take Cymbalta after this Herx Reaction, but I think I have been sensitized to Cymbalta now and never want to ever take it again. I hope I can handle the jaw migraine in the future. The pain is so bad that luckily I can’t feel pain in my jaw right now.

  4. Mike
    New York

    I have been on Cymbalta for idiopathic nerve pain for over ten years (I believe since it’s been on the market). I have tried several times to get myself off of the drug but have been beaten back by all of the negative symptoms mentioned. I am in the midst of stepping down again and I am committed being rid of it.
    I’m aware that an attempt to create a class action suit against Eli Lily recently failed in California. It’s shocking that Lily can proclaim that only 1% of patients suffer from these symptoms. I would be interested in finding how this study was done since it would only include people who stopped their drug. It seems as if the many online comments that I seen account for more that 1% .

  5. Ida

    I started having back pain three years ago. I took Gabapentin for my back pain for two years and had no side effects. About eight months ago my doctor put me on Cymbalta because he thought it might help me with my depression and back pain. He put me on 30mg Cymbalta. When I started it I was very sick with nausea, dizziness, constipation and stomach pain for awhile.

    After a few months that I was on it, I realized it’s not helping my pain/depression. But I was having brain zaps that was so difficult to tolerate. It was hard for me to remember my words and my stomach pain and discomfort was too bothersome. So I asked my doctor how should I get off of Cymbalta. He said take it every other day. I tried that and the symptoms were intolerable. Then I read some of people talking about decreasing the amount very gradually. I’ve been doing that and for two months now. I’m at 1/4 of a capsule a day. I will continue taking it like this for two weeks and try to get out of. Hopefully without getting si k to my stomach.

    As someone else said it “Cymbalta should be illegal”. If FDA was concern about people, they would get rid of this medicine for good.

What Do You Think?

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