Cymbalta Tapering

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

Thinking about coming off? Start with our complete guide to coming off antidepressants safely.

How to taper off Cymbalta safely

The safest way to come off Cymbalta (duloxetine) is a slow, gradual taper guided by a knowledgeable medical professional, never stopping all at once. Tapering can reduce how severe withdrawal is and how long it lasts.

There is no single schedule that is right for everyone, whether you take 60 mg, 30 mg, or 20 mg. The right pace depends on you and is adjusted as you respond. Expect that some steps may bring withdrawal symptoms for a few days, and that the last steps are often the hardest.⁹

The one exception to “go slowly” is serotonin syndrome, which needs immediate medical care and stopping the drug right away. In every other case, gradual and medically monitored tapering is best.^1,12

Want medical support while you taper? Learn how our residential medication tapering program in Sedona works, or call (888) 907-7075.

How ATMC tapers Cymbalta

There is never going to be a one-size-fits-all Cymbalta taper. A safe plan has to account for your chemical sensitivity, lifestyle, health history, and personal health goals.

What your taper looks like at ATMC:

• Built around you. Your protocol is based on your dose, how long you’ve taken Cymbalta, other medications, and your history with withdrawal.
• Adjusted as you go. We watch how you respond and adjust the pace. Some people move faster; others need to go slower. Both are fine.
• Precise doses. Our medical team plans each dose step, so each step is the size it should be.
• Supporting your brain chemistry. Nutrient therapy and neurotransmitter support help your body rely less on the medication, so each step is easier to tolerate.
• Treating what’s underneath. Depression can stem from many factors, such as hormone problems, nutrient deficiency, poor diet, adrenal fatigue, lack of exercise, low blood sugar, and toxic exposures. Many of these are worth investigating with non-drug therapies.²
• Slower at the end. We observe that the final reductions are often the most difficult, so we slow down near the finish to avoid unnecessary problems.⁹

All of this happens in a residential setting, with our clinical team on site.

Why Cymbalta is hard to taper

Cymbalta is one of the more difficult antidepressants to come off. Several things work against you:

• The capsule itself. Cymbalta is a delayed-release capsule filled with tiny beads, which complicates making smaller doses.¹¹ The capsules may not all contain the same number of beads, so homemade doses can be uneven.
• The lowest strength is 20 mg. Once you need steps smaller than what the capsules provide, precise dosing becomes the main challenge.
• A short half-life. Cymbalta’s elimination half-life is about 12 hours, depending on the person.⁸ The faster a drug leaves the body, the more impactful withdrawal tends to be, and Cymbalta withdrawal can set in faster than with many other antidepressants.
• Changing versions mid-taper. Switching between generic and brand-name Cymbalta and starting a taper at the same time is not a good idea. Your body needs time to adjust to one change before the next.
• The final steps. The last reductions are often the hardest, which is why the pace usually needs to slow near the end.⁹

What about switching to Prozac first?

Because Cymbalta has a short half-life, some prescribers consider a crossover to Prozac (fluoxetine), which has a long half-life and is generally one of the easier antidepressants to taper. This is a medication change, not a shortcut. Not everyone can switch to a new medication, even a similar one, without complications.¹ Prozac is an SSRI without Cymbalta’s norepinephrine effects, so some people feel tired after switching, though it may help with brain zaps. Switching antidepressants also raises the risk of serotonin syndrome. A crossover should only be planned and supervised by a prescriber who knows your situation. Learn more about Prozac tapering.

Cymbalta withdrawal symptoms

Withdrawal after stopping or lowering an antidepressant is common enough to have a name: discontinuation syndrome. The FDA found that 44% of people suffered withdrawal, compared with the 1% the manufacturer had reported.^3,16

The mnemonic FINISH, described in a 2017 article by Gabriel and Sharma in the American Journal of Medicine, sums up the most common effects of stopping antidepressants:⁶

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

Other effects can include mood swings, deepened depression, and suicidal thoughts. Any of these can make coming off Cymbalta very hard, especially without help.

When they start: withdrawal tends to emerge around the drug’s half-life range.⁸ We typically see symptoms felt for 1–3 days after a dose cut, and they usually appear within the first 3 days.⁹

How long they last: symptoms may continue for days or weeks, and in some cases much longer.⁹ If withdrawal drags on (protracted withdrawal), get under the care of a professional who can recognize and address nutritional deficiencies and other physical issues behind it. Read more about Cymbalta withdrawal.

Tapering Cymbalta at home vs. at ATMC

How long does it take to wean off Cymbalta?

There’s no single timeline. It depends on your dose, how long you’ve taken Cymbalta, and how your body responds to each reduction.

• Each step: you need enough time to settle at each level before the next change, paced to how you feel rather than a calendar.
• The end of the taper: often takes longer, because the last reductions tend to be the hardest.⁹
• If you’ve tried before: people who stopped because withdrawal was too intense usually need more time, not less.
• Inpatient at ATMC: about 60 days on average, and longer stays can be arranged.

Giving yourself enough time is one of the most important parts of a comfortable taper.

Helping a loved one taper off Cymbalta

If someone you love wants to come off Cymbalta, your support can make a real difference. A few ways to help:

• Encourage them not to stop suddenly. Never stopping abruptly is one of the two most important rules of Cymbalta tapering; the other is having knowledgeable medical oversight.
• Learn the symptoms. Knowing the FINISH symptoms helps you recognize withdrawal instead of mistaking it for relapse. Patients’ withdrawal symptoms are often dismissed or misdiagnosed.⁹
• Watch for warning signs. Deepening depression, suicidal thoughts, or signs of serotonin syndrome need immediate medical attention.
• Help them find experienced care. Look for a prescriber or program that knows how to taper Cymbalta, not one improvising as they go.

Why people taper off Cymbalta

The FDA approved duloxetine for a wider range of conditions than most antidepressants: major depressive disorder, generalized anxiety disorder, fibromyalgia, chronic musculoskeletal pain, and diabetic nerve pain. That wide range expanded its sales, despite unremarkable efficacy.^11,15

Common reasons people choose to taper:

• It isn’t working. Up to 66% of antidepressant users find the medication did not relieve their depression.¹ About two-thirds find the first antidepressant prescribed has no effect, and about 75% of those switched to a second one also get no benefit.¹ Antidepressants generally have a lackluster efficacy profile, and duloxetine is no exception.^13,14
• Side effects. In placebo-controlled trials, many of Cymbalta’s adverse events occurred 2 to 4 times as often as with placebo, including lack of appetite, weight loss, liver damage, anxiety, insomnia, sexual dysfunction, and blurred vision.¹⁵
• The prescription may not have fit. A high volume of antidepressant prescriptions come from practitioners who are not mental health professionals, and for many people the prescription was premature.²
• Pregnancy or planning one. See the pregnancy notes below.

The CDC reports that about 25% of American women over 60, and about 13% of all American adults, take antidepressants, and those numbers are climbing.⁴ Even after only 6 weeks or less on an antidepressant, stopping can cause withdrawal, so any change needs to be gradual.³

Important: switching from one antidepressant to another without a careful, gradual process can be disastrous, and switching raises the risk of serotonin syndrome. Serotonin syndrome can quickly become life-threatening and requires emergency hospitalization and stopping Cymbalta immediately.

Watch: Does your diagnosis require Cymbalta?

Cymbalta and pregnancy

Women who are pregnant or may become pregnant may want to consider coming off Cymbalta. Safety surveillance from 2004 through 2011 found that of 233 pregnancies where the mother was taking Cymbalta, 90 had negative outcomes, including:⁷

• Spontaneous miscarriage (41 of 233)
• Premature birth (19 of 233)
• Stillbirth (3 of 233)
• Congenital defects (6 of 233)
• Ectopic pregnancy (3 of 233)

More conclusive studies are needed, but these rates are higher than in pregnancies where the mother was not taking antidepressants. Duloxetine is classified as a Category C drug: pregnancy risks can’t be ruled out because human studies haven’t been done, and birth defects were documented in animal trials.^16,17 If you’re planning a pregnancy, seek competent guidance before you start a taper, and never stop abruptly.

Why many people are never told how to stop

Most clients who come to us were never told how to stop Cymbalta, or what to expect when they did. Yet prescribers are legally obligated to adequately inform patients before prescribing a drug. This “informed consent” is a basic pillar of patient rights.⁵

Part of the problem is training. Doctors write millions of prescriptions without being taught how to taper antidepressants safely.^9,16 Medical schools are not adequately teaching physicians how to build a taper, and this training is glaringly absent from current curricula.¹⁰ Some doctors are taking weekend courses to catch up.

Think of training pilots to take off perfectly but never teaching them to land. Starting someone on Cymbalta without a plan for coming off it is much the same. That’s why the first step is finding a caregiver with real experience in Cymbalta tapering.

How ATMC makes Cymbalta tapering easier

Alternative to Meds Center has specialized in antidepressant tapering for nearly 20 years, and our results are documented in published evidence. Our programs rely on holistic practices and environmental medicine.

Your individualized taper is supported by services such as:

• Brain chemistry and nutrition: neurotransmitter rehabilitation, orthomolecular medicine to modify the diet, IV treatments, and appropriate supplementation.
• Toxin removal: neurotoxin removal and nebulized glutathione, guided by lab testing.
• Comfort therapies: therapeutic massage and acupuncture to ease discomfort.
• Counseling: CBT and other counseling.

See our services overview for more detail. The goal is mental health achieved naturally, without relying on harsh medications.

Start your Cymbalta taper with support

If you or someone you know has tried to quit Cymbalta without success, we can help put a safe plan into action. Our program lasts about 60 days on average, delivered in a warm, nurturing inpatient setting in Sedona with our clinical team on site. Learn more about how we treat medication withdrawal and antidepressant withdrawal.

Cymbalta and duloxetine tapering FAQs

Sources:

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 Brief #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 2023 Aug 8]

13. Cipriani A, Koesters M, Furukawa TA, Nosè M, Purgato M, Omori IM, Trespidi C, Barbui C. Duloxetine versus other anti-depressive agents for depression. Cochrane Database Syst Rev. 2012 Oct 17;10:CD006533. doi: 10.1002/14651858.CD006533.pub2. PMID: 23076926; PMCID: PMC4169791. [cited 2023 Aug 8]

14. Li X, Zhu L, Zhou C, Liu J, Du H, Wang C, Fang S. Efficacy and tolerability of short-term duloxetine treatment in adults with generalized anxiety disorder: A meta-analysis. PLoS One. 2018 Mar 20;13(3):e0194501. doi: 10.1371/journal.pone.0194501. PMID: 29558528; PMCID: PMC5860757. [cited 2023 Aug 8]

15. FDA Final Draft for Cymbalta (duloxetine) label published online 2004 [cited 2023 Aug 8]

16. Recall Guide Cymbalta Recall 2014 [published online 2014] [cited 2023 Aug 8]

17. Leek JC, Arif H. Pregnancy Medications. [Updated 2023 Apr 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507858/ [cited 2023 Aug 8]

Originally Published Oct 16, 2019 by Diane Ridaeus

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

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Diane Ridaeus

Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.