Long-Term Side Effects of Cymbalta

Getty Images/PIKSEL

Chances are you don’t want to go back to life before you started treating and controlling symptoms of depression, but you may be worried about long-term effects of your medication. If you’re taking Cymbalta (duloxetine), part of a group of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs), you might wonder if it causes long-term side effects like those found in other antidepressants: sexual side effects, weight gain, and more.

You can exhale now. Long-term use of Cymbalta is safe for most people. Essentially, once you’re past the initial one- to four-week period necessary for the medication to begin to work, many people find side effects taper off…with one possible exception.

“The most common long-term side effect I have seen with Cymbalta is weight gain,” says Jennie Byrne, M.D., Ph.D., a psychiatrist and author in New York City. “If that happens, you should have a conversation with your doctor about whether or not you should continue. ”

Still, like any medication, there are side effects associated with this drug, such as abdominal pain, headache, nausea, and sleep disturbances. What else should you expect from your Cymbalta prescription? Let’s learn about what duloxetine is, what it does, and adverse effects it can have on your body.

What Is Cymbalta?

Experts believe that SNRIs like Cymbalta increase the availability of serotonin and norepinephrine—which are mood-affecting neurotransmitters—in your brain by preventing them from being reabsorbed.

In adults, the U.S. Food and Drug Administration (FDA) has approved Cymbalta to treat the following conditions:

• Chronic musculoskeletal pain

• Diabetic peripheral neuropathic pain (DPNP)

• Fibromyalgia

• Generalized anxiety disorder (GAD)

• Major depressive disorder (MDD)

• For pediatric uses, the FDA has approved Cymbalta to treat:

• Fibromyalgia in children ages 13 and older

• GAD in children ages 7 and older

Side Effects of Cymbalta

The good news: A systematic review of studies with data from nearly 35,000 participants concluded that duloxetine was generally safe and well-tolerated. “In my experience, Cymbalta side effects are largely not a problem,” says Gary Schnell, M.D., a practicing psychiatrist at Milwaukee Psychiatric Physicians Chartered in Milwaukee, WI.

Nevertheless, the manufacturers of duloxetine list the following side effects as possibilities:

• Abnormal dreams

• Blurred vision

• Changes in weight

• Gastrointestinal issues

• Heart palpitations

• Hot flashes

• Lethargy

• Musculoskeletal pain

• Sexual side effects

• Sleep disturbances

• Vertigo

• Weight gain

One meta-analysis found an average weight gain of about 2.5 pounds after a year on the medication (even though participants in the studies analyzed initially lost weight in the short-term).

Serious Side Effects

Although serious side effects with Cymbalta are rare, they can happen. They may include, per the Mayo Clinic:

• Gastrointestinal bleeding

• Liver damage (yellow eyes and skin is a telltale sign)

• Seizures

• Serious skin reactions such as blistering

• Vomiting blood

Studies suggest a link between the use of medications that interfere with serotonin reuptake, including selective serotonin reuptake inhibitors (SSRIs) and SNRIs, such as Cymbalta, and the occurrence of gastrointestinal (GI) bleeding.

One study in BMJ demonstrated an increased risk of postpartum hemorrhage in mothers who were taking Cymbalta, as well as possible side effects for their fetuses.

Additionally, some research has demonstrated a link between Cymbalta and liver damage. “Issues like liver damage or internal bleeding would require discontinuing Cymbalta,” says Dr. Schnell. “However, these side effects are just as much of an issue with similar medications that doctors might prescribe to replace Cymbalta.”

One study suggests there’s no difference in liver damage risk between SNRIs like duloxetine and other types of antidepressants. Another recent study of 25 antidepressants found duloxetine to be middle of the road when it comes to risk of bleeding: 11 antidepressants came with a lower risk of GI bleeding, one had the same risk as Cymbalta, and 12 caused a higher risk of GI bleeding than Cymbalta.

Like all antidepressants Cymbalta’s packaging carries a black box warning for suicidal thoughts and behaviors. Short-term studies show an increased risk of suicide in children, adolescents, and adults aged 24 years or younger.

Studies have not found an increased risk of suicide for older adults taking Cymbalta: The authors of a meta-analysis of 27 trials of duloxetine concluded that, “No increased risks of suicide-related events was found, whether or not the analyses were adjusted for exposure time,” which was, on average 20% higher than placebo groups across the studies. (Nevertheless, if you are taking this drug and find yourself struggling with suicidal thoughts, talk with your doctor immediately.)

For most people, if you’ve been taking Cymbalta for several months with no adverse effects, it’s likely you’re in the clear, says Dr. Byrne. “If you’ve been taking Cymbalta without side effects for more than a few months and you develop a new side effect,” says Dr. Byrne, “you should see your doctor right away to make sure you don’t have another medical issue.”

What’s Considered “Long-Term”?

According to Cymbalta’s prescribing instructions, “long-term” side effects are those that occur or persist after several months of using the drug. “If someone is taking Cymbalta more than 12 months, I would consider it long-term,” Dr. Byrne says. “The minimum period to take this medication is between two and six weeks.” There is no maximum length of time you can take Cymbalta for, adds Dr. Byrne: “Some people may benefit from taking Cymbalta for a few months, others for a few years, others for decades.”

It’s not so much the length of time as it is the dosage that puts people who take Cymbalta at risk of side effects. “Typically, the higher the dose of Cymbalta, the higher the risk of side effects,” says Dr. Byrne. Indeed, in one study, researchers found a link between higher dosages of Cymbalta and liver disease in patients being treated for depression.

Mitigating Side Effects

As with other antidepressants, the most important thing to consider regarding Cymbalta’s long-term use is how best to avoid withdrawal symptoms when discontinuing the drug. Most people find this manageable and can use other medications such as Prozac (fluoxetine), a selective serotonin reuptake inhibitor (SSRI), that stay in your system longer and allow you to taper off more smoothly, according to Dr. Schnell.

“The best way is to initiate a trial of Prozac with its long half-life and then use this to help wean yourself off the Cymbalta,” he says. “Then you can eventually discontinue Prozac,” which he says causes less withdrawal symptoms than SNRIs.

At the end of the day, if your doctor has prescribed you Cymbalta and it’s helping with your depression or anxiety, it’s likely safe to continue its use, as long as you are not experiencing serious side effects. If the side effects are intolerable to you, talk with your provider about trying other antidepressants. No matter what, you don’t have to go back to life before treatment.

Notes: This article was originally published August 20, 2010 and most recently updated May 9, 2023.

Antidepressant Side Effects: UpToDate. (2023.) “Chance of side effects with certain antidepressant medicines.” https://www.uptodate.com/contents/image?imageKey=PC%2F81374

Medication Overview and Adverse Effects: National Alliance on Mental Illness. (2023). “Duloxetine (cymbalta).” https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Duloxetine-(Cymbalta)

Time to Effect: MedLinePlus. (2022.) “Duloxetine.” https://medlineplus.gov/druginfo/meds/a604030.html

Duloxetine Mechanism of Action: National Center for Biotechnology Information. (2023.) “Duloxetine.” https://www.ncbi.nlm.nih.gov/books/NBK549806/

Medication Uses and Warnings: Eli Lilly and Company. (n.d.). “Cymbalta.” https://uspl.lilly.com/cymbalta/cymbalta.html

Safety Profile: Frontiers in Psychiatry. (2020.) “A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine.” https://www.frontiersin.org/articles/10.3389/fpsyt.2020.554899/full

Bleeding Risk (1): BMJ. (2020.) “Maternal and fetal outcomes following exposure to duloxetine in pregnancy: cohort study.” https://www.bmj.com/content/368/bmj. m237

Bleeding Risk (2): Frontiers in Psychiatry. (2021.) “Risk of Bleeding Associated With Antidepressants: Impact of Causality Assessment and Competition Bias on Signal Detection.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8566746/

Duloxetine and Suicide in Adults: Journal of Clinical Psychopharacology. (2006.) “Duloxetine: meta-analyses of suicidal behaviors and ideation in clinical trials for major depressive disorder.” https://pubmed.ncbi.nlm.nih.gov/17110815/

Drug Interaction Information: National Institute for Health and Care Excellence. (2023). “Duloxetine interactions.” https://bnf.nice.org.uk/interactions/duloxetine/

Prescribing Information: U.S. Food and Drug Administration. (2020). “Highlights of prescribing information.” https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021427s053lbl.pdf

Cymbalta and Liver Damage Study: Psychiatry Investigations. (2011). “Duloxetine-Induced Liver Injury in Patients with Major Depressive Disorder.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182394/

Antidepressants and Liver Toxicity: CNS Drugs. (2018.) “Antidepressants and Hepatoxicity: A Coghort Study among 5 Million Indivduals Registered in the French National Health Insurance Database.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061298/

Our Review Process

Top Side Effects to Know & Withdrawal

The most serious side effects caused by the antidepressant medication Cymbalta (duloxetine) include abdominal bleeding and liver injury. But stopping the drug suddenly may cause withdrawal symptoms such as anxiety, agitation and suicidal thoughts.

Common Side Effects of Cymbalta (Duloxetine)

The most common side effects of Cymbalta are nausea, headache, dry mouth and sleepiness, but more serious side effects may occur. A 2021 review of Cymbalta clinical trials found that participants who took the drug were more likely to experience common side effects than those who took a placebo. But people who take Cymbalta and don’t participate in drug trials also routinely report these side effects.

Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta and selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for major depression. Unfortunately, almost all can cause these side effects, leading many people to want to stop taking them.

The most common side effects associated with Cymbalta (duloxetine) are:

• Constipation
• 
  Decreased appetite
• 
  Diarrhea
• 
  Dizziness
• 
  Dry mouth
• 
  Fatigue
• 
  Heartburn
• 
  Increased urination
• 
  Insomnia
• 
  Intestinal gasMuscle pain or cramps
• 
  Nausea
• 
  Sexual dysfunction
• 
  Stomach pain
• 
  Sweating
• 
  Vomiting
• 
  Weight changes

Some of these side effects tend to accompany one another. For example, people who experience vomiting and stomach pain may lose weight as a result.

Advertisement

Professional Therapy, Done Online

A licensed therapist with BetterHelp can provide professional support and guidance, on your schedule. Sign up and get matched in as little as 48 hours.

Get Started

Serious Cymbalta Side Effects and Warnings

Cymbalta can have serious side effects, often related to drug interactions, alcohol use and coexisting medical conditions. However, most are rare and reversible.

A March 2021 case report of a 43-year-old woman admitted to the hospital for acute liver failure while taking Cymbalta shows that drug-induced liver injury is a potential side effect of duloxetine. The patient was negative for viral and bacterial causes of liver failure and had no prior history of hepatic or liver diseases.

Cymbalta may cause enlarged liver and increased liver enzymes.

Between 2005 and 2017, the U.S. Food and Drug Administration issued several warnings regarding the serious side effects of Cymbalta, including the dangers of liver injury for heavy drinkers. As a result, the FDA advises against prescribing Cymbalta for heavy drinkers or chronic liver disease patients.

Serious Cymbalta side effects include:

• Allergic Reactions: Some people are allergic to one or more ingredients in Cymbalta. Symptoms of an allergic reaction include fever, hives and difficulty breathing.
• 
  Gastrointestinal Bleeding: Also referred to as “abdominal bleeding,” this side effect is prevalent enough to be listed as a warning on Cymbalta’s label. People experiencing gastrointestinal bleeding may feel weak and tired or notice bright red or dark tarry blood in their stool.
• 
  Glaucoma: There have been a handful of cases of duloxetine-induced bilateral acute angle-closure glaucoma. One person observed in a 2017 report developed glaucoma within 15 days of beginning Cymbalta.
• 
  Hyponatremia: Low blood sodium is a severe condition in which salt in your blood becomes severely diluted. Symptoms include confusion, headache, seizures and coma.
• 
  Liver Injury: Drug-induced liver injury, liver damage, liver failure and hepatotoxicity (toxic liver disease) are rare but serious.
• 
  Serotonin Syndrome: Studies link duloxetine to increased levels of serotonin in the body that can result in agitation, heart palpitations and changes in blood pressure.
• 
  Skin Reactions: Skin reactions include rashes and hair loss. These problems are usually reversible.

Cymbalta also may cause a severe allergic reaction called anaphylaxis. Symptoms of anaphylaxis include rashes, low blood pressure, nausea and vomiting and a weak but fast pulse. Seek emergency medical treatment immediately if you experience any symptoms of anaphylaxis.

You shouldn’t take Cymbalta if you drink alcohol in large quantities, if you have an existing liver condition, if you already have high serotonin levels or if you also take a blood thinner.

Cymbalta Black Box Warning for Suicide Risk

Like most antidepressants, Cymbalta may trigger suicidal thoughts and behavior in children, adolescents and adults under the age of 24. Therefore, patients should be monitored closely for changes in mood and behavior and the emergence of such symptoms.

Some people who take duloxetine also develop suicidal thoughts when they stop taking it. The FDA requires manufacturers to include a black box warning detailing these side effects in the labeling information for all SSRI and SNRI medications. People who have new prescriptions for Cymbalta should be aware of these warnings.

If you experience suicidal thoughts, contact your doctor or a crisis line immediately. You can reach the National Suicide Hotline at 1-800-273-8255 or the Crisis Textline by texting “HELLO” to 741741.

Advertisement

Real Therapy, Done Online

BetterHelp offers flexible scheduling so you can make time for therapy in between meetings, classes, child care, and more. Get 20% off your first month.

Get Started

Pregnancy and Breastfeeding Risks Linked to Cymbalta Use

Cymbalta can be harmful during pregnancy. A 2022 study in Current Research in Toxicology found changes to the BeWo cells that stimulate the placenta, including duloxetine-induced toxicity and reduced viability. These changes may hurt the fetus during development.

Clinical data shows that breastfeeding while taking Cymbalta is safe for babies. Although tiny amounts of the drug pass to infants during breastfeeding, researchers observed no adverse side effects in babies breastfed by mothers on Cymbalta.

Talk to your doctor if you’re pregnant or plan to become pregnant while taking Cymbalta. The benefits of taking Cymbalta may be worth the risks. Only you and your doctor can decide if this is the case for you.

Alexander Bingham, MA, PhD |
1:29
Can you explain the withdrawal symptoms associated with antidepressants?

Somatic Clinical Psychologist Andrew Bingham explains the withdrawal symptoms associated with antidepressants.

Long-Term Effects of Cymbalta

Cymbalta may cause enlarged liver and increased liver enzymes.

A few side effects of Cymbalta cause long-term issues, including later in life. This is especially true for people who take the medication as children.

For example, people who gain significant amounts of weight may be at greater risk of developing conditions such as coronary artery disease and cancer.

Long-term effects of Cymbalta include:

• Increased Risk of Cardiovascular Disease: People taking Cymbalta are more likely to develop cardiovascular disease. Physicians would like more research to determine if this is a direct side effect of the drug.
• 
  Increased Risk of Falls in Elderly People: Older adults who experienced dizziness because of duloxetine were more likely to suffer a fall than those not on the drug, according to a May 2019 study.
• 
  Stunted Growth in Children: Duloxetine may cause weight loss and poor growth in children. Monitor your child’s weight while they are taking the drug.
• 
  Weight Gain: Cymbalta causes some people to gain weight, especially if they take it with other medications. Research published in May 2021 found that veterans taking duloxetine with pregabalin to treat neuropathy had increased rates of weight gain.

Side effects usually go away as people adjust to Cymbalta. However, withdrawal symptoms can be long-lasting, especially for those who have taken the medication for a long time.

Cymbalta Withdrawal

Cymbalta dependence is a common problem. According to a 2020 research paper, dependence is common with most psychoactive antidepressants.

Withdrawal symptoms can occur when patients taper or discontinue the medication. Your doctor can help you manage withdrawal symptoms safely.

The most common withdrawal symptom reported for Cymbalta is nausea. However, some people experience more severe and longer-lasting withdrawal symptoms.

Reported Cymbalta withdrawal symptoms include:

• Agitation
• 
  Anxiety
• 
  Brain zaps (electrical shock sensations in the brain)
• 
  Cognitive impairment
• 
  Depression
• 
  Diarrhea
• 
  Dizziness
• 
  Fatigue
• 
  Headache
• 
  Increased occurrence of suicide
• 
  Muscle aches
• 
  Nausea
• 
  Sleep problems
• 
  Tremor
• 
  Visual changes

A qualitative analysis published in 2020 noted: “It is now suspected that antidepressant withdrawal syndrome is more common and severe than earlier presumed, affecting roughly 30%-50% of those who attempt to stop their treatment.” It reported that some people experience debilitating withdrawal symptoms, pointing to the link between withdrawal and suicide.

If you want to stop taking Cymbalta, contact your doctor. Your physician can determine a safe tapering timeline based on your needs and medical history.

Advertisement

Professional Therapy, Done Online

A licensed therapist with BetterHelp can provide professional support and guidance, on your schedule. Sign up and get matched in as little as 48 hours.

Get Started

Cymbalta Side Effects

Please seek the advice of a medical professional before making health care decisions.

TELL US WHAT YOU THINK

Did You Find Drugwatch Helpful?

Yes

No

Thank you for your feedback. Do you have any thoughts you’d like to share about Drugwatch.com?

This article changed my life!

This article was informative

I have a question

How can we improve this page?

This article contains incorrect information

This article doesn’t have the information I’m looking for

I have a question

How can we improve this page?

Thank You for Your Feedback

We appreciate your feedback. One of our content team members will be in touch with you soon.

We appreciate your feedback. One of our content team members will be in touch with you soon.

Cymba 60 – instructions for use, dosage, composition, analogues, side effects / Pillintrip

times more often than in patients with placebo) were nausea, dry mouth, drowsiness, constipation, anorexia and hyperhidrosis.

diabetic peripheral neuropathic pain: The most commonly observed side effects in patients treated with Cymbalta (as previously mentioned) were nausea, drowsiness, decreased appetite, constipation, hyperhidrosis, and dry mouth.

Fibromyalgia: The most commonly observed side effects in patients treated with Cymbalta (as already mentioned) were nausea, dry mouth, constipation, drowsiness, decreased appetite, hyperhidrosis, and agitation.

Chronic Osteoarthritis Pain: The most commonly observed side effects in patients treated with Cymbalta (as previously mentioned) were nausea, fatigue, and constipation.

Chronic Back Pain: The most commonly observed side effects in patients treated with Cymbalta (as already mentioned) were nausea, dry mouth, insomnia, drowsiness, constipation, dizziness and fatigue.

Side effects that occur at an incidence of ≥5% in patients treated with Cymba 60 in placebo-controlled studies: Table 2 shows the frequency of treatment-related adverse events in placebo-controlled studies for approved indications that occurred in ≥5% of patients treated with Cymba 60 and at a frequency greater than placebo.

side effects that occur at a rate of ≥2% in patients treated with Cymba 60 in placebo-controlled studies: MDD and GAD pooled studies: Table 3 shows the frequency of treatment-related side effects in placebo -controlled studies of MDD and GAD for approved indications, those who received Cymba 60 at 2% or more and at a frequency greater than placebo.

DPNP, FM, OA, and CLBP: Table 4 shows the incidence of treatment-related adverse events in ≥2% of patients treated with cymbalta (defined before rounding) in the acute phase prior to market entry of dpnp, FM , OA, and CLBP are placebo-controlled studies and with a frequency greater than placebo.

Effects on sexual function in men and women: Changes in sexual desire, sexual activity and sexual satisfaction often occur as manifestations of psychiatric disorders or diabetes, but may also be the result of pharmacological treatment. Because unwanted sexual reactions are thought to be voluntarily lowered, the Arizona Sexual Experience Scale (ASEX), a validated measure for detecting sexual side effects, was prospectively used in 4 placebo-controlled MDD studies. In these studies, as shown in Table 5 as follows, patients treated with Cymbalta experienced significantly greater sexual dysfunction as measured by total ASEX than patients treated with placebo. Gender analysis showed that this difference occurred only in males. Men who received cymbalta had greater difficulty achieving orgasm (ASEX item 4) than did men who received placebo. The women did not have more sexual dysfunction in cymbal than in placebo, as measured by the total cost of asex. Negative numbers mean improvement from baseline dysfunction, which is often seen in depressed patients. Doctors should regularly ask about possible sexual side effects.

Changes in vital sign : In placebo-controlled clinical trials with approved indications for change from baseline to endpoint, treatment with Cymba 60 was associated with a mean increase in systolic blood pressure of 0.07 mmHg. and diastolic blood pressure of about 0.62 mmHg. compared to a mean increase in systolic pressure of 1.31 mmHg. and diastolic pressure of about 0.73 mmHg. in patients receiving placebo. There was no significant difference in the frequency of persistent (3 consecutive visits) increases in blood pressure.

Treatment with Cymba 60 for up to 26 weeks in placebo-controlled trials of approved indications generally produced a slight increase in heart rate from baseline to end point compared to placebo up to 1.40 beats per minute.

Weight Changes: In placebo-controlled clinical trials, patients with DMD and GAD treated with cymbalta for up to 10 weeks had an average weight loss of approximately 0. 5 kg compared to an average weight gain of approximately 0. 2 kg in placebo. -treated patients. In the DPNP, FM, OA, and CLBP studies, patients treated with Cymbalta for up to 26 weeks had a mean weight loss of approximately 0.6 kg compared with a mean weight gain of approximately 0.2 kg in placebo treated patients. In a 60-week uncontrolled long-term study with fibromyalgia, Cymba 60 patients had a mean weight gain of 0.7 kg. In a 54-week CLBP long-term study (13 weeks, placebo-controlled acute phase and 41 weeks, uncontrolled expansion phase), patients with cymba 60 had a mean weight loss of 0.6 kg in the acute phase at 13 weeks compared to baseline, then lost an average weight of 1.4 kg in 13 weeks.

Lab Changes: Cymbalta treatment in placebo-controlled clinical trials for approved indications was with a slight mean increase from baseline to endpoint in ALT-, AST-, CPA, and alkaline phosphatase associated; rare, modest, transient, abnormal values ​​were observed for these analytes in patients treated with Cymbalta compared with patients treated with placebo.

Electrocardiogram changes: The effects of Cymba 60 160mg and 200mg given at steady state twice daily were investigated in a randomized, double-blind, two-way cross-over study in 117 healthy women. items. Qt interval extension was not found. Cymba 60 appears to be associated with a concentration-dependent but clinically significant decrease in QT.

Other side effects observed during evaluation of clinical trials before and after the launch of Cymba 60: The following is a list of side effects that occur in patients treated with Cymba 60 in clinical trials. In clinical studies of all indications, 29,435 patients received Cymba 60. Of these, 30.4% (8953) took Cymba 60 for at least 6 months and 14.7% (4317) for at least one year. The following list should not contain any reactions that are already listed in the previous tables or elsewhere on the label for which the cause of the drug was identified, it was so general that you were not informative, it did not have significant clinical effects, or occurred at a speed, it was equal to or less than placebo.

Reactions are classified according to body systems according to the following definitions: general side effects occur in at least 1/100 patients; rare side effects occur in 1/100-1/1000 patients; rare reactions occur in less than 1/1000 patients. Heart disease: General: palpitations. Rare: myocardial infarction and tachycardia.

hearing and labyrinth disorders: General: dizziness. Rare: ear pain and tinnitus.

Endocrine disorders: Rare: hypothyroidism.

Visual disturbances: General: See blurry things. Rare: diplopia and vision problems.

Gastrointestinal disorders: General: flatulence. Rare: regurgitation, gastritis, halitosis and stomatitis. Rare: gastric ulcer, hematochezia and melena.

General disorders and conditions At the injection site: General: chills / severe. Rare: Feeling abnormal, feeling hot and/or cold, feeling unwell and thirsty. Rare: gait disorder.

Infections and contamination: Rare: gastroenteritis and laryngitis.

Exams: General: Weight gain. Rare: increased blood cholesterol levels.

metabolic and nutritional disorders: Rare: dehydration and hyperlipidemia. Rare: dyslipidemia.

Musculoskeletal and connective tissue: General: musculoskeletal pain. Rare: muscle tension and muscle twitching.

Nervous system disorders: General: dysgeusia, lethargy and parasthesia/hypesthesia. Rare: attention disturbances, dyskinesia, myoclonus and poor sleep. Rare: dysarthria.

Mental disorders: General: abnormal dreams and sleep disturbances. Rare: apathy, bruxism, disorientation/confusion, irritability, mood swings, and suicide attempts. Rare: Completed suicide. Renal and urinary disorders: Rare: dysuria, myctial urgency, nocturia, polyuria, and abnormal smell of urine.

Reproductive system and breast disorders: General: anorgasmia / abnormal orgasm. Rare: menopausal symptoms and sexual dysfunction.

Respiratory, thoracic and mediastinal disorders: General: yawning. Rare: neck, tightness.

Skin and subcutaneous tissue disorders: Rare: cold sweat, contact with dermatitis, erythema, increased tendency to bruise, night sweats and photosensitivity reaction. Rare: ecchymosis.

Vascular disorders: General: flushing. Rare: hot flashes, orthostatic hypotension and peripheral cold.

Spontaneous Reports After Market Placement: The following side effects have been observed during post-approval use of Cymbalta. Because these reactions are voluntarily reported by members of a population of uncertain size, it is not always possible to reliably estimate your frequency or establish a causal relationship to drug exposure.

Side effects reported since market launch that are associated with Cymba 60 therapy and not mentioned elsewhere on the label include: anaphylactic reaction, aggression and anger (particularly in the early stages of treatment or after discontinuation of treatment) angioedema, extrapyramidal disorder, Galactorrhea, Glaucoma, gynecological bleeding, Hallucinations, Hyperglycemia, hyperprolactinemia, hypersensitivity, hypertensive crisis, Muscle spasms, Rash, restless legs syndrome, Convulsions upon discontinuation of treatment, supraventricular arrhythmia, Ringing in the ears (after discontinuation of treatment) trismus and urticaria.

Antidepressant withdrawal syndrome

Antidepressant withdrawal syndrome , also called antidepressant withdrawal syndrome , is a condition which may occur after interruption, reduction or discontinuation of antidepressants after their continuous use for as long as at least a month. ^[5] Symptoms may include flu-like symptoms, sleep problems, nausea, balance disturbance, sensory changes, akathesia, intrusive thoughts, depersonalization and derealization, mania, anxiety, and depression. ^{[2] [3] [4]} The problem usually starts within three days ^[2] and can last several months or years. ^[4] Rarely, psychosis may occur. ^[2]

Withdrawal may occur after discontinuation of any antidepressant, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs). ^{[2] [3]} The risk is higher among those who have taken the drug for longer and when the drug in question has a short half-life. ^[2] The main reason for its occurrence is unclear. ^[2] Diagnosis is based on symptoms. ^[2]

Prevention methods include gradual dose reduction among those who want to stop, although symptoms may occur with gradual dose reduction. ^{[2] [6] [4]} Treatment may include restarting the medication and tapering the dose. ^[2] People can also be switched to the long-acting antidepressant fluoxetine, which can then be gradually reduced. ^[6]

Approximately 20-50% of people who abruptly stop taking antidepressants develop antidepressant withdrawal. ^{[2] [3] [4]} The condition is usually not serious, ^[2] although about half of people with symptoms describe them as severe. ^[4] Many restart antidepressants because of the severity of their symptoms. ^[4]

People with antidepressant discontinuation syndrome have taken antidepressants for at least four weeks and have recently stopped their medication, whether abruptly, after a rapid dose reduction, or each time the medication is reduced with a slow dose reduction. ^[2] Commonly reported symptoms include flu-like symptoms (nausea, vomiting, diarrhea, headaches, sweating) and sleep disturbances (insomnia, nightmares, constant sleepiness). Sensory and motor disturbances have also been reported, including balance disturbance, tremors, vertigo, vertigo, and electric shock-like sensations in the brain, often described by people who have them as “brain strokes”. These “brain shocks” have been described as an electrical shock felt in the skull, potentially caused by lateral eye movement, and sometimes accompanied by dizziness, pain, or dissociative symptoms. Some people consider it a pleasurable orgasm-like experience, but more often it is spoken of as an unpleasant experience that interferes with daily life. ^[7] Mood disturbances such as dysphoria, anxiety, or agitation have also been reported, as have cognitive impairments such as confusion and increased arousal. In cases associated with abrupt discontinuation of MAO inhibitors, acute psychosis has been observed. ^{[2] [8] [9]} More than fifty symptoms have been reported. ^[10]

An FDA advisory committee in 2009 found that online anecdotal reports of duloxetine-related withdrawal included severe symptoms and exceeded the prevalence of reports of both paroxetine and venlafaxine by more than 250% (although it was acknowledged that this may have been affected by the fact that duloxetine was a much newer drug).