Cymbalta Tapering: Guidelines to Discuss With Your Physician
There 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?
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.
15 Years Experience by Professionals Who Understand Your Journey.
Inappropriate 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
The FDA approved duloxetine extended release for a wider range of symptoms compared to the majority of other antidepressants. These approved uses include major depressive disorder, generalized anxiety disorders, fibromyalgia, chronic musculoskeletal pain, and diabetic neuropathic pain management. This wide range of symptoms has expanded sales of this antidepressant beyond normal perimeters, despite its unremarkable efficacy.11,15
Surprising Stats on Antidepressant Efficacy
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 may decide to stop.
Generally, antidepressants have a lackluster clinical profile for efficacy, and duloxetine is no exception. 13,14
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.” Drug manufacturers under-reported these phenomena according to the FDA who found 44% suffered withdrawals, as opposed to the 1% that the manufacturer had reported. 3,16
Are Prescribers Informing Their Patients Adequately?
Are prescribers explaining to patients 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 stop.
However, it is the law to adequately inform patients before prescribing a drug. This ensures what is called “informed consent” which is a fundamental pillar of any patient’s rights and is a legal obligation that the prescribing physician MUST fulfill.5
Common Adverse Effects When Stopping Cymbalta
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:
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
The prescriber can opt to induct a small amount of Prozac BEFORE discontinuing Cymbalta. This helps to see if the Prozac is being tolerated.
Utilize the lowest dose of Prozac, which is the 10 mg green elliptical.
Under the doctor’s supervision, start 5 mg Prozac for one week (one-half tablet) while still taking Cymbalta.
After a week, the prescriber can substitute half the Cymbalta, with an equivalent milligram dosing of Prozac to include the 5mg already being taken. For instance, from 30 mg Cymbalta, drop to 15mg Cymbalta, and go up to a total of 15 mg Prozac.
Your prescriber can help you with this for a period of 1-2 weeks, leaning to the longer period, especially if you are still symptomatic after one week.
If the above was tolerated, then the prescriber can 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 as 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 slowly 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, so you may feel tired. But Prozac may help with things like brain zaps during Cymbalta tapering.
About Safe Cymbalta Tapering
One 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.9,16
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.
Training the Doctors on Proper Cymbalta Tapering
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 the 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 get 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 to Consider 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, two-thirds of those suffering from major depressive disorders find the first medication prescribed has no effect on their symptoms.1 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 gradual 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. However, do not make the mistake of stopping Cymbalta abruptly.
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
MAJOR 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. Therefore, serotonin syndrome does require immediate emergency hospitalization, and immediately stopping Cymbalta. It is important to note that during switching antidepressants, the risk of serotonin syndrome is heightened significantly.
Placebo-based trials showed that a wide range of Cymbalta’s adverse events occurred 2X to 4X compared to placebo, including lack of appetite, weight loss, liver damage, anxiety, insomnia, sexual dysfunction, blurred vision, and many others.15
NOTES ON PREGNANCY & CYMBALTA
If 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. The DEA has classified duloxetine as a Category C drug, meaning the risks related to pregnancy and birth defects cannot be ruled out because studies have not been done on humans but birth defects and AEs were documented in animal drug trials.16,17
Considering these and other reasons one may conclude that trying to quit Cymbalta is a wise personal health choice, especially if one is planning a future pregnancy. Be sure to seek competent help and guidance before embarking on a Cymbalta tapering program.
The overall goal of Alternative to Meds Center is to attain 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 and ease Cymbalta tapering.
Want More Information on Cymbalta Tapering at Alternative to Meds Center?
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 that is able to uniquely address chemical sensitivity, lifestyle, health history, and personal health goals. These factors are crucial in making a Cymbalta taper not only safe but life-restoring and remarkably tolerable.
Please contact our informed and friendly Alternative to Meds Center staff for more information on safe Cymbalta weaning and titration protocols in a restful, pristine, and compassionate inpatient setting.
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.
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.
Medical Disclaimer: 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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