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Cymbalta Tapering:  Guidelines to Discuss With Your Physician

cymbalta tapering guidelinesThere are 2 really important points when considering Cymbalta tapering. One is to only do it with the guidance and oversight of a knowledgeable, trusted medical professional, and the other is never to abruptly stop taking Cymbalta. Tapering Cymbalta can reduce the severity and longevity of the withdrawals.

You can speak with your prescribing physician and request that they prescribe the lowest dose capsules to work with during the tapering Cymbalta process. In the case of Cymbalta, the lowest dosage is 20 mg light green capsules. Cymbalta is one of the more difficult antidepressants to withdraw from, in part, because of the nature of the capsule itself, which means you will have to count tiny beads, and because of the short half-life of only 12 hours. Cymbalta is a delayed-release medication, which may further complicate matters.11 There are approximately 100 beads in each capsule of 20 mg. The faster a drug leaves the body, generally, the more impactful the withdrawal. Cymbalta withdrawal can set in faster than many other antidepressants. If the rapid onset of the withdrawal is too much for you, discuss with your physician using a Prozac crossover described after this section.

Cymbalta Tapering Guidelines Include:
  • Note: Serotonin syndrome requires immediate cessation in a medical setting. In all other cases, gradual and medically monitored Cymbalta tapering is best.1,12
  • Discuss with your physician using Cymbalta 20 mg capsules. Generic brands may not work for this method. If you were not on brand name Cymbalta, and need to switch to it in order to do this taper, arrange to stay on the new version for a few weeks to ensure that you have properly acclimated to it. Switching to a new version, and then also starting a taper is not a good idea.
  • Empty gel caps are available from your pharmacy or nutrition store.
  • Bead count method: The capsules may not have an equal number of beads each. You can open up three of them, one at a time. Count the beads in each and take an average of the number that you find.
  • With your prescriber, figure out what a 10% reduction in milligrams would be for you.
  • For instance, if you are taking 60mg and are planning to go down to 55 mg, you would use two of the 20mg pills to get you up to 40mg, and then use 3/4 of the beads in the remaining one. This will total about 55mg which is very close to a 10% drop.
  • Put the beads you are planning to take into the empty gel caps you bought before consuming.
  • Keep the remaining beads in an airtight, dark container like a pill bottle.
  • Discuss with your doctor if a reduction of 10% is a good starting point. We observe that resilient people can maybe handle 25% drops, but still, it is advised to start no more than 10% just to see how you do.
  • Discuss with your prescriber a plan to take about 2-4 weeks between each cut.
  • Expect withdrawal symptoms to emerge around the drug’s half-life range. In this case, the elimination half-life is about 12 hours depending on individual variability.8 We have observed typically that the onset of withdrawal from Cymbalta may be felt for 1-3 days after a medication cut.
  • You and your prescribing physician must stay alert and flexible in making slight changes to the frequency or percentage of the cuts to make the process easiest to tolerate.
  • Allow enough time to settle out at each level, before making the next adjustment during Cymbalta tapering.
  • Discuss how long you expect to stay at each taper step — perhaps for two-four weeks, except as in the cases noted above.
  • We observe that the last adjustments in the Cymbalta taper may be the most difficult, so discuss with your physician slowing the process near the end to avoid unnecessary problems.9

There can be variable onset times for Cymbalta withdrawal symptoms but typically are expected to occur within the first 3 days, and may be prolonged for days or weeks, or in some cases much longer.9 Where a protracted withdrawal is happening, we can help at Alternative to Meds Center, or at the very least get yourself under the care of a professional who can recognize and address whatever nutritional deficiencies or other physiological challenges need to be resolved to bring such withdrawal complications under control. We also suggest that you view our Cymbalta alternatives page for holistic inclusions to assist the tapering process.

Cymbalta tapering, titration, or weaning off any antidepressant incorrectly can be a living hell. Doing it properly requires collaborating with a physician who is familiar with Cymbalta and how to taper, substantial medical investigation, compassionate oversight, and testing to determine the cause(s) of initial symptoms. Alternative to Meds Center can provide all of these and a robust support system in place, supplemented with techniques to safely and comfortably discontinue Cymbalta.

Depression can be the result of a host of factors (impaired hormonal states, nutrient deficiency, substandard diet, adrenal fatigue, lack of exercise, failed life aspirations, hypoglycemia, toxic exposures, etc). Many of these reasons would not require Cymbalta at all and would be worth investigating with the appropriate non-drug-based therapies.2


Does Your Diagnosis Require Cymbalta?
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Alternative to Meds has nearly 20 years of experience in the processes of Cymbalta tapering, weaning, and titration. Using Holistic and Environmental Medicine, we have published evidence demonstrating that a majority (over 77%) stopping antidepressants and finding alternative pathways to health actually have fewer symptoms, and feel better than when they were still taking antidepressant medications.
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Cymbalta Discontinuation Syndrome

effexor discontinuation syndromeInappropriate prescribing of antidepressants has become a subject of concern, according to research published by the American Psychological Association, which shows a high volume of antidepressant prescriptions come from practitioners who are not mental health professionals.2

For many, the prescription was an inappropriate or premature response to their condition or initial symptoms. In fact, according to a study by Keks et al in 2016, researchers found that up to 66% of antidepressant users find the antidepressant did not alleviate their depression.1

Something incredible to imagine is that the CDC reports in their 2020 Product Data Brief #377 that approximately 25% of American women over 60 are taking antidepressants. As are about 13% of all Americans aged 18 and over. And, these numbers are climbing.4 As cited above, the vast majority do not recover or get relief even if they try switching to another antidepressant or several, without success. And so they decide to stop. It is much easier to start taking antidepressants than it is to manage Cymbalta tapering correctly. This is because of the phenomenon known as “discontinuation syndrome.” 3

But are these patients told about what to expect during discontinuation syndrome? We know that typically, clients who come to us for help were never told how to stop, nor what to expect when they did, even though it is the law to give proper information to patients before a person consents to accept a prescription.5

The mnemonic “FINISH” describes the most common adverse effects of stopping antidepressants as reported in a 2017 article by Gabriel and Sharma, published in the American Journal of Medicine. The letters stand for:

  • Flu-like symptoms – lethargy, aches, sweating, headache, fatigue
  • Insomnia – along with vivid dreams and nightmares
  • Nausea – also vomiting
  • Imbalance – vertigo, lightheadedness, dizziness
  • Sensory disturbances – electric shock sensations, audio/visual hallucinations, burning, tingling
  • Hyperarousal – irritability, anger, hostility, aggression, mania, anxiety, agitation, jerkiness, movement disorders such as akathisia, and other reactions 6

Other adverse effects that can be experienced during Cymbalta tapering or withdrawal include mood swings, deepened depression, suicidality, and others. All of these symptoms or any one of them can make coming off Cymbalta or other similar drugs catastrophic to the person, especially when no help or assistance has been given.

Prozac Crossover Method for Cymbalta Tapering

Because Cymbalta has a short half-life, and because the bead counting is laborious, some people may want to consider switching over to Prozac. Prozac has a long half-life, making it generally the easiest antidepressant to discontinue by using tapering methods.

Methods described below need to be talked about with a prescriber sensitive to your situation prior to attempting.

Prozac Crossover Methods should take into account:

  • Not everyone can just switch over to a new medication, even a similar one, without complications.1
  • Induct a small amount of Prozac BEFORE discontinuing Cymbalta. This helps to see if the Prozac is being tolerated.
  • Get the lowest dose of Prozac, which is the 10 mg green elliptical.
  • Start 5 mg Prozac for one week (one-half tablet) while still taking Cymbalta.
  • After a week, take away half of your Cymbalta, and add in an equivalent milligram dosing of Prozac to include the 5mg you are already taking. For instance, if you are taking 30 mg Cymbalta, drop to 15mg Cymbalta, and go up to a total of 15 mg Prozac.
  • Do this for 1-2 weeks, preferably two especially if you are still symptomatic after one week.
  • If the above was tolerated, then convert over to all Prozac and again wait 1-2 weeks.
  • From here, look at the Prozac tapering page with your doctor and use those instructions for your guide
  • If the above is not well tolerated, then have your prescriber consider putting you back on your original dose of Cymbalta and consider the bead counting method.
  • By going to Prozac, you are jumping from an SNRI to an SSRI. Again, it is generally easier to withdraw from Prozac. Prozac does not carry the stimulatory norepinephrine-uptake aspects of Cymbalta, and so you may feel tired. But the Prozac may help with things like brain zaps during Cymbalta tapering.

About Safe Cymbalta Tapering

cymbalta prescriptionsOne of the least understood processes in modern medical practice is how to do antidepressant tapering properly. Doctors prescribe drugs, millions upon millions of prescriptions every year, without being trained in how to stop taking Cymbalta without putting the patient through hell and introducing significant risk.9

Imagine training airline pilots how to fuel up, check all the controls, and take off perfectly, but neglecting to teach them how to land the plane. Starting a patient on this drug without instructions on a Cymbalta tapering plan is quite similar to not knowing how to land the plane. The consequences of lacking these skills, obviously, would result in a crash.

Some doctors are at least scrambling to voluntarily do non-certified courses and impromptu or weekend training sessions to try and get a handle on the problem of assisting their patients with how to get off Cymbalta safely. However, this problem of missing Cymbalta tapering guidelines cannot be laid entirely at the feet of medical doctors. It is not that reducing medication is an esoteric art. It is that today’s medical schools are simply not teaching physicians adequately how to put together a Cymbalta tapering schedule or other vital information. Adequate training on Cymbalta cessation help is glaringly absent from the current medical curricula.10

Cymbalta Tapering Plan

The first goal might well be to find a caregiver that has expertise and knowledge in weaning off Cymbalta. You don’t want to fall into the still too-common situation of finding yourself in the care of a prescribing doctor or even a clinic without the know-how. A physician needs knowledge, experience, and some familiarity to guide their patients safely, so as to avoid terrible side effects of stopping Cymbalta abruptly or more aggressively than the person can handle.

Alternative to Meds Center is the world’s leading facility in drug tapering and has helped thousands of clients getting off Cymbalta and other meds for over 15 years. Our protocols have been researched and refined for client safety and comfort.

If you are someone or know someone who has tried to quit Cymbalta without success, let us help put a plan for tapering Cymbalta into action in our lovely and pristine inpatient facility, surrounded by compassionate and competent support.

Some Common Reasons for Cymbalta Tapering Treatment

  • A very common reason for considering stopping Cymbalta or other antidepressant drugs is the lack of results from drug treatment. According to research studies done and published by the National Institute of Health,1 two-thirds of those suffering from major depressive disorders find the first medication prescribed has no effect on their symptoms and according to established protocols, the person would be taken off that antidepressant and put onto another.
    PLEASE NOTE:
    This can be disastrous if done without gradually Cymbalta tapering and a “wash-out” period between the first medication and the next. In the main, physicians do not receive training or guidance on such protocols. As a further note, about 75% of those who are switched to a second antidepressant also receive no benefit, and “standard” protocols would then suggest trying a third, fourth, etc. Any switch in medications must be done with care and oversight, as doing so carries significant risks. In fact, doing so may further complicate extant health issues. This is especially true where physical conditions and illnesses had not been fully investigated and treated before opting for treatment with medications.
  • Medications can produce intolerable side effects of some severity and may make continuing the medication unworkable. Known side effects of antidepressants may lead to the decision to begin tapering Cymbalta for relief. Do not make the mistake of stopping Cymbalta abruptly, however.
  • After 6 weeks of taking antidepressants, or even less, stopping Cymbalta can produce side effects of stopping Cymbalta. This is true for any antidepressant medication and requires gradual Cymbalta titration over time for safety. It is important for caregivers to know that tapering Cymbalta or stopping any antidepressant medications, must be done gradually and should only be attempted with careful oversight and guidance, as well as compassion.3
  • getting of cymbaltaMAJOR WARNING: Due to the effects that antidepressants have on neurochemicals, there is one circumstance that does require abrupt emergency Cymbalta cessation. Where too much serotonin has been activated in the system, called serotonin syndrome, the situation can quickly become life-threatening, requiring immediate emergency hospitalization, and abruptly stopping Cymbalta. It is important to note that during switching antidepressants, the risk of serotonin syndrome is heightened significantly. Another outcome that SSRI type antidepressants can cause is too little serotonin, which can result in worsening depression and other symptoms, and may also require a very well-planned Cymbalta tapering schedule.

NOTES ON PREGNANCY AND CYMBALTA

cymbalta pregnancy side effectsIf a woman becomes pregnant or feels it is possible that pregnancy may occur, she may want to consider Cymbalta cessation to prevent damage to the unborn child. Studies that were done from 2004 through 20117 showed that out of 233 pregnancies where the mothers were taking Cymbalta, 90 had negative outcomes involving birth defects or other complications. Some of these outcomes included but were not limited to the following abnormalities:

  • Spontaneous miscarriages (41 of 233)
  • Premature births (19 of 233)
  • Still-births (3 of 233)
  • Congenital defects (6 of 233)
  • Ectopic pregnancies (3 of 233)

While more conclusive studies still need to be done, these observed rates of abnormalities are higher in comparison to pregnancy statistics where the mothers were NOT on antidepressant medications.

Considering these and other reasons one may conclude that trying to quit Cymbalta is a wise personal health choice. Be sure to seek competent help and guidance before embarking on a Cymbalta tapering program.

Information on Cymbalta Tapering at Alternative to Meds Center

cymbalta tapering sedona azPlease contact Alternative to Meds Center directly for information on safe Cymbalta weaning and titration protocols. There is never going to be a one-size-fits-all when it comes to Cymbalta tapering that will be exactly right for each person. Instead, the best way is to carefully design a Cymbalta tapering program based on lab testing, individual sensitivity factors, health history, and personal goals. These factors are crucial in making a Cymbalta taper not only safe but surprisingly comfortable and tolerable when done properly.

Clients enrolled in our medically monitored Cymbalta tapering program benefit from individually tailored cessation programs which are augmented with a wide array of helpful therapeutic services. Examples can include therapeutic massage, neurotransmitter rehabilitation, neurotoxin removal, orthomolecular medicine to modify the diet, IV treatments, nebulized glutathione, appropriate supplementation, CBT and other counseling, acupuncture, and many more. Please visit our services overview pages for a more detailed description of the services offered.

The overall goal of Alternative to Meds Center is attaining mental health naturally. This means ultimately without the need to rely on harsh and toxic medications. The medications you were prescribed did not, and ultimately, could not solve anything. We offer superior solutions.

At Alternative to Meds Center, clients experience their individualized Cymbalta tapering plan, delivered in a warm and nurturing in-patient setting. In fact, the whole program is designed for client comfort and wellness. Please ask us about the numerous holistic treatments that the program uses to soften discomforts that otherwise might interfere with an easy-to-tolerate Cymbalta tapering program.

1 (800) 301-3753 for Cymbalta Tapering Help

1. Keks N, Hope J, Keogh S Switching and Stopping Antidepressants 2016 Jun, Australian Prescriber [cited 2022 July 1]

2. Smith B, “Inappropriate prescribing.” APA June 2012 Vol 43 No.6 [print version Page 36] [cited 2022 July 1]

3. Antidepressant Discontinuation Syndrome, Am Fam Physician. 2006 Aug 1;74(3):449-456. [cited 2022 July 1]

4. CDC Product Data Bried #377 published online Sept 2020 [online] [cited 2022 July 1]

5. Informed Consent AMA Principles of Medical Ethics: I, II, V, VIII [cited 2022 July 1]

6. Wolfe RM. Antidepressant withdrawal reactions. Am Fam Physician. 1997 Aug;56(2):455-62. Erratum: Am Fam Physician 1998 Feb 15;57(4):646. PMID: 9262526. [cited 2022 July 1]

7. Hoog SL, Cheng Y, Elpers J, Dowsett SA Duloxetine and Pregnancy Outcomes: Safety Surveillance Findings 2013 Feb, International Journal of Medical Sciences [cited 2022 July 1]

8. Sangkuhl K, Klein T, Altman R, “Selective Serotonin Reuptake Inhibitors (SSRI) Pathway.” Pharmacogenet.Genomics. 2009 Nov; 19(11): 907 – 909 PMID 19741567 [cited 2022 July 1]

9. Guy A, Brown M, Lewis S, Horowitz M. The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition. Ther Adv Psychopharmacol. 2020;10:2045125320967183. Published 2020 Nov 9. doi:10.1177/2045125320967183 [cited 2022 July 1]

10. Wood E, Samet JH, Volkow ND. Physician education in addiction medicine. JAMA. 2013;310(16):1673-1674. doi:10.1001/jama.2013.280377 [cited 2022 July 1]

11. FDA label Cymbalta (duloxetine hydrochloride) Delayed-Release Capsules, approval 2004 [cited 2022 July 1]

12. Perahia DG, Kajdasz DK, Desaiah D, Haddad PM. Symptoms following abrupt discontinuation of duloxetine treatment in patients with major depressive disorder. J Affect Disord. 2005 Dec;89(1-3):207-12. doi: 10.1016/j.jad.2005.09.003. Epub 2005 Nov 2. PMID: 16266753. [cited 2022 July 1]

Originally Published Oct 16, 2019 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Cymbalta Tapering
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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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