How to Sleep While Taking Cymbalta
Medically reviewed by Lindsay Cook, PharmD
Anxiety and depression are becoming more common in the United States, with reported cases skyrocketing from 2015 to 2020.
Cymbalta (duloxetine) is a brand-name prescription antidepressant drug that is administered in the form of an oral capsule. Cymbalta belongs to the serotonin-norepinephrine reuptake inhibitors (SNRIs) drug class.
This drug is prescribed to treat depression (known as major depressive disorder [MDD]), generalized anxiety disorder (GAD), and certain types of pain. Of note, these conditions may cause symptoms that may interfere with your daily routine and your sleep.
Some people experience insomnia (trouble falling asleep or staying asleep) when starting certain SNRI antidepressants, including Cymbalta.
Therefore, when starting anti-anxiety and antidepressant medications, you may experience insomnia or other side effects, especially until the drug reaches full effect inside the body and the individual grows accustomed to using the drug.
This article will provide an in-depth analysis of Cymbalta, emphasizing its potential for insomnia and other important safety information regarding its use.
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Understanding Mood Disorders
Among other uses, Cymbalta is prescribed to treat MDD and GAD.
The medical term for depression is "major depressive disorder (MDD)." It is a common mental health disorder, with nearly 5% of American adults reporting symptoms of depression regularly.
Depression symptoms include persistent sadness and a lack of interest in activities you previously enjoyed.
MDD is increasingly common in 18- to 29-year-olds and affects females more often than males.
In comparison, GAD is defined as excessive, persistent, difficult-to-control worrying. Physical symptoms often include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
Over 15% of adults in the United States reported experiencing mild, moderate, or severe anxiety in the past two weeks. Like depression, anxiety symptoms are most commonly reported among 18- to 29-year-olds and females.
Researchers believe that there is a connection between depression and anxiety. Studies show that if GAD isn’t treated, it can increase the chance of developing MDD.
What Is Cymbalta?
Cymbalta, containing the active ingredient duloxetine, is a prescription SNRI. It is available as an oral delayed-release (DR) capsule typically taken once daily.
Cymbalta works by increasing the availability of serotonin and norepinephrine in the central nervous system.
However, it is unclear how this action directly translates into the antidepressant, pain relief, and anti-anxiety effects associated with Cymbalta.
The Food and Drug Administration (FDA) has approved Cymbalta to treat the following conditions:
MDD in adults (18 years and older)
GAD in adults and children 7 years and older
Fibromyalgia (FM) in adults and children 13 and older
Chronic musculoskeletal pain in adults
Healthcare providers may also prescribe Cymbalta off-label for urinary incontinence.
For context, "off-label use" is the act of using a drug for a purpose or at a dose for which it was not originally FDA-approved.
Side Effects & Safety
Like most drugs, Cymbalta may cause undesirable side effects. Many of these side effects are common initially but go away with time.
While taking Cymbalta, talk to a healthcare professional if these common side effects persist. Remember that these lists do not include all possible side effects of Cymbalta.
These side effects may likely vary with the condition being treated by Cymbalta.
Boxed Warning
Cymbalta also notably carries a black box warning—the highest warning the FDA issues—for the increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
These warnings are intended to caution the public and prescribers by highlighting potentially severe or life-threatening side effects or risks.
Patients and caregivers need to monitor for worsening depression or changes in behavior, as this could be a sign of suicidal thoughts and seek immediate assistance if they occur. Help is available.
Common Side Effects
In general, typical side effects associated with the use of Cymbalta include:
Drowsiness
Sweating
Insomnia
Cymbalta may treat children as well as adults for certain conditions.
Thus, side effects of Cymbalta that are more common in children include:
Decreased appetite
Nausea
Vomiting
Diarrhea
Severe Side Effects
Cymbalta may cause severe side effects that require more immediate medical assistance.
Potential severe side effects associated with the use of Cymbalta may include:
Hypotension (low blood pressure) when standing or sitting up, which may cause dizziness, falls, or fainting
Serotonin syndrome, especially when taken in combination with other medications that increase levels of serotonin
Withdrawal symptoms (if you suddenly stop taking Cymbalta)
Difficulty urinating
Sexual side effects, such as decreased sex drive or erectile dysfunction
Who Should Avoid Cymbalta?
Cymbalta may not be appropriate for everyone.
Healthcare providers may not prescribe this medication to people taking certain other drugs or with a history of specific medical conditions.
These factors could increase the risks of side effects with Cymbalta.
Healthcare providers may recommend avoiding Cymbalta if you:
Take a monoamine oxidase inhibitor (MAOI) medication (or recently stopped)
Have liver or kidney problems
Have a history of seizures
Have a history of mania
In addition, Cymbalta can interact with other medications, supplements, and alcohol.
To help prevent harmful interactions, discuss your current medications with your provider and pharmacist, including any over-the-counter (OTC) products.
Cymbalta and Quality Sleep
Cymbalta has been reported to cause insomnia as a side effect. Conversely, some people have reported experiencing fatigue or daytime tiredness after taking Cymbalta.
Cymbalta is typically taken daily. Since this medication can cause different reactions among individuals, including fatigue and drowsiness, the ideal time of day to take it can vary.
If it’s causing insomnia, take Cymbalta earlier in the day. If it’s causing you to feel tired, taking it in the evening would be best.
Effects on the Brain
Cymbalta affects neurotransmitters (chemical messengers) in the brain, such as norepinephrine and serotonin by preventing their reabsorption and increasing their availability.
This reaction has been shown to decrease sleep continuity and rapid eye movement (REM) sleep time and increase the time it takes to fall asleep.
Typically, effects on sleep are most bothersome during the first few weeks of treatment or after an increase in dose.
Using Other Prescription Medications
It’s common for healthcare providers to consider prescribing a temporary course of medication to help with sleep, such as a benzodiazepine like Ativan (lorazepam). However, this type of medication carries a risk of dependence when used for extended periods.
Although uncommon, the effects of Cymbalta on sleep can persist past a few weeks and may become significantly disruptive.
If you have persistent sleep disturbances, talk to your healthcare provider. Your provider may recommend adjusting the dosage of Cymbalta or prescribing a different drug or an additional medication to treat side effects.
For instance, a sedating antidepressant, such as trazodone, another antidepressant medication may be used alongside Cymbalta to mitigate insomnia-like symptoms.
However, medications like trazodone may increase the risk of side effects associated with Cymbalta, so you must talk to your healthcare provider to assess the risks and benefits.
Consult with your healthcare provider before changing your dose or discontinuing the medication.
Cymbalta should not be stopped suddenly; your provider will instruct you on slowly tapering your dose to allow time for your body to adjust and avoid withdrawal symptoms.
Dosing Overview
The dosage of Cymbalta depends on the condition being treated. The drug is available in brand and generic versions as a duloxetine delayed-release oral capsule. Its strengths are 20 milligrams (mg), 30 mg, and 60 mg.
The table below summarizes the typical recommended dosing for Cymbalta. Exceeding the target dosages may lead to more side effects without necessarily providing additional benefits.
Talk to your healthcare provider to confirm your dosage of Cymbalta.
Cymbalta (Duloxetine): | Starting Dosage: | Target Dosage: | Maximum Dosage: |
• MDD in adults | • 40–60 mg daily, which may be taken once daily or divided into two doses daily • In some cases, 30 mg once daily for one week before increasing to target dose | • 40–60 mg daily, which may be taken once daily or divided into two doses daily | • 120 mg once daily |
• GAD | • Adults (18–65): 60 mg once daily, or in some cases, 30 mg once daily for one week before increasing to target dose • Adults (65 and older): 30 mg once daily for two weeks before considering an increase to target dose • Children (7–17): 30 mg once daily for two weeks before considering a dose increase | • Adults: 60 mg once daily • Children: 30–60 mg once daily | • 120 mg once daily |
• Diabetic neuropathic pain in adults | • 60 mg once daily | • 60 mg once daily | • 60 mg once daily |
• Fibromyalgia | • Adults and children (13–17): 30 mg once daily for one week before increasing to target dose | • 60 mg once daily | • 60 mg once daily |
• Chronic musculoskeletal pain in adults | • 30 mg once daily for one week before increasing to target dosage | • 60 mg once daily | • 60 mg once daily |
How to Effectively Take Cymbalta
Next, a look at commonly asked questions and answers regarding the safe consumption of Cymbalta:
How should I take Cymbalta capsules? Cymbalta is typically taken once daily, with or without food. The capsule should be swallowed whole; do not crush, chew, or open the capsule.
Should I expect Cymbalta to give me energy or make me tired? Cymbalta may cause drowsiness or insomnia. Based on any effects you experience, you can decide the best time of day for you to take it. Taking this medication daily is ideal to avoid accidentally skipping a dose and potentially experiencing withdrawal effects. Taking it daily also helps avoid accidentally taking doses too close together, which could increase the risk of side effects.
What should I do if I miss a dose? If a dose is missed, take the next dose as soon as you remember unless it is almost time for the following dose. In that case, skip the missed dose and take your usual dose at your next scheduled time.
What if I want to stop taking Cymbalta or change my dose? When discontinuing Cymbalta or looking to change your dosing schedule, consult with your prescribing provider. They can instruct you on how to taper the drug safely. To stop Cymbalta, your healthcare provider will have you gradually reduce the dosage over several weeks to help avoid withdrawal symptoms. Withdrawal symptoms may include dizziness, headache, nausea, diarrhea, pins-and-needles sensations, irritability, vomiting, insomnia, anxiety, sweating, and fatigue.
Alternative Treatment Options
Nondrug approaches can be utilized in addition to taking Cymbalta for depression, anxiety, or pain-related conditions.
Lifestyle changes that have been shown to help these conditions include:
Diet changes
Exercise
Stopping smoking and substance use
Lifestyle changes may be practical additions to taking medications such as Cymbalta. Some people can manage their condition (or sleep disturbances) with lifestyle changes alone.
Talk to a healthcare provider to find a personalized plan for implementing and sticking to lifestyle changes.
Summary
Rates of anxiety and depression have been on the rise in the United States.
Cymbalta, an oral SNRI antidepressant, is prescribed to treat depression, anxiety, and specific types of pain, which can disrupt daily life and sleep patterns.
Cymbalta can cause trouble falling or staying asleep in some people, particularly when starting the medication or after the dosage is increased. Because of this, you may want to take Cymbalta in the morning.
However, you may need to use trial and error to find the best time of day to take Cymbalta. You can consult a healthcare professional or pharmacist for guidance.
A healthy sleep hygiene routine is essential to help prepare your body for sleeping.
Some basic tips include adhering to a consistent bedtime and wake-up time (including weekends), avoiding caffeine and alcohol after mid-day, and limiting screen time before bedtime.
Frequently Asked Questions
How can I safely store Cymbalta?
Store Cymbalta at room temperature (68-77 F). As with all medications, keep Cymbalta out of reach of children and pets.
Can Cymbalta be used for insomnia symptoms?
Not typically. Cymbalta treats depression, anxiety, and certain types of pain. These conditions may cause symptoms that disrupt your sleep.
Some people may experience insomnia as a side effect of Cymbalta, particularly when they start taking the drug or after a dose increase.
This side effect should go away with time or after adjusting the time of day you take your dose. Consult a healthcare professional for personalized advice.
How long does it take for your body to adjust to Cymbalta?
It varies depending on individual factors, such as age, the severity of the condition being treated, other health conditions, and the dosage your provider prescribes.
In studies of Cymbalta, many participants took a lower starting dose for the first week or two. Then their dose was increased until they reached the target dose. It may take a couple of weeks for the drug to reach its full effects in your body after initiating treatment or after a dose increase.
Read the original article on Verywell Health.
