As with most SNRIs, your chances are pretty damn good that Cymbalta will work for depression and anxiety spectrum disorders. They’re not the solution for everyone, but they all have a decent response rate, they are far less likely to poop-out than SSRIs, and Cymbalta is no different.
For DPNP & CMSP The odds are decent. It’s about as good as a TCA, with fewer side effects, which basically makes it a first-choice coin-toss.
For fibromyalgia - who the fuck knows. Even opioids may as well be placebos for a lot of people, and those folks are the Crazymeds’ demographic. And meds tend to poop-out (tachyphylaxis) a lot. I’ll get back to you if I can find some numbers I can trust.
Per the PI sheetEli Lilly Recommends:
For adults with Major Depressive Disorder (MDD): start at 40 to 60 mg , taken either in one or two doses a day . The target dosage is 60mg a day, with a maximum of 120mg a day.
For adults with Generalized Anxiety Disorder (GAD): start at 60 mg once a day , with a maximum of 120mg.
For MDD & GAD we suggest starting at 20mg a day, and increasing by 20mg a day as required. We also suggest taking Cymbalta twice a day due to its short half-life, but since you can take it only once a day at 20mg, if you need to increase your dosage you’ll know soon enough which works better for you.
While theoretically a once-a-day, delayed-release product, so is Depakote ER. And you only need to take regular Keppra twice a day. From all the evidence I’ve collected I’ve learned that you sometimes often need to take some meds more frequently than what the PI sheet states. And, please, discuss that with your doctor and pharmacist. The only real side effect to taking two 30 mg capsules instead of one 60 mg is how much it costs. Your doctor will probably be OK with it. You insurance company might have a different idea.
How to Stop Taking Cymbalta (Discontinue, Withdrawal)
2.4 Discontinuing Cymbalta
Symptoms associated with discontinuation of Cymbalta and other SSRIs and SNRIs have been reported. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible [see Warnings and Precautions (5.7)]. --the PI sheet
And that’s it.
Very slowly. Reduce your dosage by 10–20 mg a day each week. If 20mg per day every week is too fast, try to get some samples from your doctor so you can step down by 10mg per day until you hit 20mg. Cymbalta comes in 20, 30 and 60 mg capsules. Now do the math. Once you’re at 20mg you have to stop taking it after one or two weeks at that dosage. If the discontinuation symptoms don’t go away, ask your doctor for a Prozac prescription.
Works quickly with a fairly low side effect profile for an SNRI. Less likely to poop-outthan an SSRI. Probably the best painkiller around as far as approved antidepressants are concerned (because Savella (milnacipran) is not approved in the US as an antidepressant).
It’s an SNRI, which means a discontinuation syndrome from hell if you want/need to stop taking it.
Interesting Stuff your Doctor Probably didn’t Tell You about Cymbalta
Cymbalta is more effective when taken in the morning than in the evening. This has nothing to do with meals, it all has to do with our circadian rhythms.
Smoking decreases Cymbalta’s bioavailability by about one-third. Eli Lilly doesn’t recommend any changes to how much you take or how fast to increase the dosage if you smoke, but don’t be surprised if you need to take more sooner than you thought.
Best Known for
Not that much these days. It’s either the med approved for a much stuff as Prozac or Paxil, or the drug that makes you feel better enough to not celebrate with any alcohol because your liver could explode if you do. In-Depth Pros & Cons
Don’t worry about buying one. Windows shop and share the designs you’d like to buy. Do you have anything better to do right now?
Cymbalta’s Potential Side Effects (Adverse Reactions)
Typical Side Effects
The usual for SNRIs - headache, nausea, dry mouth, sweating, urinary hesitancy (it is a med for urinary incontinence after all), sleepiness or insomnia, diarrhea or constipation (my money is on the latter), weight gain, loss of libido and a host of other sexual dysfunctions. Most everything but the constipation, urinary hesitancy and weight gain, if any, will go away in a couple of weeks. Sexual dysfunction is a coin toss, although some women will get a sexual boost instead of a sexual dampening.
Uncommon Side Effects
Controlled narrow glaucoma (but you already have to be at risk for eye problems to start with), elevated liver serum (your doctor should have you get an annual liver panel), blurry vision, muscle cramps, and weight loss (yes, that can be a problem).
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on duloxetine’s pharmacokinetics page.
In a rare case of useful information in advertising, Eli Lilly’s “Depression Hurts” campaign let people know that physical pain is a common symptom of MDD. It’s too bad that they dropped the part about all meds that are serotonin and norepinephrine reuptake inhibitors (including cheap-as-dirt TCAs) could help with depression-induced pain from the TV commercials. In fairness to Lilly, they did need to free up some time to address that bit about severe liver problems.
Cymbalta has gone from being the poster child for anti-antidepressant hysteria to being one of the top-prescribed drugs in the country. Although its use as an analgesic are as much responsible for that as its use as an antidepressant and anxiolytic (anti-anxiety drug). In fact, Lilly has positioned it primarily as a non-narcotic pain medication instead of a psychiatric medication. Why? Because there’s no stigma3 in having and taking medications for chronic pain, and less stigma = more money. Hey Lilly, ever thought about funding some anti-stigma campaigns that actually work?4
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If you’re still feeling judgmental as well as just mental5, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 Outside of the military and similar cultures with a "walk it off" attitude for anything that isn't cancer.
4 I.e. Not NAMBLA's NAMI's useless stigma busting campaigns that spend too much time and money combating sitcoms, TV commercials, and arguing about using "patient" or "consumer" in literature. Oh, and they haven't done anything since January 2011.
5 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
6 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
If you have any questions not answered here, please see the Crazymeds Cymbalta discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
Last modified on Monday, 29 December, 2014 at 16:49:10 by JerodPoore
Cymbalta, and all other drug names on this page and used throughout the site, are a trademark of someone else. Cymbalta’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot. Know your sources! Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!
‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internetis a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.