How to Taper Off Duloxetine Safely
Duloxetine, also known by its brand name Cymbalta, is an SNRI prescribed for conditions such as depression, anxiety, fibromyalgia, nerve pain and musculoskeletal pain. Stopping this medication is safest when it is done gradually under medical guidance. Patients often ask how to taper off duloxetine safely. A carefully scheduled taper plan can lower the chance of uncomfortable withdrawal symptoms that are typical when stopping antidepressant use.
An estimated 20% of people who suddenly stop using antidepressants can experience some form of substance withdrawal. Researchers have found that an estimated 44% of those who quit Cymbalta reported having withdrawal symptoms. A gradual taper is the most effective way to stop using an antidepressant medication and reduces intense and uncomfortable withdrawal symptoms.
What is Duloxetine?
Duloxetine, or Cymbalta, works by increasing levels of serotonin and norepinephrine in the brain. These two neurochemicals are important in helping to regulate mood and pain. The drug works on your central nervous system. Because of this, the body can easily become tolerant of the drug and when you suddenly stop taking it, withdrawal symptoms can occur.
When you are on Cymbalta, the brain becomes accustomed to getting higher levels of serotonin and norepinephrine. When those levels suddenly drop because you stop using or you drastically reduce the drug dosage, the brain needs time to adjust to lower levels of brain chemicals. The adjustment period is what causes withdrawal symptoms. Withdrawal or discontinuation syndrome is a common experience among antidepressant users.
How to Taper off Duloxetine safely?
The safest way to stop taking Cymbalta is to reduce dosage in stages. A gradual taper. Individual taper schedules under the guidance of a medical professional will take into account factors such as the timing of each reduction based on your current dose, how long you’ve taken the medication, the reasoning for taking it and how you respond to each gradual reduction.
When tapering from Cymbalta, experts suggest a gradual reduction in dose over a minimum of four weeks. Other experts may suggest a plan that can last from two weeks to several months. While a slow taper might not completely prevent withdrawal symptoms, it is generally recommended as the safest way to discontinue antidepressant use.
Tapering is a feedback process: reduce, observe, stabilize, then reduce again. If the symptoms remain mild a short lived, the next step in reduction can proceed. However, if symptoms are intense, it may be safer to pause and return to the last comfortable dose and then restart with a smaller reduction.
A practical plan starts with an appointment with your healthcare provider. They will go over with you options for tapering and what factors can impact the process.
- Confirm reasoning for tapering. Side effects, symptom improvement, lack of benefit and medication changes are all reasons for wanting to taper off the medication.
- Current dose and schedule. Have a list of your current dosage and when you take it.
- Set a first reduction. Some people are able to tolerate a larger reduction, while others may need something smaller and more gradual in the beginning.
- Stay with the new dose long enough to judge your reaction. Many taper plans wait at least a few weeks between reductions. The right intervals will depend on symptoms.
- Slow down if symptoms become disruptive. If withdrawal symptoms become worse, it is best to consult your physician and maybe plan for a slower and more gradual reduction.
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Examples of tapering off Duloxetine
Starting at a dose of 90 mg. The first reduction is to 60 mg. The second reduction goes down to 30mg. For the third reduction, the medication dose is reduced to 20mg. After the third reduction, the patient may be able to stop taking the medication and monitor symptoms. This is just an example of a generalized taper schedule. In reality, tapering schedules are individualized for each patient depending on many varying factors.
Some people use the bead counting method to taper. This is when they open up the medication capsules and slowly remove the tiny beads containing the active ingredients to decrease the dose by very tiny increments. This can give the brain time to adjust to slightly lower levels of serotonin rather than a massive drop.
Others may be prescribed bridge medication such as a longer-lasting antidepressant that can make it easier to taper from a short-term medication. This doesn’t typically stop withdrawal symptoms, but it can make them less intense and more manageable.
With any type of taper, medical guidance from a healthcare provider will be the safest and most effective pathway to quitting antidepressants.
Common Withdrawal Symptoms after stopping Duloxetine
About 65% of people who experience withdrawal from antidepressant medications like duloxetine find they last about a week or so. The withdrawal symptoms are generally considered mild compared to other medications and SNRIs. They can affect mood, sleep, digestion, balance and body sensations.
- Balance and sensory changes that include dizziness, vertigo, tingling, brain zaps, and ringing in the ears.
- Digestive issues that include nausea, vomiting, diarrhea, appetite changes and upset stomach.
- Sleep and energy issues that include insomnia, vivid dreams and flu-like symptoms.
- Mood and cognitive changes such as anxiety, irritability, low mood, confusion, poor concentration and emotional swings.
How long can withdrawal symptoms last?
Withdrawal symptoms can start soon after a dose reduction or missed dose of an antidepressant medication and last between 1 to 3 weeks. While relapse of depression or anxiety often builds up gradually, unusual sensations like brain zaps are stronger indicators of discontinuation syndrome.
Withdrawal typically occurs in two phases. The acute withdrawal phase produces physical symptoms such as brain zaps, nausea, headache and fatigue. Post-acute withdrawal is the prolonged phase that can last as long as 6 months.
Not everyone fits a short timeline for Cymbalta withdrawal. Some people have more severe symptoms that can last longer. Others have much shorter withdrawal timelines.
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Treatment for Substance Use Disorder
There are a few different ways to help manage withdrawal symptoms. Above all, refrain from stopping antidepressant medications cold turkey. Try not to miss a dose. Or seek out professional guidance with a healthcare provider for a taper schedule or a therapist to help with adjusting to psychological withdrawal symptoms. Having a support system of friends and family can also be helpful to manage your mental health support during this time.
Professional behavioral health programs like Hotel California by the Sea offer treatments for detox and tapering off prescription medications. We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-based methods such as CBT, DBT and EMDR therapy. Hotel California by the Sea is dedicated to helping clients reach their goals in sobriety and overcome their addiction.
References:
https://www.talkspace.com/blog/cymbalta-withdrawal
https://www.verywellmind.com/cymbalta-withdrawal-symptoms-timeline-and-treatment-4707711
https://www.medicalnewstoday.com/articles/drugs-cymbalta-withdrawal
https://goodhealthpsych.com/blog/cymbalta-withdrawal-symptoms-timeline-and-how-to-cope/
