What is Cymbalta (duloxetine) used for?
The SNRI antidepressant Cymbalta (duloxetine) is most widely used to treat depression, anxiety disorders, and certain types of pain. Following is a timeline showing when the FDA approval for these uses came into effect:
- In August of 2004 Cymbalta was approved for treating depression, and a month later the FDA added approval for treating diabetes-related peripheral neuropathy.
- In 2006, the drug gained approval to be prescribed for the treatment of GAD, or general anxiety disorder.
- In 2008, the FDA granted approval for prescribing Cymbalta in managing symptoms relating to Fibromyalgia, a medical condition that causes widespread pain throughout the entire body, rather than pain localized to a specific area or body part.
- In 2010, FDA expanded its approval for Cymbalta to be prescribed in the treatment of CMP, or chronic musculoskeletal pain, for example, chronic back pain.
- An SNRI is sometimes prescribed for conditions that lay outside the above list, which practice is generally called “off-label” prescribing. Often, where a certain condition has not yet been successfully treated or managed with a particular medication, trials are done to explore medications that may be of some help.
- When enough positive results have been documented, such off-label use can eventually become FDA approved.
Some off-label uses for Cymbalta (duloxetine) in the USA include:
- Urinary incontinence in females, i.e., after pelvic surgery. (3)
- Chemotherapy-induced neuropathy, i.e., after breast cancer treatment.
Cymbalta Alternative Treatment Options
Speak to your caregiver, or ask us at the Alternative to Meds Center for alternative treatments that do not involve SNRI drugs. It is possible to attain natural mental health.
Cymbalta Alternative Names and Slang
Duloxetine is the generic name for the brand or trade name Cymbalta. Other trade names include Yentreve, and the drug is sold in the EU as Xeristar and Ariclaim.
Care should be taken not to confuse Cymbalta or its generic name, duloxetine with “SALA” drugs, meaning drug names that sound alike or look alike. To avoid mistaking one drug for another, drug manufacturers often use specific colors, add markings, or use other distinctive features to help minimize this risk.
For example, the Institute for Safe Medication Practices (4) lists Symbyax as a drug that is often confused with Cymbalta (duloxetine). Symbyax is an SSRI drug that compounds two drugs:
- An SSRI called fluoxetine, and
- An antipsychotic drug called Olanzapene
These similarities make Symbyax a drug which might be confused with Cymbalta, but are, in fact, much different from each other in how and when they would be prescribed, despite their similar sounding names.
Cymbalta Side Effects
Cymbalta (duloxetine) primarily targets the serotonin and norepinephrine neurotransmitters, and to a lesser extent, dopamine. Cymbalta has a blocking effect, so that these naturally occurring neurotransmitters are restrained from following their normal pathway, and remain suspended instead of being reabsorbed as they normally would be. The pooling or building up of these substances can result in a wide variety of effects such as mood-brightening or feelings of euphoria that speak to its popularity in the treatment of depression and pain relief. These effects are temporary.
They are temporary because after the neurotransmitters have been suspended or pooled, they eventually degrade and become inactive. This can result in a deficit over time, as the drug does not create new stores of these naturally produced chemicals, but only purges and uses up existing resources in the body.
The result of this deficit might explain some of the more long-term negative Cymbalta side effects where an initially perceived benefit can often be overshadowed by other troubling side effects that begin to appear after weeks or months. There are hundreds of reported Cymbalta side effects but we will focus on the most common ones here (1%-10% or higher) and a number of less common reactions that would signal a high health risk and potentially require swift medical intervention, should they occur.
- Suicidal behavior, suicidal ideation, especially in those under the age of 25
- Respiratory tract infection, throat/mouth inflammation or pain
- Gastrointestinal hemorrhage or other internal bleeding
- Pain in the upper right abdomen area
- Swelling of the abdomen region
- Blurred vision, dilated pupils
- Back or neck pain, muscle spasms
- Anorgasma, premature ejaculation, decreased libido, erectile dysfunction
- Stevens-Johnson Syndrome (extremely serious reaction of the eyes, skin and mucous membranes caused by certain medications, signaled by a fever and flu-like symptoms, followed by discoloration and rash/eruptions/skin ulcers which can become septic, skin then blisters and falls off, requires medical intervention done best in a burn unit or ICU, and is fatal in approximately 5 to 10% of cases.)
- Pruritis (severe and unrelenting itchiness)
- Hyperhidrosis (extreme, excessive sweating)
- Spiking blood pressure
- Heart palpitations
- Decreased appetite
- Weight loss/gain
- Worsened depression
- Mood swings
- Hyponatremia (abnormally low sodium level, can result in seizure, coma, spasms, mental confusion, muscle weakness, inability to speak clearly, vomiting, swelling of the body, etc.)
- Insomnia, abnormal dreams, sleep disorders
- Emotional blunting (reduction or total absence of normal emotional responses)
- Mental confusion, inability to focus or think clearly
- Panic attacks
- Irritability, hostility, aggressive, impulsive behaviors
- Akathisia (a relentless internal sensation of discomfort involving a compulsion to rock, pace, march, shift the feet, or otherwise stay in constant motion)
- Mania or the lesser hypomania (an abnormally intense episode of racing thoughts, hyperactivity, euphoria, decreased need for sleep, disorganized behavior, elevated self-esteem, grandiosity, etc.)
- Darkened urine (may be a sign of liver or other organ dysfunction and should be medically assessed without delay.)
- Abdominal pain
- Unusual bruising or tenderness in the upper abdominal area may be a sign of internal bleeding and requires medical attention.
- Serotonin Syndrome (a potentially life-threatening condition that occurs when too much serotonin is in the body which can result in seizure, coma, heart palpitations and other symptoms and requires immediate medical intervention.)
Cymbalta (duloxetine) Withdrawal Symptoms
WARNING: While no one wants to suffer any longer than necessary, it is important to strongly reiterate that the process of Cymbalta withdrawal can be made more difficult if attempted too rapidly. Abrupt or “cold turkey” cessation from Cymbalta is NOT recommended, as it can actually lengthen recovery time greatly. There are many treatment methods that have been found to lessen the discomfort, and to help ease the process in a much gentler manner, and these can be found explained in further detail in the below section on “Treatment”. There are effective methods of Cymbalta withdrawal help that are surprisingly gentle and easy to tolerate when implemented with care and compassion.
There can be many adverse effects felt when coming off Cymbalta. Some of the more common ones that may present when stopping Cymbalta are listed here:
- Electric shock sensations, also called “brain zaps”
- Suicidal thoughts
- Deepened depression
- Muscle spasms
- Nightmares, unusual or vivid dreams
- Mental fog, confusion, inability to focus
Discontinuing/Quitting Cymbalta (duloxetine)
Because of the mechanics of SNRI antidepressants, there can be a significant measure of difficulty without comprehensive Cymbalta withdrawal help. Some of the side effects of Cymbalta while taking it can be hard to differentiate from those that can arise and even intensify when tapering off Cymbalta. Working with an experienced medical practitioner who can help monitor the process of Cymbalta cessation is recommended.
In addition to Cymbalta side effects and the adverse effects of Cymbalta withdrawal, a person may also be struggling with their initial symptoms that led to taking an antidepressant in the first place. This can be an overwhelming process to embark on alone, especially where such problems may have arisen.
There are holistic treatment methods that may prove beneficial in regaining natural mental health, especially during Cymbalta withdrawal and also recovery phases of treatment. This is a journey that may be best taken with caregivers who can provide encouragement and effective, compassionate care along the way.