DOSE:

20 mg

oral

Duloxetine

(daily)

BODY WEIGHT:

125 lb

I’m providing this information specifically because it seems that there are basically no other accounts of this type of reaction to a low-normal dose of SNRIs. The psychiatrist on call told me that he’d never heard of someone having such a horrible reaction to SNRIs within only days of starting.

I was having pretty severe anxiety towards the end of 2020 and the start of 2021 because of some heartbreak and traumatic events that occurred during that time period including an unexpected surgery failure. While I’d tried fluoxetine (Prozac) and sertraline previously, they both caused worsened anxiety, mood swings, and anorgasmia, so I stopped them within a few months of starting. So, at this point, I was specifically looking for a drug that would help with anxiety while reducing the likelihood of sexual side effects or weight gain. That brought me to SNRIs.

After discussing options with my psychiatrist, we decided that I’d try duloxetine (Cymbalta), and if that didn’t help (knowing my history with other antidepressants), venlafaxine (Effexor). She warned me that duloxetine could mess up my sleep and advised taking it in the morning, but I still decided to take it at night since that’s when I took all my other meds and I didn’t want to forget. This didn’t really end up mattering though. We also intentionally started me at a lower dose to mitigate potential side effects since I’ve had an unusual metabolic history with other medications, so I started at only 20mg — the normal starting dose is typically 30mg.

So, I began duloxetine in earnest. The first night I took it, I noticed some difficulty sleeping, but I mostly ignored it. Side note, I have a sleep disorder, so I already had zaleplon (Sonata) available to combat this sleeplessness. For the first two or three days, this sleeplessness got progressively worse until by the third day, I could not physically sleep without the sleep meds. Since zaleplon is short-acting, this meant I was getting between 1-2 hours of sleep despite being drop dead exhausted.

By the third or fourth day, I was having some other uncomfortable and increasingly severe side effects. I had no appetite, my heart was racing over 100bpm even at rest, I had a very dry mouth, I couldn’t think straight, and there were probably other side effects I just don’t remember since it was in the middle of a traumatic time of my life. This was during college and I was struggling to work on anything because I couldn’t think. By the fifth day, I was so exhausted from both sleeplessness and lack of appetite. I remember just sitting in my lab partner’s chair and staring at a wall unable to form complete thoughts. My heart was pounding and the back of my eyes hurt from not being able to sleep. I tried to nap but I physically couldn’t. I felt terrible. Strictly speaking, I wasn’t anxious anymore, but that was because I was so tired I couldn’t think.

In desperation, I called the psychiatrist after-hours and requested a callback from the doctor on call. He called me back a bit later and I described my experience and side effects to him. Knowing that duloxetine is infamous for its post-discontinuation side effects, I was mostly concerned about whether or not I’d taken it long enough to trigger that. He said no, it was safe to discontinue, and was also very shocked that my side effects were that pronounced from such a low dose. He said he’d never seen that happen to someone and advised that I stop taking it until I can see my psychiatrist again.

When searching through my texts that were sent during this time to see if I said anything about the experience and to determine the exact time period, I found that I’d also texted my therapist to tell her that I was so tired and probably wouldn’t be recovered from duloxetine before our appointment, so I cancelled it. It took two or three days until my sleep went back to normal and the other side effects subsided. I understand what it means to have severe insomnia and I feel for the people that experience its horrors chronically.

Because the duloxetine had been a failure, I figured I’d give a last-ditch shot to venlafaxine before giving up on SNRIs entirely. The first night I took it, I physically couldn’t sleep. Needless to say, I didn’t take it again.

Nowadays, I take fluvoxamine (Luvox) to manage my anxiety and depression. I offer this less as a cautionary tale and more to show the full spectrum of side effects that are rarely if ever discussed, especially by prescribing doctors with financial motivations. Be careful with Cymbalta.

Exp Year: 2022	ExpID: 117585
Gender: Female
Age at time of experience: 20
Published: Nov 17, 2024	Views: 15
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Duloxetine (395) : Difficult Experiences (5), Hangover / Days After (46), Medical Use (47), Alone (16)