*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Cymbalta, with the active ingredient duloxetine, is an antidepressant medication in the serotonin and norepinephrine reuptake inhibitors (SNRIs) drug class. Cymbalta is an FDA-approved treatment for depression, generalized anxiety, and several physical conditions. Some taking Cymbalta may experience common side effects, such as nausea, dry mouth, sleep changes, and constipation. It is considered a safe and effective treatment, but there is risk for serious side effects as well.
If you’re considering duloxetine, online psychiatry platforms such as Talkiatry and Brightside Health can connect you with a provider quickly. They offer assessments and can provide a prescription if they determine Cymbalta or another medication may help your symptoms.
Boxed Warning: Duloxetine (Cymbalta) – Risk of suicidal thoughts and behaviors in certain people
Cymbalta, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Duloxetine can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with duloxetine and any other medications before starting treatment.
Key Takeaways
Cymbalta is a prescription antidepressant medication used to treat major depression in adults. It is also used to treat generalized anxiety disorder in children and adults.
Cymbalta, with the active ingredient duloxetine, is a serotonin norepinephrine reuptake inhibitor (SNRI).
If you are considering Cymbalta, a good place to start is with an evaluation from a medical provider. Many online psychiatry platforms offer online assessments and medication management, such as Talkiatry, or Circle Medical.
Personalized Treatment for Depression Talkiatry can match you with an actual psychiatrist. Talkiatry psychiatrists can evaluate you for depression and other issues that may be impacting your mood then implement a personalized treatment plan. Insurance accepted. Get started with a short online assessment.
What Is Cymbalta (Duloxetine)?
Cymbalta is a brand name SNRI antidepressant medication. It is FDA-approved for treating generalized anxiety disorder and fibromyalgia in adults and children. Cymbalta is also FDA-approved to treat major depression, chronic musculoskeletal pain, and diabetic peripheral neuropathic pain in adults only.1 Cymbalta is available as the generic medication duloxetine with the same risks and treatment benefits as the branded form.
How Does Cymbalta Work?
Cymbalta is thought to work by affecting the levels of two chemical messengers in the body, serotonin and norepinephrine.1 Increased amounts of these two chemicals may help the communication between brain cells, which may improve mood and other symptoms of depression and anxiety.
What Is Cymbalta Used to Treat?
Cymbalta is considered a first-line treatment for depression and anxiety disorders as well as several physical conditions.
Cymbalta is FDA-approved to treat the following conditions in children and adults:1
- Generalized anxiety disorder
- Fibromyalgia
Cymbalta is FDA-approved to treat the following conditions in adults only:
- Major depression
- Chronic musculoskeletal pain
- Diabetic peripheral neuropathic pain
Off-Label (Non-FDA-approved) Uses of Cymbalta
Cymbalta is used off-label to treat a variety of conditions. Off-label means that it is not FDA-approved, but a provider can use it for treating a particular condition because they believe the medication may offer a benefit. Common off-label uses include as a medication for chemotherapy-induced peripheral neuropathy and stress urinary incontinence.2
How Effective Is Cymbalta?
Cymbalta has been studied for use in depression, anxiety, and multiple types of pain. For treatment of depression, four studies showed that when taken daily between 20 mg and 60 mg of Cymbalta, patients improved significantly more than placebo. Cymbalta was also studied for its effectiveness in treating anxiety for patients of all ages, including children who were at least 7 years old and elderly adults. In each of these studies, patients were given 30 mg of Cymbalta, and all studies showed a significant reduction in anxiety symptoms.1
When Cymbalta was studied as a treatment for certain kinds of pain, results from three studies showed mixed outcomes. Two studies showed a significant reduction in pain, while one study failed to show a significant reduction in pain when compared to placebo patients.1 The data for Cymbalta as a pain reducing therapy is less clear cut than for other mental health disorders, but it could still be beneficial for you. Usually Cymbalta is used to treat certain chronic muscle or bone pain, fibromyalgia, or nerve pain caused by diabetes.
How Long Does it Take for Cymbalta to Work?
Cymbalta can take about 4-8 weeks to become fully effective, but some individuals may start to feel better after the first week or two. Each person may have a different response time based on how their body absorbs and processes the medication.
How Long Do I Need to Keep Taking Cymbalta?
The length of Cymbalta treatment will vary for each patient. It typically takes about 4 to 6 weeks for Cymbalta to work. Cymbalta has been studied in patients for at least 6 months, and many patients take Cymbalta for even longer. Deciding how long to take Cymbalta will be a joint process between you and your prescriber. Examples of factors that may influence this decision include symptoms of your condition, Cymbalta side effects, new medications, or changes in your lifestyle.
Common Cymbalta Side Effects
Individuals taking Cymbalta may experience common side effects that impact their digestive system, sleep, appetite, and sexual functioning. Some may require medical attention but many often resolve on their own.
Common side effects of Cymbalta may include:*1
- Nausea
- Dry mouth
- Sleep changes (drowsiness, insomnia)
- Constipation
- Loss of appetite
- Increased sweating
- Sexual dysfunction
Common side effects of Cymbalta for children may include:*1
- Nausea
- Decreased weight
- Dizziness
*All medications, including Cymbalta, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
Serious Cymbalta Side Effects
There is a risk for Cymbalta side effects to be serious or persistent. If these side effects appear, it is important to seek immediate medical attention.
Serious side effects of Cymbalta that require immediate medical attention include:*1
- Suicidal thoughts or actions
- Bruising or unusual bleeding
- Symptoms of mania or hypomania
- Heart palpitations
- Blurred vision
- Low blood pressure that can lead to dizziness and falls
- Severe skin reactions such as Stevens Johnson Syndrome
- Signs of liver damage (yellow skin or eyes, dark urine, upper abdominal pain)
- Seizures or convulsions
- Allergic reactions
- Muscle rigidity, tremors, fever, and/or seizures (could be a sign of serotonin syndrome)
*All medications, including Cymbalta, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
What Are The Long-term Effects of Taking Cymbalta?
Taking Cymbalta long term may increase the risk of experiencing severe side effects. As treatment continues, your prescriber may decide to increase your dose and this can lead to a higher exposure to the medication.
Notably, long term use of duloxetine, the active ingredient of Cymbalta, may cause an increased risk of heart problems, but more research is needed to know if this risk applies to everyone. A small study found that these risks may be preventable with proper monitoring of severe side effects. For all patients in this study, symptoms of heart problems improved after the dose of duloxetine was lowered or stopped.3
Personalized Treatment for Depression Talkiatry can match you with an actual psychiatrist. Talkiatry psychiatrists can evaluate you for depression and other issues that may be impacting your mood then implement a personalized treatment plan. Insurance accepted. Get started with a short online assessment.
What Are the Risks & Warnings for Cymbalta?
Suicidal Ideation & Behaviors
Duloxetine, the active ingredient in Cymbalta, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Duloxetine can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with duloxetine and any other medications before starting treatment.
Triggering Manic Episodes
For some people with bipolar disorder, taking Cymbalta can increase the risk of triggering manic episodes. Prior to starting treatment with an antidepressant like Cymbalta, patients with depressive symptoms should be screened to determine if they are at risk for bipolar disorder.
Allergic Reactions
For some people taking Cymbalta, an allergic reaction may occur which may be dangerous.
Severe allergic reactions to Cymbalta can include:
- Breathing problems
- Swelling
- Rash/hives
If you experience wheezing, difficulty breathing, or swelling in the throat, seek immediate medical help.
Serotonin Syndrome
Taking Cymbalta may increase the risk of a serotonin syndrome, a potentially life-threatening condition resulting from high levels of serotonin in the body.
Symptoms of serotonin syndrome include:
- Fever
- Sweating
- Confusion
- Fast or irregular heartbeat
- Severe muscle stiffness or twitching
- Agitation, hallucinations
- Loss of coordination
- Nausea, vomiting, or diarrhea
Seek immediate medical care if you experience these symptoms.
Heart-related Problems
For some people, taking Cymbalta may increase the risk of heart-related problems, such as a fast or irregular heart rate that may be fatal.
Pregnancy Risks
Cymbalta may increase some risks for newborns when taken by mothers in the last few months of pregnancy.
Breastfeeding Risks
Cymbalta is present in breast milk, which may carry some risk for a nursing newborn.
Glaucoma (Serious Eye Condition)
Cymbalta may cause angle-closure glaucoma, which can develop suddenly and lead to vision loss. If you have eye problems or a family history of glaucoma, your doctor may recommend an eye exam before taking Cymbalta.
Liver Damage
For some people, taking Cymbalta may cause liver damage.
Kidney Damage
For some people, taking Cymbalta may cause harm to the kidneys.
Abnormal Bleeding
Medications that affect serotonin activity, such as Cymbalta, can increase the risk of abnormal bleeding. Signs of abnormal bleeding can include bruising under the skin, a cut that does not stop bleeding, discolored stool, nose bleedings, or vomiting blood.
Urinary Problems
Cymbalta may cause problems with urine flow, such as urinary hesitation and urine retention.
Hyponatremia (Low Sodium in the Blood)
A rare but serious side effect, hyponatremia (low sodium levels in the blood), has been associated with the use of antidepressants such as Cymbalta. Low sodium levels in your blood may be serious and may cause death. Elderly people may be at greater risk for this.
Antidepressant Discontinuation Syndrome
People discontinuing Cymbalta abruptly may have symptoms of Cymbalta withdrawal, also called antidepressant discontinuation syndrome.
Here are common symptoms of Cymbalta withdrawal:
- Dizziness
- Nausea
- Fatigue
- Anxiety
- Shaking
- Sweating
- Agitation
- Sleep problems
- Seizures
- Electric shock sensations
Always take your medication as instructed by your provider. Do not stop taking Cymbalta or adjust your dosage on your own.
Drug Interactions
Taking certain medications, herbs, or supplements alongside Cymbalta can change how Cymbalta works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions.
Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Substances you should avoid using while taking Cymbalta include:
- Additional SNRI or SSRI medications
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants (TCAs)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Thioridazine (Mellaril)
- Buspirone
- Alcohol
This is not a comprehensive list of medications that interact with Cymbalta. Be sure to talk with your doctor or pharmacist about any prescription or over the counter medications you take, as well as supplements, herbs, and teas.
Who Should Not Take Cymbalta?
Some patients may experience side effects from Cymbalta more than others. While predicting who will respond poorly is difficult, specific patient populations should be cautious with Cymbalta. Patients taking other SNRIs, SSRIs, or medications that increase serotonin in the brain should avoid Cymbalta due to the risk of serotonin syndrome.
Adolescent patients and their parents should be aware of the risk of increased suicidal ideation when starting Cymbalta. It is essential to discuss your health conditions with your physician to select the medication that is the most suitable for you.
Populations who are at an increased risk for experiencing side effects include those who are or have:1
- Diabetes
- Liver problems
- Kidney problems
- Suicidal ideations
- A history of serotonin syndrome
- A history of heart conditions
- Low sodium levels in the blood
- Delayed stomach emptying
- A history of bleeding problems
- Pregnant or plan to become pregnant
- Breastfeeding or plan to breastfeed
- A history of bipolar disorder, symptoms of mania or hypomania
- Prior allergic reactions to duloxetine
- Prior vision issues such as glaucoma
- A history of seizures
Drug Interactions With Cymbalta
Taking certain medications, herbs, or supplements alongside Cymbalta can change how Cymbalta works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions.
Please let your doctor, psychiatrist, and pharmacist know about all the substances you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medications without your provider’s approval.
Substances you should avoid using while taking Cymbalta include:
- Additional SNRI or SSRI medications
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants (TCAs)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Thioridazine (Mellaril)
- Buspirone
- Alcohol
This is not a comprehensive list of medications that interact with Cymbalta. Be sure to talk with your doctor or pharmacist about any prescription or over the counter medications you take, as well as supplements, herbs, and teas.
Cymbalta Withdrawal
Those who stop taking Cymbalta abruptly may develop symptoms of Cymbalta withdrawal, also called antidepressant discontinuation syndrome.
Here are common symptoms of Cymbalta withdrawal:
- Dizziness
- Nausea
- Fatigue
- Anxiety
- Shaking
- Sweating
- Agitation
- Sleep problems
- Seizures
- Electric shock sensations
Always take your medication as instructed by your provider. Do not stop taking Cymbalta or adjust your dosage on your own.
Cymbalta Dosages for FDA-Approved Treatment
The typical starting duloxetine dosage for adults is 40 mg per day, taken as two 20 mg doses. Providers may choose a lower starting dose, slowly increasing it after a few months of use if the individual hasn’t seen a positive effect. The provider may also decrease the dosage if side effects are too bothersome.
How Should I Take Cymbalta?
Take your Cymbalta dosage exactly as directed with a full glass of water. You may take the medication with or without food but do not chew, crush, or open the capsules themselves.
What Happens If I Miss a Dose of Cymbalta?
If you forget to take your Cymbalta dose, take it as soon as you remember. If your next dose is due soon, skip the missed one and take your next scheduled dose. Never take two doses at once, and continue taking your medication as prescribed unless your prescriber directs you to do otherwise.1
Can You Overdose on Cymbalta?
Cymbalta overdose can happen and is harmful. This is more likely to happen when the drug is mixed with other substances. Serotonin syndrome, irregular heartbeat, and convulsions are all possible side effects of Cymbalta overdose.
What Should You Do If You Take Too Much Cymbalta?
A Cymbalta overdose is a medical emergency. If you believe that you or someone else has overdosed on Cymbalta, call 9-1-1 or go to the closest emergency room. Do not wait to see if overdose symptoms appear.
How to Get a Prescription for Cymbalta
To get a prescription for Cymbalta in person, start with an evaluation for your symptoms. Your primary care provider, who may be a physician, nurse practitioner, or physician assistant, can help you get the process started. They may make a referral to a psychiatrist or specialist to determine if a prescription for Cymbalta should be included in your treatment plan.
Can I Get Cymbalta Prescribed Online?
To get an online prescription for Cymbalta, you will also start by getting evaluated by an online psychiatric provider. We have thoroughly reviewed platforms like Talkiatry or Circle Medical that prescribe non-controlled substances such as antidepressants and some anti-anxiety medications.
Personalized Treatment for Depression Talkiatry can match you with an actual psychiatrist. Talkiatry psychiatrists can evaluate you for depression and other issues that may be impacting your mood then implement a personalized treatment plan. Insurance accepted. Get started with a short online assessment.
Questions to Ask Your Provider
It is important to discuss the potential side effects of Cymbalta with your doctor, psychiatrist, or therapist you may experience immediately after starting the treatment. Ask them whether these side effects will go away on their own or if any intervention is needed.
Also, many online psychiatry services are available with convenient access to mental health care for depression and anxiety problems. Individuals may even change prescribers and get a mental health evaluation, diagnosis, and personalized treatment plan.
Questions to ask your care team about Cymbalta may include:
- How long will it take for me to adjust to taking Cymbalta?
- How quickly can Cymbalta cause side effects?
- What are the first days of Cymbalta side effects like?
- How often should I see you for checkups while taking duloxetine?
- Should I let my therapist know I am taking this medication?
- What should I do if I want to stop taking duloxetine?
- What is the dosage of my medication?
- How often should I take my medication?
Prescriber’s Tips
Your prescriber will share important information about your Cymbalta prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Cymbalta.
- Take your medication as prescribed, do not change your dose or stop taking it unless your prescriber tells you to. Keeping a consistent dosing schedule reduces the chance of unwanted side effects. When taking antidepressants, this approach can prevent withdrawal symptoms such as dizziness, brain zaps, and flu-like symptoms.1
- Take your medication at the same time each day. Doing so can help you remember to take it, making it as effective as possible. Your healthcare provider can help determine the optimal timing based on your sleep patterns and initial medication response.
- Tell your prescriber right away if you or your child have any worsening mental health symptoms. Antidepressants have a boxed warning for increased risk of suicidal thoughts and behaviors in children under age 18 and young adults.
- You should take your first dose while you are home and not needing to drive. Cymbalta has been known to cause drowsiness in some patients, and you should avoid driving after taking Cymbalta until you know how it affects you.1
- Drinking alcohol while taking Cymbalta is highly discouraged.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications.
Frequently Asked Questions
Can Cymbalta Be Used During Pregnancy?
Cymbalta may increase some risks for newborns when taken by mothers in the last few months of pregnancy. Talk to your provider about the risks and benefits of treatments such as Cymbalta while pregnant.
Can Cymbalta Be Used While Breastfeeding?
This medication is excreted in breast milk and may harm a nursing newborn. Speak with your provider about options for feeding your baby during your treatment.
Is it Safe to Drive While Taking Cymbalta?
Cymbalta can cause drowsiness and may affect your decision making. Do not do dangerous activities such as driving or operating heavy machinery until you know how Cymbalta affects you.
Is It OK to Drink Alcohol While Taking Cymbalta?
Do not drink alcohol while taking Cymbalta. Cymbalta and alcohol can interact with each other, affecting your judgment, coordination, and motor skills.
What Are Common Side Effects of Cymbalta?
Common side effects of Cymbalta include nausea, dry mouth, and sleep changes such as drowsiness and insomnia.1
How Long Will Cymbalta Side Effects Last?
Common Cymbalta side effects usually last for a few weeks after the initial dose but may last longer for some people.
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Cymbalta – duloxetine hydrochloride capsule, delayed release. (November 6, 2024). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Dhaliwal JS, Spurling BC, Molla M. Duloxetine. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from https://www.ncbi.nlm.nih.gov/books/NBK549806/
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Cui, Y., Abdi, S. A. H., Wei, J., & Azhar, G. (2024). The Long-Term Cardiovascular Risks of Duloxetine Use in Older Adults: A Retrospective Medical Record-Based Adverse Drug Reaction Assessment. Journal of clinical medicine, 13(24), 7595. Retrieved from https://doi.org/10.3390/jcm13247595
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary updates: Added “Key Takeaways” feature. Edited for clarity and reorganized. Removed “History of Duloxetine)”. Revised and retitled content in “What is Cymbalta (Duloxetine)?”, to include “How Does Cymbalta Work?” What Is Cymbalta Used to Treat?” Added sections titled “How Effective Is Cymbalta?”, “How Long Does it Take Cymbalta to Work?” “How Long Do I Need to Keep Taking Cymbalta?”, “What Are the Long-term Effects of Celexa?”. Consolidated “Allergic Reactions to Duloxetine” and “Duloxetine Warnings & Associated Risks” into new “Risks” feature. Added “Who Should Not Take Cymbalta?”, “Cymbalta Withdrawal”, “How Should I Take Cymbalta?”, “How to Get a Prescription for Cymbalta”. Retitled “Questions to Ask Your Health Team” to “Questions to Ask Your Provider”. Removed “For Further Reading” section, added FAQs. Replaced “Final Thoughts” with “Prescriber’s Tips” feature.
Author: Osama Tariq, M.D.
Medical Reviewer: Dena Westphalen, Pharm.D
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