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. Angela
    NC
    Reply

    I took Cymbalta for over 5 years, but felt it was no longer helping me and decided I wanted to stop taking it. I also moved to another state around this time and lost my doctor, so I really had no help in developing a plan for discontinuation or a doctor to help me through it. I tried to stop taking it cold turkey, but I discovered quickly that it wasn’t the best method. Almost immediately, I started to feel like I had the flu. I was achy and dizzy and felt nauseated all the time. But the worst symptom of all was the night terrors. I had Freddy Kruger style nightmares that were so bad, I was afraid to sleep. I started taking it again as prescribed and called my local pharmacy for help.

    The local pharmacist was extremely helpful in helping me develop a plan for how to discontinue Cymbalta safely. It was a royal pain in the rump, and it took SIX MONTHS for me to get off it completely. It involved opening the capsules and decreasing the amount of little balls in each capsule. The pharmacist told me I could pour the contents of the capsules into yogurt or cottage cheese and take it that way. I also did a lot of research on the internet and found some helpful discussion threads.

    I will say that, although it was slow getting off it, I had ZERO withdrawal symptoms. If someone is looking for a good way to discontinue Cymbalta, call your local pharmacy for advice on how to taper off the capsules. I’ve been Cymbalta-free for over a year now, and I’ve had no problems.

  2. Sue
    Reply

    Here are some more that cause discontinuation symptoms.

    One is Paxil. I should have never let myself get talked into taking that stuff in the first place. It caused substantial weight gain, despite a diet and exercise regimen. It also caused daytime sleepiness. My doctor gave me a tapering chart, and then went out of town. One day at work, I had a sudden, I mean sudden onset of several unpleasant symptoms at all once. Nausea, dizziness, severe anxiety, the sensation I was moving in ‘slow motion’, and the people at work told me I had no color in my face.

    I carefully drove home, called the Dr.’s office, and they told me to take 2.5 mg valium. This happened on a Friday; instead, I took 5 mg every six hrs, cancelled all my activities for the weekend and toughed it out for several more days. Then things evened out. Paxil has a short half-life, so the stuff leaves your system quickly. When I described the severity of my symptoms, my doctor had the nerve to tell me I was exaggerating. Too many doctors don’t have a clue on how to get their patients eased off these drugs.

    I’m taking the long route with gabapentin, and made my own chart. I started April Fool’s day, 2017, and I’m still tapering. I was on 900 mg; now I’m down to 100 mg every other day. It hasn’t been a breeze, but I haven’t had the nightmarish experiences I’ve heard from others. My plan is to be completely free of this drug by mid-July 2017.

    The worst time I had discontinuing a drug was stopping Prilosec, a heartburn medicine. I did this under a doctor’s supervision, and it was still awful. It took a total of 5 months, and a heap of rebound heartburn. Even after that, I had to watch my diet carefully. I still take an acid reducer because my doctor wants me to, but rarely get heartburn. One reason I rarely have problems is I lost 30 pounds. This is one of the single best things people can do for themselves to reduce and possibly even resolve their acid reflux symptoms. This is one I wouldn’t recommend trying to do alone – you’ll need your doctor’s help. Along with the acid reducer, a generic for Pepcid, I kept almonds and papaya enzyme tablets handy. A few almonds does a great job, and the papaya enzyme is good too. You can get it a Whole Foods and other health food stores. I’ve read about the mustard and vinegar remedies; I’m skeptical about trying to fight acid with more acid.

    If you don’t think you’re in charge of your healthcare, take a look at your checkbook and your insurance premiums. Good luck and good health to everyone.

  3. Francy
    CT
    Reply

    Somewhere in the mid 1990’s, I mentioned to my podiatrist that I had restless legs. He put me on Cymbalta. I didn’t know of all the other things it is reported to help. At some point, I was switched to Duloxetine and I think the symptoms of the brain buzz are worse on this one. If I miss one day I get those buzzes.

    So, now years later I am a type 2 diabetic and my GP said the duloxetine was probably the best bet to help with neuropathy and my arthritis. I don’t like taking something that is so hard to stop taking. Heaven forbid that I am not able to afford this – stopping abruptly would be a disaster.

    Or, as in the case of my husband in the ER or another nursing home after an incident related to his 8-year survival from a major stroke – the Doc took away all meds for several days – horrible and then they might start him on the ones they like instead of the ones that had been successful for his condition.

    I don’t know how to feel about this drug and whether or not I really need to take it. I’m seeing my diabetic doctor soon and will ask his opinion.

  4. Jane
    New York
    Reply

    I was on 120 mg of cymbalta for years. For the last 4 to 5 years I developed involuntary movements (chattering teeth, teeth snapping shut, severely biting into tongue, hand tremors, jerking of arms and legs) so I finally asked my MD to take me off. He started me on a reduction that was way more than I could tolerate, resulting in severe depression, inability to function, brain zaps, balance problems, memory problems and more. Only by reading online anecdotal reports from fellow sufferers did I finally get off after 11 months and more suffering than I care to describe, by removing 3 pellets from a capsule every ten days and taking Abilify for the first 5 days of every reduction. After finally getting off, I found myself crying at every little thing for weeks, and brain zaps continued. Online accounts were the only help available. Thank goodness for them.

  5. Cindy M. Black
    Reply

    Regarding the above comments and the case studies cited: HORRIBLE! There’s no way to believe these are just isolated cases, anomalies. The doctors who put these poor people on this drug and did not fully educate them of the associated addiction and withdrawal problems, should be arrested for assault. Period.

  6. O.G.
    SC
    Reply

    The comments on this dangerous drug were all excellent. I both empathize and sympathize.

    I have commented on my own negative experience with Cymbalta before on this site, so I won’t go over that again: suffice it to say that stopping post-surgical morphine was much easier than stopping Cymbalta, which I had taken for only three days, and from which I experienced serious physical and psychological side effects even in that short time.

    My best advice to anyone prescribed this drug would be very simple: DON’T FILL THE PRESCRIPTION.

  7. shirley
    USA
    Reply

    I was on cymblata for a little while (it did not make me feel very well). I had withdrawal symptoms. I had to see a psychiatrist who had experience in taking people off this med. Gradually I managed to get of it. He remarked that some people could never successfully get off Cymbalta and would have to stay on it the rest of their life. This was many years ago. I hope they have a better solution for it now.

  8. Rebecca
    Idaho
    Reply

    Any experience with going off Bupropion (Wellbutrin)? I forgot it when I went out of town at end of April for a few days so decided to try to get off it. Had been taking it or something else for depression/anxiety for maybe 27 years. Doctor had me take a half dose for 2 weeks then alternate days for 2 weeks. I have no energy, am always tired even after a night’s sleep. Doc said it might take 6 to 8 weeks to feel better. Anyone else experience withdrawal symptoms from this drug?

  9. Sonia
    N.Ireland
    Reply

    Just a question, Is “Fluoxetine 20 mg the same as Duloxetine?”. Really concerned after reading this article. My husband is on it now for the past 3 weeks. Thank you. Sonia.

    • Terry Graedon
      Reply

      Fluoxetine is not the same compound as duloxetine. They are both SSRI antidepressants, but fluoxetine (Prozac) is a very long-acting compound and doesn’t often cause the type of withdrawal difficulties people report with duloxetine (Cymbalta).

      • Carey
        Chicago
        Reply

        That said, you should taper off any antidepressant.

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