Introduction

We are the volunteers who run the Cymbalta® Hurts Worse Facebook group.  The group has about 40,000 members with hundreds of thousands of posts and has been helping people discontinue Cymbalta®/duloxetine for about a decade.  Over that time, and with deep research into the latest medical techniques, we have developed the Gradual Taper method.  We are not doctors, but our protocol is based on the findings of the current world-class researchers in this area.  References are on our About Us and Authorities pages.

Watch one of the world’s most eminent experts on discontinuation, Anders Sørensen, PhD for less than 5 minutes.  The rest of this page uses his research and advice, along with that of others, to present a way to taper safely.

https://www.youtube.com/watch?v=or0MRaEdNBE

Safe Tapering

Understand that we are all different and that no single tapering formula is going to work exactly the same way for all people.  So, we encourage you to listen to your body and adjust the recommended tapering process to suit your body.  Sometimes you may need to reduce the amount by which you drop your dose, or you may need to hold longer at a particular dose before reducing the dose again.  The guidelines below are general.

Decrease by 5% or less of the most recent dose, holding 14 days or more between each decrease. Even lower reductions are highly recommended. The first hold should always be at least 3 weeks.  More on this topic below…

Unsafe Tapering

Contrast the slow, steady recommendations above with what many people try for themselves and many doctors still recommend – even after recent changes to national guidelines and media publicity.

• going cold turkey (CT) – stopping all at once
• making large and/or rapid decreases
• alternating days
• bridging to other drugs
• using large beads, chunks, or pellets
• dumping random numbers of beads or guesstimating
• only counting how many beads you remove, not how many you actually take
• dropping too far and going back up
• any other form of off-roading

We highly discourage cold turkey (CT), decreasing rapidly and every-other-day discontinuation.

The Facebook Group Cymbalta Hurts Worse was created by Toni Samanie in 2013 with the help of qualified healthcare professionals. Since then, we have developed our knowledge and understanding through the many hundreds of thousands of posts and comments in the group of about 40,000 members, along with reports and research documented in the media. Our recommendations are now based on all of the above and are constantly monitored by the group’s moderators and administrators.

Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems. In short, it is not only dangerous to start taking psychiatric drugs, it can also be dangerous to stop them. Ideally, withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision. The key is to find a practitioner who knows what they are doing, and this can be difficult. This website is part of a community of mostly non-medical-professionals who are sharing their personal stories and reading published research – it is not meant to replace working with a knowledgeable doctor.

What are the bad effects of unsafe tapering?

For example:

• Protracted Acute Withdrawal Syndrome (PAWS)
• violent outbursts or actual rage
• bouts of overwhelming depression and anxiety
• a MUCH longer withdrawal and recovery period than if the drug was slowly tapered
• overwhelming fatigue that interferes with daily function and work
• insomnia, possibly leading to a psychotic break and commitment to a psychiatric ward
• REM Sleep Behavior Disorder, which has caused suicide and homicide during a sleep state
• seizures or other life-threatening reactions

These will not just go away in a few weeks.

About 25% will experience difficult, long-lasting withdrawal symptoms and about 10% will experience the most severe withdrawals. We cannot predict when they will start, how long they will last, who will be hit the hardest, or how any one individual will be affected.

Protracted Acute Withdrawal Syndrome (P.A.W.S. or PAWS)

PAWS is the highest level of withdrawal symptoms. This can be completely debilitating and even life-threatening. Only time and patience can gradually heal you and that may take months or even years.

You are more likely to get PAWS if you have been on the drug – or other similar drugs – for many years. PAWS can mimic many serious health and mental health disorders. It is a major destabilization of the central nervous system.

Misdiagnosis

As doctors believe withdrawal only lasts a few weeks – some believe just 2 weeks – you risk having your withdrawal symptoms misdiagnosed as bipolar disorder or other serious health or mental health disorders. The only way the doctors know to treat these is with even more dangerous drugs.

Akathisia

This is a dangerous condition related to antidepressant use. Notes about it online suggest it is not a serious condition. However, it is dangerous. This condition can become permanent. It mostly consists of overwhelming internal anxiety, extreme restlessness and involuntary movement.

Delayed withdrawal

Withdrawal symptoms can be delayed. You may stop cold turkey and you may feel wonderful at first. Many people report feeling better for a while. Then they are hit by harsh withdrawals months later. It may or may not then be too late to reinstate a very low dose. It can also be a period of manic behavior.

You don’t know what is going to hit you – until it hits you. And then it is too late.

Cyclic withdrawal symptoms

Cymbalta has a short half-life of around 12 hours (range: around 8-17 hours). This means that about 12 hours after a dose is taken, the levels of the drug in your body drop to approximately half, and after about 24 hours the body enters withdrawal.

Alternating days causes the body to go into withdrawal every other day. One day the dose plummets, the next day it shoots up. Every-other-day discontinuation is dangerous.

In fact, we suggest that if you are on 60mg or greater, you consider splitting the dose in half, taking the half-doses 12 hours apart.  This could minimize the stress on your body from starting withdrawal every 12 hours after taking a dose.

Switching or bridging to another drug

Bridging to other drugs causes more confusion for your brain and body.  This interferes with the ability to reinstate Cymbalta and then taper slowly off.  Bridging does not necessarily stop antidepressant withdrawal and can leave you with Cymbalta withdrawals as well as another drug to slowly taper off later. They all also come with similar side effects, risks, dangers, and the potential for bad, long-lasting withdrawal. There is no fast or easy way off Cymbalta.

Kindling

Kindling is an increase in the severity of symptoms. It is caused by numerous unsafe tapering attempts and withdrawal episodes, that lead to it becoming more and more difficult to come off the drug. Even if you have never had problems going on and off psychiatric drugs in the past, the next time might be the spark that ignites the inferno.

Kindling is a hyper-sensitization of the nervous system. It is most often associated with hypnotic drugs such as alcohol and benzodiazepines but is now recognized to occur with antidepressants and other psychotropic drugs as well.

Cymbalta® Warning for Suicide Risk

The best way to minimize withdrawal symptoms and reduce the risk is through a gradual taper.  Important for your recovery is working on diet and good nutrition, supplementing for any lacking vitamins/minerals, and other healthy and natural lifestyle changes.

Reinstatement

If you have stopped taking Cymbalta/duloxetine abruptly, after 2 (maybe 3) weeks it is no longer safe to go back onto your last full dose to try to reverse the withdrawal symptoms. After that, it is CRITICAL to attempt any reinstatement of the drug only at a LOWER dose. Going back onto a full dose can be very dangerous. The longer you have been off the drug, the lower the attempted reinstatement dose should be. We strongly urge you to do this process only in consultation with a Cymbalta Hurts Worse moderator/admin or one of the specialists listed on our Authorities page.

See the article here: https://healthwithoutantidepressants.com/reinstatement/

SAFELY Quit with the Gradual Taper Method

The GRADUAL TAPER method we document on this site will help to minimize the withdrawal effects of depriving your brain of the Cymbalta/duloxetine that it has become dependent on.

See an excellent video featuring tapering expert Dr. Mark Horowitz and CHW’s Maria Pastoor.  This will provide excellent background and explains the concept of the Gradual Taper that is presented on this site.

We encourage you to do your own research and thinking. We ask you to make your own decisions, based on the information available to you. Tapering slowly, steadily and consistently off Cymbalta/duloxetine will keep you safe from most withdrawals. Our recommendation is a slow, steady taper while working on natural lifestyle changes to address the reasons the drug was prescribed. Only very dangerous situations call for a sudden stop: serotonin syndrome, organ failure, or an allergic response.

Stopping “cold turkey” is extremely dangerous, both short- and long-term.

You need to work on diet, supplements and other natural remedies to help fortify the body and manage withdrawal symptoms.

The Three Basic Tapering Methods

These methods are based on the presumption that you can be prescribed capsules that contain small white microbeads, from about 70 to hundreds of them depending on your dose.  Using our online calculator, we will show you how to create reduced doses.  Once you calculate the required dose for a drop, typically taken for at least two weeks, you will put that dose in a new capsule for each day. Plain gelatin or vegan capsules are readily obtained from online vendors like Amazon.  We provide all the details for this in our following pages:

1. Gradual Taper by weighing beads

Some of us prefer to use a small jeweler’s scale (20 gram capacity in 0.001 increments) to weigh the doses.  These are available for ~USD$25 and we provide a comprehensive tutorial on where to get them.  Once you reach a very small dose, maybe 60 beads, you will switch to the counting method as the scale will no longer be able to resolve to that small weight.

Weighing page

2. Gradual Taper by counting beads

Some prefer to count the beads from the beginning of the taper, typically using a craft “bead counting” tray.  For those, we offer the following instructions.

Counting page

3. Compounding Pharmacy

Using a compounding pharmacy can be very expensive, and you have to make sure that they use beads, NOT a liquid or powder form of Cymbalta/duloxetine. It cannot – as far as we know – be used in a liquid form and only the beads are delay-released. Grinding the beads into powder destroys the enteric coating that allows them to reach the small intestine, which is where they should be absorbed. This means that powder may or may not cause “interdose withdrawals” in which your levels of Cymbalta fluctuate so much that withdrawals start before your next dose is due. it may even cause full withdrawals. Also, compounding is not always easily available, if at all.

Pharmacy CAUTION

The biggest issue with using a compounding pharmacy is that the doses are often pre-made to a rigid schedule.  Regrettably, your body does not work that way.  Gradual Tapers require you to MONITOR your body and your reaction to the dosages, and often to hold longer than the minimum two weeks recommended (while the pharmacy may only supply you with 14 capsules), or to slow the taper to a lower percentage.  This is made FAR more complicated by using a third party.  We strongly suggest you attempt to weigh or count first, before you resort to a pharmacy.

Make sure you have the correct microbeads for tapering. Tell the pharmacy/doctor you always want to use that brand, but be aware that in some countries there can be no guarantee.  Compounding by dissolving the medicine in water, oil, or any other liquid is not viable for Cymbalta/duloxetine.

You must have a good working relationship with both your pharmacy and your doctor. You need them to respond quickly if you need to change the taper instructions. Your doctor will write a taper prescription to give to the compounding pharmacy. Your doctor and pharmacist must agree with your plans to follow our guidelines for a 5% or less reduction of the most recent dose each time, holding at each dose for 2 weeks or longer. Few doctors and compounding pharmacies know how to do a proper gradual taper.

They must be willing to adjust your taper as necessary: for example, if you need to hold longer and/or reduce your percentage rate. Tell the pharmacy as soon as you experience any withdrawal symptoms. Work with them on slowing the taper or reducing the percentage. It is vitally important that you fully understand the process. You must work with them very closely to ensure they are doing it correctly.

You will need to switch to bead counting as you near the end of your taper. At 30 beads or more, you will need to begin decreasing by only 1 bead each time.

How long does it take to taper?

This depends on many factors. It will likely take at least 2-3 years to taper off 60 mg.  To model a Gradual Taper, use our online Calculator on the CALCULATOR PAGE  We suggest a taper rate of 5% of the most recent dose and holds at each dose for a minimum of 14 days.  As you taper, you will listen to your body and possibly hold for longer, or reduce the taper rate to a lower percentage.

Everyone wants to taper as fast as possible, but slower is much safer. Your brain needs time to adjust. There are no absolutes or guarantees when tapering off a psychotropic drug. Everything is unpredictable, so these are guidelines based on experience.

The maximum taper we suggest is 5% or less of the most recent dose, holding a minimum of 2 weeks between dose reductions.  The 1st hold should be 3 weeks. If you have had a previous bad taper or gone cold turkey, a taper rate of even 2% or 3% may be too fast. Taking or having previously taken other similar drugs will also affect the time it takes to taper.

Important! A 10% taper is ONLY suitable for people who have been on Cymbalta for a month or less, who are pregnant, or who are in a life-threatening situation affected by Cymbalta – if in fact they are able to taper and don’t have to go cold turkey.

Most people find they need to slow the taper at the mid-way point and definitely towards the end. From 50 beads on, many people only reduce by 1 bead at a time. From 30 beads this is essential. This may also mean holding longer between drops.  This is because of that hyperbolic effect shown in the chart above.

You must taper down to the very end.  From two beads to one is a 50% drop and at these low bead counts, be prepared to hold longer.  That last bead will be a 100% drop!

Even after finishing, you may still have a difficult time. It depends on your brain and body, your taper, your previous experiences and prescribed drugs.

Have you only been on this drug for a short time?

• It takes only 2 to 3 weeks for the brain to become dependent on Cymbalta/duloxetine.
• Many people on the drug for a short time find they need to taper much longer to avoid harsh and/or protracted withdrawal.
• The following suggestions are all up for discussion. You, the patient, must make the decision, based on the information available to you here.
• The closer you are to 2 weeks on the drug, the more likely you will need to gradually taper. The taper needs to be steady but not too long. If you are in CHW, moderators can discuss this, based on their experience with other members.
• When on the drug 2-3 weeks it becomes much more difficult to decide. Withdrawal may resolve quickly, or it could produce a more protracted withdrawal.
• So, from 2 weeks to 4 weeks you can consider a 10% taper. But anyone on the drug less than a year should proceed with caution. The general rule is to taper at least as long as you have been on the drug. However, many find they need to taper much longer than that.

Have you tapered by alternating days?

This horrible method is all too commonly prescribed by doctors who know no better.  Our posts are filled with horror stories from patients who suffered horrendous withdrawal effects because of this illogical concept. Alternating days throws the body into deep withdrawal every other day. Cymbalta has a short half-life of 12 hours on average (range: 8-17 hours), meaning that around 24 hours from the last dose, the body will start to go into withdrawal.

You should be on a daily dose for tapering. After alternating days for more than 2-3 weeks, it is risky going back to the previous daily dose. Find a mid-point between the two doses and try to stabilize there. Example: alternating 60mg and 30mg – try to stabilize at 45mgs daily for at least 2-3 weeks before beginning a gradual taper.

Do you plan to taper while taking other drugs?

Cymbalta/duloxetine is such a difficult, dangerous drug on its own. In combination with other drugs the situation is much more complicated. There are no clear recommendations for tapering when taking other drugs.

The Gradual Taper Process

Careful preparation, full knowledge and understanding are essential. Please make sure you read all these sections.

The prescription and capsules: you must be on the correct prescription for tapering and be sure to use the correct capsules

What type of beads do you have?

Not all brands will work for bead counting or weighing, or other tapering methods. You need to switch to a brand suitable for tapering BEFORE beginning the taper. Then you should hold on one dose and stabilize for at least 3 weeks. Switching after the taper has begun may cause problems.

How you arrange this with your doctor or pharmacist may need some thought. You may find it easier to discuss with the pharmacist. You could mention previous problems with a particular brand. You might want to try a different pharmacy.

• Microbeads – small, round, similar sizes: if you have these, you are lucky! You can use the bead weighing or bead counting method.
• Large beads or pellets, generally 5mg each: DO NOT USE for tapering. Switch to microbeads.
• Chunks – irregular shapes: cannot be used for bead counting. You may be able to use the weighing method for a while, but at lower doses you will need a brand with microbeads.
• Powder – this is uncommon. It needs a highly sophisticated scale. Switch to microbeads or use a compounding pharmacy.

Which is better, name brand Cymbalta or generic duloxetine?

If you have the name brand Cymbalta or the generic duloxetine, with similar-sized beads that number from about 70 up into the hundreds, then you can do either the counting or the weighing method. Some people can tolerate one product but not the other, as there is a difference is in the fillers and the enteric coating. Name brand Cymbalta is less likely to cause problems, it seems.

How should I prepare for my taper?

The first few weeks will likely be stressful. Be fully prepared – that can help to ensure a successful taper.

• Doctor: be careful mentioning a GRADUAL TAPER. You may be forced to follow a fast taper plan that could be devastating. You need to keep getting your regular script. Find a backup doctor who can write a prescription in case your original prescriber is not available.
• Pharmacist: ask about always getting the correct brand for tapering. BEFORE paying for or accepting your prescription refill, make sure you have been given the correct brand. Sometimes pharmacies change brands without warning!
• Start a tapering journal – dates, doses, decreases, symptoms, and then keep it going.
• Use the Tapering Calculator here on this site or the downloadable Excel spreadsheet to prepare your tapering doses and schedule.
• Select your tapering method, counting beads or weighing them.
• Get everything together that you need for your particular tapering method.
• Buy appropriate supplements to support your healing – good quality ones.
• Make a crisis and safety plan with close, trusted family and friends.
• Stabilize for at least 2-3 weeks before you start. In that time . . .
• Get plenty of fresh air and sunshine.
• Add gentle exercise, meditation and breathing exercises to your routine.
• Stay well hydrated – lots of water and electrolytes
• Use this website to find natural ways to address withdrawal symptoms.
• Start working on an anti-inflammatory diet.
• Take good probiotics and eat plenty of cultured and fermented foods to repair gut health.
• Avoid refined foods, GMOs, sugars, sweeteners, simple carbs, dairy, alcohol & caffeine.
• Stock your freezer with healthy meals for bad days.

Which capsules should I buy?

Some people manage to reuse the original capsules but they are smaller and difficult to fill. Some people will find they are damaged when emptying the beads for counting. Plain gel capsules can be bought online or in a pharmacy or health store. Size 0 or 00 are larger and easier to fill. Size 00 is the larger of the two. Size 1 is smaller than size 0 and can be used if you have difficulty swallowing the larger sizes. For comparison: Cymbalta/duloxetine usually comes in size 4. You can easily find vegetarian ones.

Enteric capsules are not to be used.

The beads already have an enteric coating.  And NEVER take any beads that are not in a capsule!  The capsule is required to help deliver the beads to the correct part of your digestive system.

What else should I know?

If you take a morning dose and an evening dose, you will need to make capsules with the correct number of beads for each dose. Your morning dose and your evening dose should be equal to each other. Keep your percentages the same. You will need to empty both capsules and reload them with the correct number of beads.

How do I prepare the dose?

DO NOT take the beads without a capsule. Empty capsules can be bought. Set aside a regular time each week to make up your doses.

Store capsules and beads safely – away from children and animals. Do not store the drug in the refrigerator, but if you need to reduce static and keep the beads under control when counting or weighing, try refrigerating just the beads to be handled that day, for just 1 to 2 hours beforehand.

Keep your leftover beads. Store the extra beads in an airtight glass container. You can also just use them in the next capsules you make up, if you are using new capsules. Dispose of unwanted beads by taking them to a pharmacy, fire station, or other drug disposal service. Do not flush down the toilet or put into regular garbage/rubbish.

Taper down to the last bead

Tapering advice on this website is specific to Cymbalta/duloxetine, but people suffer horrendous withdrawals from coming off any psychiatric drugs in unsafe ways. Advice from doctors is all too often dangerous.

Everyone wants to get off the drug quickly, but anything other than a slow, steady taper will almost inevitably cause problems. The nervous system craves stability and consistency. The method we recommend has been used successfully by thousands of people to get off Cymbalta/duloxetine with the least possible ill-effects.

If you are thinking of going “cold turkey,” rushing, or “off-roading,” please do NOT!

Reinstatement is possible after a dangerous reduction.

Sadly, there are no guarantees of success. That depends in part on your history with this and other drugs. See the topic on this page.

A journal could save your life

For anyone to support you effectively and also for your own purposes, you must record as much information as possible.  It is very important to keep a journal while taking a drug and possibly even more so when tapering.  Set it up BEFORE you start to taper. Keep it safe, make it available to others.  Keep it up-to-date.

Tell people: your spouse, significant other, a family member or friend about your journal and where you keep it. Tell them to show it to a paramedic or take it to the Emergency Room/Accident and Emergency if you are unable to explain the details of your taper.

Keep track of the number of beads you take, the percentage you are reducing, the length of hold and the specific dates.  This can easily be done by printing the dosage schedule from the Calculator page on this site that you are using, and marking on it where you are in the taper and the actual date of the dose.

Keep a note of withdrawal symptoms.  You can then consider whether to reduce the percentage by which you drop or increase the time you hold at each dose.  You could also include what you eat and life events to see what effect they may have.

You can look back and be proud of the progress you have made. If your doctor knows about your taper, take your journal with you to consultations.

We suggest you record the minimum: date, % drop, length of hold, any problems, other medications or supplements you take, and their dose. Always check for interactions on the Interaction sites on our Authorities Page.

Example:

• Saturday Oct 24, 2021. Beginning taper according to calculator printout with same date row. Feeling a bit nervous. No other meds. Taking Omega 3, one capsule each day, a baby aspirin, and a multivitamin.
• Sunday Oct 25. All fine.
• Monday Oct 26 – took dose 5 hours late.  Palpitations, trouble breathing.  Anxiety?  Once I took dose, soon felt fine.

Other possibilities will depend on your motivation, focus, need.  But you should at least consider them.

• Weight – on a strictly regular basis. Keeping track of your weight may encourage you to consider nutrition and other lifestyle changes.
• Blood pressure, if you self-monitor, especially if you have a problem with high or low blood pressure.
• Blood sugar, if you self-monitor, especially if you have diabetes or hypoglycemia.
• Everything you eat and drink and how much. Remember that while tapering you need to keep toxins out of your diet and feed your brain well.
• Bowel movements and urine output – if you start to suffer in some way, these are basic signs of what might be wrong: constipation, diarrhea, dehydration, or fluid retention; bloating, headaches, itchy skin.  These may be connected with your diet. The frequency and nature of these bodily functions and reactions are a guide to what might be wrong with you.  Note: how often; what your excreta is like – colour, soft or hard, very loose etc. Cymbalta/duloxetine affects so many parts of our bodies that the sooner you recognize issues, the better. Possible intolerances can be spotted by correlations between what you eat and how your body reacts.
• Activity – note the things you do and how they help/distress you: physical, mental, emotional well-being activities. This can show your improvements and also help you spot what you may need to add or avoid. You might find you suddenly have the courage or energy to walk for a mile!

Select Your Method

Each decrease is a decrease from the PREVIOUS DOSE and NOT from the ORIGINAL DOSE. That is why we provide these calculators, one an Excel spreadsheet for those who like that, and the other an online calculator on this site.  Both result in the same calculations.

Links to Weighing, Counting, and Calculator Pages

Click here for WEIGHING Page

Click here for COUNTING Page

Click here for CALCULATOR Page

Tapering off Multiple Drugs

Three ways to taper off multiple drugs:

Having to taper off even one drug is not easy. The more drugs you are taking, the more complex it will be. But that does not mean it is not possible. It is. Decide on how to do it and write your plan down carefully. Stick to the plan when you are able to. Go more slowly when you must.

Keep very careful, detailed records of dates, doses, withdrawals.

1. Taper one drug at a time

Get to know your body and see how decreasing the drug affects your withdrawal symptoms.

“If no one drug is clearly causing an adverse effect, discontinue the more activating drugs first.”

We recommend you taper the most activating drug first. Activating is the opposite of sedating. It may help to think of them as accelerators and brakes. A sedating drug may be added or may have been added to an activating one to treat drug-induced anxiety or sleep problems.

Normally, Cymbalta/duloxetine is the most activating drug, so you should taper that fully, unless you are having obvious adverse reactions to a particular drug.  Then taper off the ones that are more sedating. The brake may make it easier to manage withdrawal symptoms.

2. Taper all the drugs at once – very slowly

Your brain and body are used to the combination of drugs.  This may cause the least disruption to your brain.

However, if one of the drugs is causing a problem, you won’t know which drug. Trying to figure out all the different tapering doses could be a challenge, too.

3. The stair-step method

Taper just one drug for a while, then stop. Start tapering the next drug. By alternately tapering each drug, you will slowly discontinue all of them.

Activating or sedating?

Antidepressants and ADHD drugs (mostly amphetamine analogs) tend to be activating drugs.  These cause jitteriness, anxiety, or sleeplessness.

Benzodiazepines, the “Z” drugs for sleep, anticonvulsants (such as Lamotrigine), Lyrica, gabapentin (Neurontin), and antipsychotics tend to be regulating or sedating drugs. These cause drowsiness, sluggishness or dopiness.

Withdrawal symptoms

The most common and significant antidepressant withdrawal symptoms are: nervous system activations (possibly from a too-fast taper); hyper-alertness; sleeplessness; abnormal anxiety; agitation etc.

All of these make tapering much harder and recovery from post-acute withdrawal syndrome more difficult.

If you reduce the activating drug while taking a sedating drug, the sedating drug may help you manage the withdrawal better. You may plan to taper the sedating drug later.

Do not add any more psychiatric or pain drugs!

Do not increase your risk of neurological damage by taking more and different drugs. A new drug may interact with one you are already taking.

The new drugs will also need tapering and can create a withdrawal syndrome of their own.

Remember to check drug interactions

www.drugs.com/drug_interactions.html

Do your own research. Make your own decisions.

From Surviving Antidepressants. This is an old link but still useful and very thorough. Remember that our guidelines for tapering Cymbalta/duloxetine are very clear: maximum 5% reduction from the most recent dose each time with a minimum 2-week hold before the next drop.

https://survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

What to Tell Your Doctor

Preparing thoroughly for all doctor visits will help you achieve your desired results, such as securing prescription refills/repeats. Many patients are harmed by well-meaning providers who are not informed about how to taper safely off from antidepressants, including duloxetine. Most doctors do not understand that the drug works in a hyperbolic fashion. This means that the drug has the strongest effect at the very lowest doses.

Consider starting the conversation with your doctor like this:

“If I wanted to get off duloxetine, how would you recommend that I go about tapering off of it? I’ve heard it can be a difficult drug to come off. Have you read the latest evidence-based science about the need to slowly taper off of duloxetine?”

Ask questions about how they would recommend tapering off duloxetine to get a sense of their knowledge level about safe tapering. Keep in mind they either may be supportive of a slow taper or may not be. Once you understand their perspective on tapering you may or may not want to disclose your tapering goal. Your goal is to keep getting your prescription! Some doctors will cancel your prescription or prescribe a dangerous rapid taper. Avoid this at all costs. Some doctors will want to switch (bridge) you to a different drug. Typically, bridging to another drug does not prevent withdrawals.

You ultimately are the driver of your own health care decisions. If your doctor recommends a fast taper, it is best to tell them that you will think it over and for now want to stay on the drug at the full dose. This will allow you to secure your prescription and leave all options open.

Be aware that if you tell them that you are opening the capsules and counting/weighing beads, they may discount your knowledge about tapering. Some members have had doctors cut them off from refills/repeats due to lack of knowledge about the necessity of a gradual taper. Sometimes the less said the better.

If the doctor suggests using a compounding pharmacy be aware it can be very costly and difficult to find a knowledgeable compounding pharmacy.

If you feel comfortable printing off the following letter by Angie Peacock MSW and handing it to them, that might work to your advantage. The letter lists evidence-based resources for deprescribing and patient experiences of tapering and healing from psychiatric drugs.

https://healthwithoutantidepressants.com/wp-content/uploads/Letter-for-Ther_Doc-.pdf

What evidence do we have for our process?

About 40,000 members of the Facebook Group Cymbalta Hurts Worse over more than a decade have been assisted with the Gradual Taper process.  Above, you saw three testimonials of people suffering by listening to their Doctors.  That was the motivation to find a better way.

See this page for Bad Doctor Tapers.

Even the manufacturer of Cymbalta, Eli Lilly, warns not to stop abruptly. The warning labels on the drugs advise that large, abrupt decreases are dangerous. Read Section 6 of this Cymbalta guide. 

The FDA warns that any abrupt change in the dose of an antidepressant can produce suicide, hostility, or psychosis. These withdrawals can either come on very rapidly or be delayed for months. You MUST taper very slowly, over months and YEARS to avoid these risks.

We provide a page of authorities whose research and materials we study and employ.  Authorities Page Link

Eli Lilly package insert

These are all actual quotes from the Eli Lilly package insert: https://pi.lilly.com/us/cymbalta-pi.pdf

You will find similar in these two links: https://pi.lilly.com/ca/cymbalta-ca-pm.pdf and https://medlibrary.org/lib/rx/meds/duloxetine/

“2. Dosage and administration”
There is no evidence that dosages greater than 60 mg/day confer additional benefit, even in patients who do not respond to a 60 mg/day dosage, and higher dosages were associated with a higher rate of adverse reactions.

“2.8 Discontinuing CYMBALTA”
Adverse reactions after discontinuation of CYMBALTA, after abrupt or tapered discontinuation, include: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.

“5.7 Discontinuation Syndrome“
Discontinuation symptoms have been systematically evaluated in patients taking CYMBALTA. Following abrupt or tapered discontinuation in adult placebo-controlled clinical trials, the following symptoms occurred at 1% or greater and at a significantly higher rate in CYMBALTA-treated patients compared to those discontinuing from placebo: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g. paresthesia such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Although these events are generally self-limiting, some have been reported to be severe. Patients should be monitored for these symptoms when discontinuing treatment with CYMBALTA. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the healthcare provider may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.8)].

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