When to See a Doctor During Cymbalta Withdrawals

Cymbalta (generically called duloxetine) is a medication used for the treatment of major depressive disorder by regulating the amount of seratonin in the brain. Psych Central online defines major depressive disorder as a patient experiencing five or more symptoms of depression that last for at least two weeks. Cymbalta is also used to treat symptoms of fibromyalgia, general anxiety disorder and is used by some physicians off-label for stress urinary incontinence. Sold in capsules of 30 mg and 60 mg, the maximum daily recommended dosage is no more than 60 mg.

Withdrawal Symptoms

• There is anecdotal evidence that withdrawal from Cymbalta is not only difficult but can be extremely dangerous. You should never simply stop taking the drug; it is best to taper off slowly over a period of days or weeks. Reported withdrawal symptoms include severe nausea and vomiting, muscle cramps, extreme fatigue and debilitation, cognitive dysfunction, headaches and general flu-like malaise. There are also reports of strange "brain zaps," which patients describe as a physical and auditory phenomenon that is likened to electricity zapping quickly through the brain.

Suicidal Ideation

• People withdrawing from Cymbalta also have cited heart palpitations, an increase in thoughts of suicide and much higher levels of anxiety. Several suicides have been reported in conjunction with Cymbalta, but there is no supporting evidence either with the FDA or Eli Lilley, which manufactures the drug, other than a generalized warning on the company's website that antidepressants can cause increased thoughts of suicide in "children, teens and young adults."

When to Call Your Doctor

• Contact your doctor immediately if you are having suicidal thoughts or feel like you want to hurt yourself. If it is after office hours, contact either the police or the EMTs for help immediately. Don't leave your well-being at risk. If you have intractable pain (severe, constant pain that negatively affects biological functions such as blood pressure, heart rate and neurology), it is very important that you see your doctor as soon as possible. According to the Mayo Clinic, if you develop yellowish skin tone or yellowed eyes, experience pain on your right side in the front, or have dark urine, these can be signs of liver toxicity.

  If you or your loved ones notice a sudden change in behavior or observe you having difficulty thinking or expressing yourself, see your physician right away. Also contact your doctor if you experience the "brain zaps," as they could be signs of a stroke or other brain damage.

What to Tell Your Doctor

• Discuss tapering slowly off the medication. Understandably, many physicians are not aware of the severity of Cymbalta withdrawal, as the evidence is anecdotal. Take printouts of what other patients have observed in trying to withdraw from the drug. Discuss the ideal steps you can plan together to minimize or eliminate symptoms. Make sure your doctor knows about all the medications you are taking, as this can affect you negatively while you are taking Cymbalta, as well as when you are trying to taper off.