Depression, anxiety, and chronic pain are a major health concern in the U.S. It is estimated that over 50 million American adults have a mental illness, and that over 20% have chronic pain. It is thus no surprise that many people turn to medications like Cymbalta to cope with these issues.

Cymbalta works by controlling neurotransmitters in the brain that are responsible for pain perception, mood, and energy. However, while this drug is generally considered to be non-addictive, it does pose a high risk for abuse, especially as it produces uncomfortable withdrawal effects. Individuals can also become psychologically addicted to Cymbalta if they find it difficult to function normally without it.

However, there is hope for recovery among those who become addicted to Cymbalta. With multiple treatment options available, individuals can restore their health and lead new lives free from addiction.

Before going into the treatment methods that are available for Cymbalta addiction, this article will provide an outline of what Cymbalta is and what the long-term effects are.

What is Cymbalta?

Cymbalta is the brand name for duloxetine, an anti-depressant medication belonging to a class of anti-depressants known as serotonin-norepinephrine reuptake inhibitors (SNRI). Cymbalta is used as a treatment for depression, anxiety disorders, fibromyalgia, neuropathic pain, and osteoarthritis.

Compared with other anti-depressants on the market, Cymbalta is a fairly new drug, having only been authorized for medical use in 2004. In 2018, it was the 36th most prescribed medication in the U.S., with over 21 million prescriptions.

How Does Cymbalta Work?

As an SNRI, Cymbalta works by blocking the reabsorption of serotonin and norepinephrine, which allows more of these neurotransmitters to be available in the brain and nervous system. The result of having heightened levels of serotonin and norepinephrine is that it can improve energy levels, mood, and sleep quality, as well as decrease levels of fear, panic, and anxiety.

The availability of serotonin and norepinephrine is also thought to calm pain signals in the brain, since these chemicals inhibit pain perception. It is therefore an effective treatment for mood disorders and anxiety conditions, as well as for pain associated with diabetes and fibromyalgia.

Is Cymbalta Addictive?

Originally, anti-depressants were designed for the short-term treatment of mood disorders, with their intended period of use being about 6 to 9 months. However, according to some estimates, in 2018 over 15 million Americans were said to have taken anti-depressants for at least 5 years. This extended use can lead to stronger addiction, along with worsened withdrawal effects.

In physical terms, the brain can become accustomed to the way anti-depressants like Cymbalta alter serotonin and norepinephrine levels, especially over the long term. While Cymbalta is claimed to be non-addictive, people can experience severe withdrawal effects, such as rebound depression, suicidal thoughts, dizziness, and neurological issues. It is these uncomfortable withdrawal symptoms that cause people to continue taking the drug for many years.

Psychologically, Cymbalta can be addictive because individuals may find it difficult to cope with their change in mood if they stop taking the drug. They may struggle to feel normal without it and symptoms such as rebound depression and anxiety can cause them to be dependent on Cymbalta for an indefinite period.

Cymbalta Addiction Vs. Dependence

It’s worth noting that there is a difference between Cymbalta dependence and addiction. Dependence is a state of adaptation in the body that is caused by regular use of the drug. In this state, the individual isn’t mentally attached or obsessed with the drug. However, withdrawal symptoms can occur following abrupt discontinuation, and medical support may be required to help taper them off the drug.

In the case of Cymbalta, dependence is more likely than physical addiction. However, psychological addiction can occur if the individual feels like they cannot function normally without the drug and they engage in compulsive use and go to extreme lengths to keep using it.

Statistical Overview of Prevalence of Abuse

Below are some statistics surrounding Cymbalta, anti-depressant use, and their related mental health conditions:

  • Over 17 million prescriptions have been written for Cymbalta since 2006.
  • Roughly 50% of people who take Cymbalta experience withdrawal symptoms after discontinuing use of the drug.
  • According to the Anxiety and Depression Association of America, approximately 40 million Americans suffer from anxiety, and 17 million from depression.
  • It is estimated that about 10% of Americans take or use anti-depressants.
  • The rate of anti-depressant use increased by almost 400% between 2005 and 2008.
  • The World Health Organization (WHO) estimates that depression affects some 350 million people worldwide.

The History of Cymbalta

Cymbalta was developed by a group of researchers from Eli Lilly and Company in 1986. Further studies were conducted throughout the 1990s, once it was discovered that the drug inhibited serotonin reuptake.

In 2001, a New Drug Application (NDA) was filed for approval, but the Food and Drug Administration (FDA) rejected it due to potential liver toxicity and poor manufacturing standards at Eli Lilly and Company. The company subsequently improved its manufacturing standards and included details about the potential liver complications in its prescribing information. This allowed it to be approved and branded for medical use by the FDA in 2004.

Initially, Cymbalta was approved for stress urinary incontinence, but this was later withdrawn. The medication was then approved for use in depression and diabetic neuropathy in 2004 and for anxiety disorders in 2007. It was then approved as a treatment for fibromyalgia in 2008 and as a pain reliever for osteoarthritis in 2010.

Methods of Use

Cymbalta comes in three different dosages: 20 mg, 30 mg, and 60 mg. These capsules can be identified by the brand name and dosage imprinted on the side. They are also color-coded, depending on their strength:

  • 20mg: yellow capsule
  • 30 mg: blue and white capsule
  • 60 mg: blue and yellow capsule

Dosage

An average adult dose of Cymbalta is 60 mg per day. This applies to dosages for depression, anxiety, fibromyalgia, and chronic pain. However, doctors may initially recommend 30 mg daily for a week or two until the patient is used to the medication. The dosages can also be spread across the day, with users taking 30 mg twice per day, rather than 60 mg all at once.

Pediatric patients aged 13 to 17 typically start at 30 mg per day and may increase to 60 mg, depending on tolerability.

Physical and Neurological Effects of Cymbalta

Cymbalta influences brain chemicals that are responsible for mood, energy, pain, alertness, and appetite. Some of the initial effects that a person may experience while getting accustomed to Cymbalta include:

  • Increased energy
  • Pain relief (for conditions like diabetic neuropathy and osteoarthritis)
  • Improved appetite
  • Better quality sleep
  • Improved mood
  • Reduced anxieties and fears

In higher doses, the drug can lead to feelings of euphoria. People who abuse the drug report symptoms such as:

  • A sense of well-being
  • Elevated mood
  • A chronic state of borderline mania
  • Deep relaxation
  • An empowering sense of confidence

Potential Side Effects

Cymbalta can also cause uncomfortable side effects, especially during the first few weeks while the body adjusts. They include:

  • Dry mouth
  • Nausea
  • Muscle weakness
  • Vomiting
  • Constipation
  • Tremor
  • Loss of appetite
  • Fatigue
  • Low blood pressure
  • Weight loss
  • Excessive sweating
  • Skin rash
  • Lightheadedness

Serious Side Effects

Although these are generally rare, Cymbalta also comes with a risk of serious side effects, such as:

  • Liver damage
  • Orthostatic hypotension (changes in blood pressure when standing up too quickly)
  • Serotonin syndrome (due to high levels of serotonin)
  • Severe skin reactions, such as Stevens-Johnson syndrome
  • Eye problems, such as glaucoma
  • Hyponatremia (low sodium levels)
  • Trouble urinating
  • Hypertension (high blood pressure)
  • Unusual bleeding or bruising
  • Allergic reaction
  • Suicidal thoughts and behaviors

Common Cymbalta Combinations

While Cymbalta is rarely used to get high, some people report taking it in excess to achieve higher states of euphoria and alertness. Sometimes Cymbalta is also mixed with other substances, either accidentally or to increase its effects.

Alcohol

Although you can drink alcohol while taking Cymbalta, one of the primary concerns is liver damage. Cymbalta carries a risk of liver damage (as does alcohol), so combining the two can be dangerous. Also, as alcohol and Cymbalta cause sedation, mixing these two substances is risky. Alcohol can enhance some of the uncomfortable side effects of Cymbalta, such as dizziness, drowsiness, and headaches. Alcohol is also a depressant and can worsen anxiety or depression, leading to an increased risk of suicidal thoughts.

Another danger of mixing alcohol and Cymbalta is that they can lead to overdoses. Having too much alcohol in the system can impair judgment and a person may take more Cymbalta than intended — or vice versa.

Cocaine

Sometimes people on anti-depressants also end up abusing stimulants. However, the problem with mixing these substances is that cocaine causes the brain to release serotonin, while anti-depressants allow more of this neurotransmitter to be available. Therefore, the combination of these two drugs results in an over-abundance of serotonin in the body and can cause a dangerous condition known as “serotonin syndrome.” In this state, the brain and body receive more serotonin than they can handle, leading to symptoms like:

  • Vomiting
  • Seizures
  • Fever
  • Confusion
  • Anxiety
  • Diarrhea
  • Coma

Cannabis

Like alcohol, cannabis can increase the sedative effects of anti-depressants like Cymbalta. While this may be appealing at first, it can lead to abuse. Also, there is a risk that a person may take too much of either or both substances, leading to over-sedation and loss of consciousness.

Also, cannabis can worsen or enhance anxiety, which is dangerous for someone with panic disorder or anxiety issues. Cannabis also shares similar side effects to Cymbalta, such as dizziness, confusion, and difficulty concentrating, so combining the two will only worsen these symptoms.

Negative Health Consequences

Cymbalta use can leave lasting and damaging effects on a person’s physical and mental health. Some of the long-term health consequences include:

  • Liver problems
  • Sexual problems
  • Weight gain
  • Emotional numbness
  • Weight loss, weight gain
  • Thoughts of suicide or self-harm
  • Blood pressure issues
  • Cardiac issues
  • Feeling suicidal
  • Brain zaps
  • Higher risk of death

Overdose

Another important thing to look out for is a potential Cymbalta overdose. Key signs and symptoms of an overdose include:

  • Excessive sleepiness
  • Vomiting
  • High or low blood pressure
  • Loss of consciousness
  • Coma
  • Seizures

Signs & Symptoms of Cymbalta Abuse


While Cymbalta is said to be non-addictive, there is a risk of abuse. The signs and symptoms of abuse can vary from person to person, depending on how much they take and for how long they’ve used it. However, there are physical, psychological, behavioral, and social signs to watch out for.

Physical Signs of Abuse

Individuals who regularly take Cymbalta for long periods can exhibit physical signs of abuse, such as:

  • Slurred speech
  • Bloodshot eyes
  • Noticeable weight loss
  • Reduced appetite
  • Sleeping too much or too little

Behavioral Signs

Any sudden changes in behavior can be clear indicators of a problem. Some of the behavioral signs of Cymbalta addiction also apply to other prescription drug dependencies. These include:

  • Running out of prescriptions early
  • Faking symptoms to get Cymbalta prescriptions
  • Hiding or lying about Cymbalta use
  • Difficulties controlling Cymbalta use
  • Continuing to use Cymbalta, despite its negative side-effects
  • Isolation from work, family, and social life
  • Loss of interest in activities or hobbies
  • Insomnia or over-sleeping
  • Worsening performance at school or work
  • Suspicious behavior
  • Abusing other substances (poly-substance)
  • Relationship problems

Other Abuse Signs

Aside from the signs above, there are a few other identifying behaviors to watch out for if you suspect someone is abusing Cymbalta.

“Doctor Shopping”

Most doctors will restrict the amount of Cymbalta a person can obtain, and will only prescribe a certain amount at one time. People who abuse Cymbalta may resort to finding multiple doctors who can give them prescriptions for the drug. This can be a more extreme sign of psychological addiction, as the individual is taking desperate measures to acquire more than the prescribed amount. As part of this doctor shopping, individuals will also tend to travel great distances to different pharmacies in order to remain undetected.

Mood Swings

Due to the way that Cymbalta influences moods, some people may find it difficult to stabilize their mood or even function normally without it. Therefore, if someone is having frequent mood swings and you know that they regularly use Cymbalta, it can be a sign of ongoing abuse.

Financial Problems

Like many drug addictions, excessive use can lead to financial burdens. Individuals may struggle to pay for their Cymbalta use while maintaining daily living costs, such as rent and bills. Also, long-term drug use may cause them to lose their jobs, resulting in a downward spiral of substance abuse and financial problems.

Resources

If you or a loved one are struggling with Cymbalta abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Alternative to Meds Center. (2021). Side Effects of Cymbalta Long-Term Use. https://www.alternativetomeds.com/blog/long-term-effects-of-cymbalta-what-to-expect-when-discontinuing-cymbalta.

Brody, D.J., and Gu, Q. (2020). Antidepressant Use Among Adults: United States, 2015-2018. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db377.htm.

Centers for Disease Control and Prevention. (2020). Chronic Pain and High-impact Chronic Pain Among U.S. Adults, 2019. https://www.cdc.gov/nchs/products/databriefs/db390.htm.

Lesser, B. (2021). Antidepressant Addiction. Dual Diagnosis.org. https://dualdiagnosis.org/prescription-drug-treatment/antidepressant-addiction.

Medical News Today. Cymbalta (duloxetine). https://www.medicalnewstoday.com/articles/cymbalta.

National Institute of Mental Health. (2021). Mental Illness. https://www.nimh.nih.gov/health/statistics/mental-illness.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

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