Does Cymbalta work for anxiety?

You may have an anxiety disorder if you experience nonstop, uncontrollable, and crippling anxiety that affects the quality of your life. “Anxiety is the result of chemical imbalances in the brain, specifically with mood-controlling neurotransmitters such as serotonin,” says Todd Hill, DO, board-certified psychiatrist with 20 years of experience, currently with Neuro Wellness Spa. It’s a common mental health problem, affecting nearly 30% of adults at some point in life, according to the American Psychiatric Association. In fact, the national prevalence data suggests that 40 million people in the United States experience an anxiety disorder in any given year. 

Now the good news: Anxiety is highly treatable with medication and lifestyle changes. Yet, only 43.2% of those affected are receiving treatment. Cymbalta (duloxetine) is one option that “effectively corrects neurotransmitter imbalances in the brain and body back to an equilibrium, allowing those prescribed Cymbalta to experience relief from anxiety, depression, and pain,” says Dr. Hill.

RELATED: Anxiety statistics 

What is Cymbalta (duloxetine)?

Cymbalta is the brand name for duloxetine. Duloxetine belongs to a class of medicines known as serotonin and norepinephrine reuptake inhibitors (SNRIs). Your healthcare provider may prescribe Cymbalta if you are diagnosed with a generalized anxiety disorder—a mental health condition characterized by persistent and unrealistic worry over everyday situations. 

The FDA has also approved Cymbalta for treating the following health conditions:

• Major depressive disorder (MDD)—a mental health condition characterized by symptoms of depression like persistent sadness and loss of interest in pleasurable activities
• Fibromyalgia—a condition that causes widespread muscle pain, fatigue, and mood and memory issues
• Chronic musculoskeletal pain—pain in the bones, tendons, ligaments, nerves, and muscles
• Diabetic peripheral neuropathy—nerve pain and damage associated with diabetes

Similarly, Cymbalta has been found effective for treating other clinical conditions, including nerve damage caused by chemotherapy (drugs for treating cancers) and stress urinary incontinence.

How does Cymbalta work for anxiety?

Researchers note that Cymbalta (duloxetine) works for anxiety because it targets two essential brain chemical messengers (neurotransmitters): serotonin and norepinephrine. Serotonin is the “feel good” brain chemical that regulates your mood. While, norepinephrine prepares your brain and body for action by causing you to become alert and attentive, especially in stressful situations. “Cymbalta increases serotonin and norepinephrine in the brain. The increase in serotonin is what makes it effective for anxiety,” says Sandip Buch, MD, a board-certified psychiatrist in New York and founder of Skypiatrist.

According to Dr. Hill, “Cymbalta is prescribed instead of other anti-anxiety medications—anxiolytics and selective serotonin reuptake inhibitors (SSRIs)—when there is a combination of symptoms accompanying the anxiety. Rarely is Cymbalta used as a first line of defense for anxiety.” 

Rather, it’s a better fit if someone is experiencing anxiety and another mood disorder or pain. This medication treats all of those symptoms by raising serotonin levels—which are also low for those with chronic pain disorders (such as fibromyalgia) and depression. Or, Cymbalta may be prescribed after other anxiolytics or SSRIs have failed.

How effective is Cymbalta for anxiety?

After treatment with Cymbalta for 10 weeks more than 50% of people saw an improvement of 50% or greater in their anxiety symptoms, according to one study. “Cymbalta is effective for anxiety when taken as prescribed,” says Alisha Reed, Pharm.D., The FLY Pharmacist. “Patients have reported a decrease in panic attacks within four weeks.”

An extensive 2007 study that pooled data from three independent clinical trials on more than 1,100 patients concluded that duloxetine was an effective treatment for anxiety. The patients received 60-120 mg daily of duloxetine for a period of nine to 10 weeks, and at the end of the study—the patients who received duloxetine reported reduced symptoms of generalized anxiety disorder, and improvement in their quality of life compared to patients who received placebo.

In this study, Cymbalta was well tolerated; nausea was the most reported side effect. However, the study did not include people with comorbid psychiatric disorders (a combination of mental health problems and other medical conditions).

Cymbalta dosage for anxiety

According to the FDA, the recommended dosage of Cymbalta for adults younger than 65 years old with anxiety is 60 mg, taken once daily. Your healthcare provider may start you on 30 mg daily and gradually increase it to 60 mg when your body adjusts to the medication. The maximum dosage of Cymbalta is 120 mg daily. However, research suggests that there are no extra benefits for most people when they take more than 60 mg of Cymbalta daily. 

“Cymbalta is generally not recommended for children under the age of 18,” Dr. Hill explains. “However, a doctor may decide that it is the best medication according to the patient’s symptoms and proceed within the same dosing procedures that they prescribe for adults.” It is FDA-approved for children ages 7 and older, but may not be commonly prescribed.

Keep in mind that for both adults and children, your healthcare provider may adjust the dosing as needed depending on factors such as your tolerance level, age, weight, and others.

You can take Cymbalta with or without food. Swallow the capsule as a whole without chewing, crushing, or opening the capsule. Cymbalta is absorbed in your body two hours after ingestion, but it may take six to eight weeks to see full results. It’s recommended to avoid certain activities, such as driving and cycling, in the first few days of starting on Cymbalta—this allows you to note how your body responds to the medication so you can take any needed precautions. You should also avoid alcohol while taking Cymbalta. 

If you miss a dose of Cymbalta, then take it as soon as you remember. But, if it’s almost time (less than 12 hours) for the next dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses of Cymbalta simultaneously to make up for a missed dose—it may lead to an overdose. Overdosing on Cymbalta may cause symptoms including sleepiness, serotonin syndrome (a condition caused by too much serotonin), increased heart rate, fever, muscle twitching, confusion, coma, seizure, hypertension (high blood pressure), and hypotension (low blood pressure).

Your healthcare provider will tell you how long you need to be on Cymbalta. Do not stop using Cymbalta without a go-ahead from your healthcare provider. When it’s time to take you off Cymbalta—your healthcare provider will need to wean you off gradually by reducing the dosage—to avoid withdrawal symptoms that occur due to discontinuing the medication. “This is referred to as serotonin discontinuation syndrome. Symptoms include flu-like symptoms, dizziness, brain zaps, nausea, and may feel like depression is coming back, but in reality, it is just the withdrawal symptoms,” Dr. Hill explains.

Cymbalta side effects and interactions

Some of the common side effects of Cymbalta include:

• Headache
• Dry mouth
• Appetite changes and weight loss
• Fatigue
• Stomach problems such as nausea, vomiting, stomach pain, constipation, or diarrhea
• Drowsiness and dizziness
• Trouble sleeping or excessive sleepiness
• Excessive sweating
• Blurry vision
• Decrease in sex drive (sexual dysfunction)

On the other hand, the following are some of the serious side effects of Cymbalta. These adverse effects are rare, generally occurring in less than one out of 100 people. 

• Suicidal thoughts and behaviors (all drugs classified as antidepressants, including Cymbalta, have a black box warning for suicidal thoughts and behavior)
• Serotonin syndrome
• Bleeding
• Serious, life-threatening allergic reactions (symptoms may include hives, difficulty breathing, or swelling of the face, lips, tongue, or throat)
• Serious, life-threatening skin reaction (symptoms may include fever, burning eyes, sore throat, skin pain, red or purple rash, blistering or peeling skin)
• Seziures
• Difficulty urinating
• Liver problems or liver failure (symptoms may include itching, stomach pain, dark urine, clay-colored stools, fatigue, yellowing of the skin or whites of the eyes)

Note that this is not a full list of side effects and other side effects may occur. Do not hesitate to check with your healthcare provider if you have the symptoms above or worsening side effects. “If side effects such as an increase in activation, agitation, or suicidal thoughts are present, a patient should stop taking the medication immediately and contact the prescribing psychiatrist,” says Dr. Hill.

Drug interactions

Some Cymbalta drug interactions include:

• SSRI antidepressants, tricyclic antidepressants, other SNRI antidepressants, MAOIs (monoamine oxidase inhibitors), triptans (migraine medications), St. John’s wort (a supplement used for depression), or opioid pain medications, among others, may cause serotonin syndrome, a medical emergency which is life-threatening and can cause death if not treated immediately
• Nonsteroidal anti-inflammatory drugs (NSAIDs; including aspirin), warfarin, and other anticoagulants (blood thinners) where Cymbalta increases the risk of bleeding, which can be life-threatening.
• Antihypertensives (medications that treat high blood pressure) combined with Cymbalta may cause orthostatic hypotension (low blood pressure when standing up from a sitting or lying down position). This may also result in people who take an increased dosage of Cymbalta—greater than 60 mg daily. Orthostatic hypotension can lead to falls and fainting—and in some cases, fractures and hospitalizations have been reported. 

This is not a full list of drug interactions. Other drug interactions may occur with Cymbalta. It’s a good idea to always inform your pharmacist and healthcare provider if you’re taking any medications (including prescription and OTC drugs, vitamins, and supplements) before you start taking Cymbalta, and they’ll give you relevant medical advice. 

Cymbalta is not safe for everyone. Before you take Cymbalta, your provider will review your medical history. Cymbalta is contraindicated (should not be used) in people using MAOIs to treat depression and those with chronic liver disease, as it may worsen their condition. And, because of possible interactions between alcohol and Cymbalta—you should avoid Cymbalta if you have a history of chronic alcohol use, as it increases the risk of liver disease. People with severe kidney disease, bipolar disorder, and narrow-angle glaucoma should also avoid using Cymbalta.

According to the FDA, you can only take Cymbalta during pregnancy, labor, or delivery if the benefits outweigh the risks; if not, it should be discontinued under a healthcare provider’s supervision. Cymbalta can cause serious complications when used in the third trimester. If you are breastfeeding, consult your healthcare provider for medical advice.

How much does Cymbalta cost?

Brand-name Cymbalta costs about $343.41 for 30, 60 mg capsules if you’re paying out of pocket. However, with the SingleCare Cymbalta coupon, you can get up to 80% discount. This means you may get generic Cymbalta for as low as $6.70 using a SingleCare prescription discount card. Medicare prescription plans and Medicaid may cover the cost of generic Cymbalta, but generally do not pay for the brand-name medication.

Here are other medications for treating anxiety:

Alternatives to Cymbalta for anxiety

Bottom line

Anxiety disorders can disrupt your daily life when left untreated. Cymbalta can be a very effective part of your treatment plan, especially for people with co-occurring pain or depression. If you’re considering medication for your symptoms, talk to your provider about whether this prescription could be right for you—and what other lifestyle changes might help. Meditation, mindfulness, regular physical activities, healthy eating, yoga, and journaling can also help you cope with symptoms of anxiety disorder.