Cymbalta To Treat Anxiety: What You Need To Know

Cymbalta, also known by its generic name of duloxetine, is a type of antidepressant. It has also been approved by the US Food and Drug Administration (FDA)¹ to treat and manage generalized anxiety disorder (GAD). 

Cymbalta may also be prescribed off-label for other anxiety disorders, such as panic disorder and social anxiety disorder.

Anxiety and medications 

Generalized anxiety disorder is a type of anxiety disorder characterized by:

• Excessive and persistent worry which lasts for at least six months

• Perceiving everyday situations as threatening

• Having difficulty concentrating

• Fatigue

• Heart palpitations and trembling

• Nausea

• Irritability 

Medications such as Cymbalta can play an important role in treating anxiety and its symptoms. However, if you are considering taking regular medication for anxiety, you should consult your doctor about the range of benefits and risks to determine whether it is right for you.

What is Cymbalta?

Cymbalta belongs to a group of medications called serotonin and norepinephrine reuptake inhibitors (SNRIs). 

Serotonin and norepinephrine are neurotransmitters, which are chemical messengers that send information and signals between nerve cells in our brain. 

Serotonin regulates our behavior, memory, mood, and happiness, while norepinephrine is associated with alertness, bursts of energy, mobilizing the brain and body for action, and retrieving memories. We need a balance of both neurotransmitters for healthy mood regulation. 

Serotonin and norepinephrine are produced in nerve cells and then are released into the synaptic cleft (the space between two nerve cells). Once there, they are active and can bind to a second nerve cell (the postsynaptic neuron) which allows the message to be received. 

However, serotonin and norepinephrine can also be reabsorbed back into the nerve cell that released them, and they become inactive again and recycled in preparation for the next signal. 

How does Cymbalta work?

If you have an anxiety disorder, you will likely have a neurotransmitter imbalance with low amounts of serotonin and norepinephrine in your brain. It is believed that GAD results from poor neural functioning² in the systems associated with serotonin and noradrenaline. 

Cymbalta helps restore the balance of these neurotransmitters in the brain, and it does this by preventing serotonin and norepinephrine from being reabsorbed back into the nerve cells. 

This increases the amount of active serotonin and norepinephrine in the synaptic cleft so that more can bind to postsynaptic neurons, allowing them to send their anxiety-reducing signals. 

What does the research show?

In a study³ of participants with moderate to severe GAD, their Hamilton Anxiety Rating Scale scores decreased by 49% after nine weeks of taking Cymbalta. They also showed greater sustained improvement rates once treatment ended compared to participants taking a placebo. 

Another study² found that Cymbalta prevented a relapse of symptoms associated with an anxiety disorder. Over a 26-week period, 13.7% of people who took Cymbalta relapsed compared to 41.8% in the placebo group. 

How quickly does Cymbalta work for anxiety?

Taking Cymbalta is not a quick fix. It can take six to eight weeks⁴ for Cymbalta to work to its full potential. This is because it takes time for serotonin and norepinephrine levels to rise and stabilize in the brain. 

However, you may notice some initial signs of improvement in anxiety-related symptoms, such as better sleep, higher energy levels, and a healthier appetite. 

You may feel worse when you start taking the medication because Cymbalta can increase anxious feelings, but these should subside if you keep taking the medication as prescribed.

How can you get Cymbalta?

As Cymbalta is a prescription medication, you will need to see your doctor or a psychiatrist to access it. 

Cymbalta costs⁵ approximately US$516.88 per 60 capsules. However, the generic form of Cymbalta, duloxetine, is significantly cheaper at around US$17.79 per 60 capsules. 

How do you take Cymbalta?

When prescribed for anxiety, the dose of Cymbalta can range from 30 to 120 mg per day. However, some studies⁶ suggest that there is no benefit to taking 120 mg per day. 

You’ll likely be given a starting dose of around 60 mg per day; however, older adults and children between the ages of 7 and 17 years old should start with 30 mg per day, gradually increasing the dose if needed. 

Your dose may be influenced by factors such as pre-existing medical conditions, other medications you are using, and any side effects you may have had from previous medicines. 

Always read the manufacturer’s information on the packet and follow your doctor’s instructions. However, as a general guide:

• Cymbalta is usually taken as a pill once a day. 

• It can be taken with or without food. 

• You can take Cymbalta in the morning or the evening, depending on whether you feel alert or drowsy, but make sure to stick with a specific time once you find out what works for you. 

If you forget to take a dose, you should take it as soon as you remember to prevent withdrawal symptoms. However, if it’s close to the time of your next dose, you should skip it because a double dose can be dangerous. 

How long should you take it for?

Do not suddenly stop taking Cymbalta, even if you start feeling better or think it isn’t helping your anxiety. This can lead to discontinuation syndrome, which causes withdrawal-like symptoms⁷ such as dizziness, nausea, diarrhea, anxiety, numbness, and irritability. If you no longer wish to take Cymbalta, you will need to be gradually weaned off of it.

Generally, you’ll need to take Cymbalta for at least six months after you’ve noticed significant improvements. However, it’s also safe to take it for longer periods⁸ should you want or need to. 

Who should not take Cymbalta?

Cymbalta is safe for most people over the age of seven years old. However, some factors may need to be considered before you start Cymbalta. 

Despite it being effective for treating anxiety, it’s important to keep in mind that Cymbalta, like all other antidepressants and anti-anxiety medications, will not cure an anxiety disorder. It’s helpful to engage in other treatment strategies, such as psychotherapy, relaxation or calming techniques and making positive lifestyle changes. 

Pre-existing medical conditions 

Several pre-existing medical conditions listed below could make it dangerous for you to take Cymbalta. However, having one of these conditions doesn’t necessarily mean that you won’t be able to try Cymbalta. It may just mean that you need extra support from your doctor. 

Some of these medical conditions include: 

• Liver or kidney disease (these diseases can make it harder to remove Cymbalta from the body)

• Diabetes (this can worsen blood sugar control)

• Low sodium levels 

• Being in a manic phase of bipolar disorder 

• Bleeding problems

• High blood pressure 

• Seizures 

• Urination problems 

• Glaucoma (when there’s too much pressure on the eye, this could trigger an angle-closure attack)

Other important factors to consider are:

• Older adults — This population is more likely to have low sodium blood levels and could be more sensitive to Cymbalta and its side effects. 

• Pregnant women¹ — Cymbalta can be dangerous to the growing fetus, especially in the third trimester. It may cause respiratory distress, temperature instability, feeding difficulties, and body tremors in the baby.

• Alcohol use ⁷— Alcohol can increase the risk of serious side effects from Cymbalta. It can also worsen the side effects of being drunk, such as drowsiness and poor coordination, especially in heavy drinkers.  

• Children under the age of seven years old⁹ — Cymbalta is currently only approved to treat generalized anxiety disorder in people over seven years old. Insufficient evidence exists to determine how safe and effective Cymbalta is for children under seven.

Interaction with medications  

Some medications can negatively interact with Cymbalta. These include,⁷ but are not limited to:

• Monoamine oxidase inhibitors, including both current users and those who have used them at some point in the past 14 days

• Blood thinners 

• Other antidepressants 

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen 

• Anything that increases serotonin levels, such as St John’s Wort, lithium, tramadol, SSRIs, and tryptophan supplements

• Heart medications

• Diuretics 

Before starting treatment, it’s essential to let your doctor know about any medications, supplements, and herbal remedies you are using or have used recently. 

What are the benefits and risks of taking Cymbalta?

Like any medication, it is important that you weigh the benefits and risks associated with Cymbalta before you decide to start taking it. 

Benefits

• Cymbalta is believed to have fewer² drug interactions than other antidepressant or anti-anxiety medications. 

• It’s safe to use as a long-term treatment. 

• It isn’t addictive, so it won’t cause dependence.

• Its predictable tolerability profile² suggests that adverse effects are usually only mild to moderate. 

Risks and side effects

Some of the most common side effects¹⁰ of Cymbalta include: 

• Physical effects — Headaches, dry mouth, sweating, dizziness, muscle pain, and cramps 

• Sexual dysfunction — Low sex drive and difficulty ejaculating or reaching orgasm 

• Digestive problems — Diarrhea, constipation, decreased appetite, and nausea 

• Anxiety symptoms — Agitation and restlessness 

• Sleep problems — Insomnia, drowsiness, and fatigue

These common side effects are generally mild and usually subside after a few weeks of continuing the medication. If you notice these side effects, don’t stop taking the medication. However, symptoms such as weight gain or loss, excessive sweating, and sexual dysfunction may not subside and can persist as long-term side effects. 

It is recommended to report any symptoms to your doctor so they keep an eye on your dosage and health status. 

Serious side effects

There are also a few rare but very serious side effects. These include:

Increased risk of self-harm or suicidal thinking and behavior

As noted in an FDA warning, this can be a side effect of taking Cymbalta. The risk is highest in children, young adults, and adolescents¹⁰ and is most likely to occur when you first begin taking Cymbalta or increase your dose. This may be due to increased levels of serotonin and norepinephrine, which can worsen anxiety or depression. 

Serotonin syndrome

This occurs when serotonin levels in the brain are outside the normal range. It can happen when Cymbalta is used in combination with other medications that increase serotonin levels, having a large Cymbalta overdose, or if your Cymbalta dose is increased too quickly. Signs of serotonin syndrome include agitation, hallucinations, a rapid heart rate, dizziness, hyperthermia, seizures, nausea, and diarrhea. 

Liver damage

Live damage is characterized by yellow skin, pain in the upper abdomen, and dark urine. People who drink alcohol or have a history of liver damage are at the highest risk.

Bleeding which does not stop

If you are on blood thinner medications, your risk is higher. 

Severe skin reactions

Examples include a rash or blisters.

Discontinuation/withdrawal syndrome

This can occur if you suddenly stop taking Cymbalta. Symptoms include anxiety, sweating, dizziness, electric shock sensations, and vomiting. 

Low sodium levels

Low sodium levels can result in frequent headaches, confusion, muscle cramps, or muscle weakness. Older adults and/or people on diuretics are the most at risk of developing this condition.

Low blood pressure and the risk of fainting after standing up

The risk of low blood pressure is higher in older adults, people on a high dose of Cymbalta, and/or people on other drugs that have the effect of lowering blood pressure.

These side effects are serious and have the potential to be life-threatening. If you are experiencing any of these severe symptoms, it is important to seek medical attention immediately as you may need to be hospitalized.  

The lowdown

Anxiety disorders such as generalized anxiety disorder can be severe and debilitating conditions. Cymbalta can be a highly effective treatment for managing anxiety disorders, and it is commonly prescribed. If you are considering taking anti-anxiety medication, discuss with your doctor whether Cymbalta is right for you. If you and your doctor decide it isn’t, there is a range of other medications available that may be suitable.