Duloxetine tapering programs may be recommended where persons have become dependent on this SNRI type antidepressant. Duloxetine (sold under various brand names including Drizalma Sprinkle, Cymbalta, et. al.) is thought to affect the CNS in ways that are, though not completely understood, quite pervasive. Therefore, in stopping duloxetine, it is important to withdraw from duloxetine slowly, i.e., within the recommended guidelines provided by the FDA. (1)
However simple those FDA guidelines might seem, prescribing physicians are often at a real loss when it comes to any kind of detailed help for a person asking for duloxetine tapering treatment. This is because the art or science of how to get off duloxetine or other SNRI antidepressants is not part of what physicians are taught at medical school. Seems like a glaringly missing subject, and sadly so, since such a large percentage of the population has become subject to prescription drugs in this modern age. And as more researchers study these drugs, the controversy as to whether antidepressants work to treat depression any better than placebo continues. (3)
What we have seen is that in as little as six weeks a person trying to quit duloxetine will run into problems which can be exacerbated greatly if they are trying to quit duloxetine too quickly or all at once. Even a slow taper where basic nutrition, sleep, or other important factors are neglected, can result in much discomfort for the person.
Like a car with no brakes or a winding mountain road with no map at all, this missing expertise concerning duloxetine cessation puts many people at risk each day. At the Alternative to Meds Center, our programs can help with getting off duloxetine safely, gently, and comfortably.
There may be a concern if a woman is planning to get pregnant while taking duloxetine. Duloxetine is thought to be possibly linked to some birth defects. Some research, such as that sponsored by Eli Lilly report no increased risk of birth defects (4), while other research referred to on the FDA drug label of 2017 warns of fetal/neonatal adverse reactions such as seizure, tremors, hypoglycemia, constant crying, an many other adverse effects found in infants born to mothers taking duloxetine. There have been no actual clinical trials on pregnant women taking duloxetine as to do so would be outside the ethical lines that govern testing procedures. (5) Even though these researchers are noncommittal on the subject, a woman may want to consider the health of the infant as a possible motivation for duloxetine tapering before becoming pregnant.
A person who has become dependent on antidepressant medications, or is experiencing unmanageable symptoms may decide that it’s time to begin trying to quit duloxetine. The side effects of SNRI medications can be harsh and may outweigh any of the perceived or hoped-for benefits of drug treatment. For many reasons, one may decide it’s time for getting off duloxetine.
Other side effects like insomnia and the resulting sleep-deprivation may make life and work quite difficult for anyone. There can be many reasons for an individual to consider getting off duloxetine.
But now the reality hits. The doctor who prescribed the medication may not seem to know how to proceed. There can be quite a significant challenge in finding qualified and competent help (beyond best-guesswork) concerning stopping duloxetine. (2) Doctors are typically not trained on how to administer medication tapering, and though they generally are trying their best, that often means using their best-guesses for treatment suggestions.
If the duloxetine was in solid pill form, the prescribing doctor might give the patient a number of pills which can be “cut” with a special pill cutter, according to a suggested schedule. However, where the SNRI is a timed-release version, or comes in “sprinkles”, the pills cannot be simply cut. So, a patient may be switched to another type of medication first, one which can be cut with a pill cutter, or kitchen knife, etc.
However, sometimes there can be problems with switching over from one drug to another, which may further complicate getting off duloxetine smoothly. Another option exists called “cross-tapering”. Cross-tapering can sometimes be used to smooth out the transition from one drug to another, where the second drug is hoped to cause less intense side effects. These types of actions are best done within a treatment center where a person receives constant monitoring, and are considered not suitable for self-administering due to their sometimes unpredictable outcomes.
A person’s doctor may tell the person to “take half a pill daily for 2 weeks and then come back and see me”. So for those 2 weeks, the person is basically doing a self-administered duloxetine tapering process. For some, the person who has become disorganized in their life, with each day an uphill struggle of tasks that involve both self-care and care of family members or struggling with a work situation, these sorts of real-life factors almost guarantee that the schedule will not be followed exactly, and this can introduce even more complexity.
Other complications can arise, especially where a person is doing duloxetine tapering using a timed-release version. The physician may need to write a prescription for a liquid form of the drug, and may give directions for measuring exactly to achieve a 20% or 40% reduction, or whatever has been suggested. To complicate what sounded straight-forward and simple in the doctor’s office, some responses to reductions in dosage might not occur right away, but may set in after a couple of days or even longer. There can be many variations and “tweaks” that may need to be alertly responded to during the course of duloxetine tapering to try and keep pace with emerging side effects and reactions.
One is seeking to achieve a reduction as the goal of reducing or stopping duloxetine without running into unmanageable withdrawal effects. For instance, brain zaps are a common duloxetine withdrawal symptom, along with insomnia, nausea, and a possible host of other common withdrawal symptoms. Should these become too intense this scenario might bring trying to quit duloxetine to a disastrous crashing halt.
If the person who is attempting the duloxetine tapering is already feeling unwell, already experiencing harsh side effects and unpredictable mood swings, lapses in memory and other troubles, it may be too burdensome to expect a person in such a weakened condition to be their own duloxetine tapering administrator. It does not have to be this difficult.
If you or your loved one have been considering getting off duloxetine, but are not confident about how exactly to proceed, or are looking for options that you want to explore, we invite you to find out more about how our program works. Please feel free to contact us directly. We are here to help. We can give you more information on the many treatment protocols that are designed to soften the whole duloxetine tapering process, and to provide a compassionate, warm and nurturing space in which to experience a true resurgence of health. Find out why we feel our duloxetine tapering program is the best in the world, but more importantly, designed to be a revitalizing experience, with the focus on helping our clients toward natural mental health and vitality.
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.