With this post, we continue our sort-of-biweekly series on medications used to treat bipolar disorder and related symptoms. A few weeks ago, we began our coverage of the SSNRI antidepressants with Effexor (venlafaxine).
SSNRIs are Selective Serotonin and Norepinephrine Reuptake Inhibitors. They work by increasing the levels of two brain chemicals, serotonin and norepinephrine, in the synapses between brain cells. Like serotonin (described in our Prozac post), norepinephrine is important in regulating mood and anxiety, along with alertness and concentration.
The potential benefits versus side-effects profile for Cymbalta is similar to that of Effexor and other medications in this class. To avoid redundancy, we encourage you to reference our post on Effexor for benefit/side-effect information regarding SSNRI’s. Here, we cover potential benefits and side effects related specifically to Cymbalta.
Cymbalta has FDA indications for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder. Additionally it is approved for treating diabetic peripheral neuropathy (DPN) and fibromyalgia. Symptoms of DPN include a burning or tingling sensation in the extremities, typically the hands and feet, which develops in individuals with diabetes. Fibromyalgia is a disorder that presents with chronic pain and severe fatigue. Cymbalta may also be useful in treating other pain syndromes, such as chronic pain related to depression.
Some studies also support the use of Cymbalta in reducing the symptoms of stress incontinence – the involuntary passing of urine associated with coughing, sneezing, laughing, exercising, or other activities that apply pressure to the bladder.
Cymbalta can be taken once or twice a day with the daily adult dose ranging from 20 mg to 120 mg. Follow your prescriber’s recommendations on dose and when to take it.
Remember: Any antidepressant can take 2-3 weeks or even longer to become fully effective; it may take several weeks to work up to a therapeutic dose. This means that your depression may not lift for several weeks. I often tell patients that however they feel in the first two weeks is unlikely to be how they feel in a month – so if they are feeling some early side effects, hold on because they will likely get better.
Patience is important in getting these medications to work, but if you have any concerns about how you are feeling, contact your doctor. You will most likely have a follow-up visit with your doctor within a month or less of starting the medication; this is a good time frame for checking in to see if benefits have started or if side effects have faded or persisted.
Like most medications in its class, Cymbalta can potentially cause any of several negative side effects, including increased suicidal ideation (especially in children and teenagers), increased risk of mania, anxiety or agitation, worsening depression, and serotonin syndrome. For a more comprehensive list of side effects related to SSNRI’s as a whole refer to “Bipolar Disorder Medication Spotlight: Effexor (Venlafaxine).”
Warning
Cymbalta is metabolized by the liver and therefore can interact with many other common medications including blood thinners, some antibiotics, and some pain relievers. If you are being prescribed Cymbalta, be sure to tell your prescriber about all of your other medications, including over the counter (OTC) products, such as ibuprofen. Also, because of Cymbalta’s effect on the liver, it should not be used in people who drink a lot of alcohol – which stresses the liver. Alcohol intake should be kept in moderation for someone taking Cymbalta.Cymbalta can cause withdrawal symptoms such as nausea, vomiting, and agitation if it is discontinued abruptly. If you need to stop Cymbalta, consult with your prescriber about the safest way to do this.
Since Cymbalta is the newest of the antidepressants, I have not had extensive experience with it, but the response has been positive in the people that have started using it. Fatigue and stomach upset were the most common early side effects, but these usually resolved within a few weeks. I have reserved Cymbalta for people who have not tolerated or responded well to older antidepressants and/or if they have significant pain issues associated with their depression or anxiety. Cymbalta is being marketed heavily as an antidepressant that also treats physical pain, and in my limited experience it has reduced pain in some patients.
For more information from the manufacturer, visit Lilly’s Cymbalta page.
If you’ve taken any form of Cymbalta for bipolar depression or other conditions or are a doctor who has prescribed it, please share your experiences, insights, and observations.
Related Posts
You can leave a response, or trackback from your own site.
Working with Bipolar Disorder (June 15, 2009)
Medications Used To Treat Bipolar Disorder (June 18, 2009)
From Psych Central's Dr. Candida Fink & Joe Kraynak:
Bipolar Disorder Medication Spotlight: Wellbutrin (Bupropion) | Bipolar Beat (July 17, 2009)
In late 2007 and Spring 2008 I was put on Cymbalta by a neurologist for treatment of migraines. This was prior to me being diagnosed as Type II Bipolar. Cymbalta triggered a series of manic episodes involving spending sprees, drinking far more than usual. I went off Cymbalta last summer; subsequently an astute psychiatrist made my bipolar diagnosis and emphasized that giving an antidepressant alone to a Bipolar patient can trigger mania. I might add that Cymbalta was very difficult to get off of.
After having switched to hypomania on SSRI against depression I was diagnosed bipolar. My new doctor gave me Cymbalta together with Lithium, a combination that turned out to be a ticking bomb… When I was ordered to change the Cymbalta dose from 60 to 90 mg it just took three days before I exploded into mania and a month of madness that ruined my life.
On Cymbalta I was drinking much more alcohol than before and finally totally lost controll. The drinking problems stopped as soon as I quit Cymbalta.
As far as I can remember I have never been manic/hypomanic without beeing on an antidepressant.
(Lamictal now seems to work very well on me)
Cymbalta is the worst thing that ever happened to me. I was on several meds for a little longer then 4 years, but nothing seemed to treat the depression and self harm impulses. They upped me to the highest dose and in weeks I was hospitalized. I was hospitalized several times in the next year. The suicidal feelings and actions were seemingly unavoidable. Finally some brilliant md took me off of it. I immediately went into a mania, having never been manic in my life, so I got put on lithium which did nothing except cause bad diarrhea. It took months, but I am finally off of all meds, and feeling better then I have in 8 years. I am even thinking of going back to work.
My experience with Cybalta has been great, it is like a wonder drug. I took other SSRI’s before this one. I have had no side effects other than feeling flat, less emotions. Each body is different and the side effects are varied too. I hope people will give a drug a chance before knowing how they will react to it. You never know, you will have to see if your body chemistry reacts well.
Hi Tracy!
I’m glad that C works for you!
Are you using it against unipolar or bipolar depression?
Any other meds?
Cymbalta was the last of a long list of antidepressants, the others either stopped working or I was intolerant of higher doses. I went from Effexor to Cymbalta on the third day of taking it I woke up. After 3 yrs of living in a daze, it was amazing to literally wake up in the morning and ask “what the hell happened”? I took cymbalta for 2 years before it started to become ineffective (60mg). We tried a higher dose but I became quite agitated and aggressive. My doctor passed away shortly after this and I found myself having to wean myself off as best I could alone.
I consider myself very fortunate in as much that I didnt do physical harm to anyone particularly to my loved ones or myself. I tried to wean off as best I could and took about 5-6 weeks in doing it. The aggression, agitation and violent psychotic episodes took a harsh toll for not only myself but my daughter and grandchild and lasted for 2-3 months. My eye sight went down the tubes and now mistrust all psych meds. This is sad, they saved my life in the beggining but almost killed me in the end.
While on cymbalta, I slit my throat twice and stabbed myself in the stomach…I prefer paxil
I take Cymbalta (60×2) and Lyrica (75×2) for my fibromyalgia pain and Lamictal (100×2) for my bipolor along with 6 other meds including hydrocodone 7.5/500. The combination keeps my pretty quiet and does slow my thinking. My fatigue is from the fibro and is actually my most disabling issue.
I have occasionally tried to cut back on each of these drugs with uncomfortable results. At 57 I don’t even think about being “addicted.” At this point, I just take what gets me through the day.
I was on Cymbalta and it was doing great, but I got pregnant and my doc had to take me off. I was really bad off. I had a misscarraige and fell into a deep depression. I am now back on Cymbalta and happy to say that the “black cloud” has lifted! I wish it worked this way for everyone.
Wow! I just noticed how many of you mentioned you began drinking more with Cymbalta. I started Cymbalta almost a year ago and I went from drinking MAYBE once or twice a month to drinking a LOT several days a week. I’ve always just thought that I lost it somehow, but now I strongly wonder if Cymbalta might have somehow affected it. My doctor switched me from Effexor to Cymbalta and I want to ask him if I can switch back. (I also take Wellbutrin, Lamictal, and Cytomel.) I’d probably have to get off of it even slower than I have any other med b/c I’ve noticed that if I skip my dose more than one day, I become almost non-functioningly nauseous.
I have to say that Cymbalta has almost ruined our lives. Our GP put my husband on it for pain which he said was due to fibromyalgia ..as he has Bi-Polar he is often labeled as it turns out his pain was due to the vertebra in his neck being crushed from an old injury! My husband over the past few months has gone from stable to completely unstable. He would stay away for 2 days straight and only sleep when completely exhausted. He would get up in the middle of the night wandering the streets with his camera and taking photos as he was just so hyper. He felt constantly nauseous and was sweating like nothing I have ever seen. His eye sight deteriorated and he also took to having a drink at night …he thought it might help him sleep! His mind raced and it all came to a head two weeks ago with the loss of his job. I finally decided to do a check on Cymbalta and was horrified …horrified that a doctor who knows of his bi-polar would even put him on such a medication! He has been off it for a week and is now on the way down …is sleeping again but now I fear the big crash after such a huge high.
Cymbalta has taken away the person I am, it robbed me of my personality and looks, and I hit near 200 lbs while I was on it. Although I was directed to take Cymbalta for fibromyalgia, if I wasn’t into depression before that period, friends, I’ll tell you it’s like being in prison! In my fourth week without Cymbalta, the withdrawal effects are a living hell, but I’ll get past that and get that woman I really was. Not to mention spending sprees on credit cards, outburst of anger coupled with the “I’ll hurt you” statement in reaction to an innocent comment, and 40 unnecessary lbs. Still laying low, and hoping family and friends will forgive me. If just one person can be saved from my story, then I’ll be at peace knowing that my wasted year had to happen so another patient and his/her family might be spared this pain.
No drug works for everyone. You, your doctor and your loved ones should be aware of bad reactions and side effects, and if the drug is not working for you, STOP TAKING IT.
That being said, Cymbalta has been improving my life for about 4 years now. I have chronic depression, fibromyalgia and suffered from migraines for years. Other antidepressants , etc., were only marginally effective. Cymbalta has lifted the depression, stopped the migraines and taken the edge off the fibro pain.
So, is it a good drug? It is for me!
I was diagnosed with fibromyalgia, then CFS, but it was actually undiagnosed Lyme disease. I have been on anti-depressants and pain meds of all kinds for the past 10 yrs. Not much has worked. I started to get suicidal on Welbutrin XL, so my Dr. switched me to Cymbalta about 1 month ago, and I have to say it is the first time in as long as I can remember that I feel happy, have energy, and more control over the excrutiating pain. I wish I had switched a long time ago- I keep thinking of the time I wasted taking meds that didn’t do anything but leave me flat. Too bad it didn’t work at all for some!
I was put on Cymbalta spring of 2006 for postpartum depression. I felt better, I was more happy than I had been in years. I lost weight. But about a year and a half later I began having manic episodes (this was before I was diagnosed bipolar II). Though I did not know it then that it was a manic episode, I kept taking the Cymbalta. Another year goes by and by this time I am loosing my mind. I had another manic episode and now I am trying to put the pieces back together. I was hospitalized. Coming of the Cymbalta was VERY hard. I had withdraw symptoms so bad that I could have easily been thought to have been coming off of a street drug. The drug it self is wonderful for depression. But, for Bipolar it is a food!
cymbalta + lamactil + trazadone has been a life saver for me. Cymbalta and Lamactil alone did not fully treat my symptoms and stress would cause me to want to overdose on ativan. I needed help to sleep and trazadone, which is also an antidepressant added both benefits, drowsiness at bedtime, plus additional control over my moods. I now have a much happier and functional life.
Copyright © 1992-2009 Psych Central. All rights reserved.
Site last updated: 21 Nov 2009
|
