What is Duloxetine and What Is It Prescribed For?
Duloxetine is in a class of medications called SNRIs (serotonin and norepinephrine reuptake inhibitors). Also known under the brand names Drizalma Sprinkle and Cymbalta, duloxetine is FDA-approved to treat:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Fibromyalgia
- Diabetic peripheral neuropathy (tingling or loss of feeling in the legs or feet)
- Chronic musculoskeletal pain
Off-label uses include chemotherapy-induced peripheral neuropathy and stress urinary incontinence (difficulty urinating).
How Does Cymbalta Work: Its Impact on Brain Chemistry
Duloxetine inhibits the reuptake of the neurotransmitters serotonin (which helps regulate and stabilize emotions) and norepinephrine (the body’s alertness and arousal system). In doing so, it increases the amount of these neurotransmitters in the brain and thereby combines two therapeutic mechanisms in one agent to treat both depression (serotonin) and anxiety (norepinephrine).
Duloxetine also enhances dopamine levels in the prefrontal cortex, where executive functions such as goal setting, planning, and decision-making are located, among other functions. Additionally, duloxetine treats various pain states by suppressing the activity of certain neurons that reach the brain [1].
Benefits vs Risks of Cymbalta: Effects Over Time
The primary benefits of cymbalta (duloxetine) are in the treatment of the conditions listed earlier.
Common side effects include [1] [2]:
- Nausea
- Dry mouth
- Dizziness
- Drowsiness or tiredness
- Constipation
- Feeling less hungry
- Sweating
- Slowed growth
- Diarrhea (in children)
Serious adverse effects, while less common, include:
- Severe allergic reactions
- Suicidality
- Serotonin syndrome (an excessive accumulation of serotonin in your body)
- Liver damage
- Mania
- Fainting or a temporary loss of consciousness
- Excess water retention leading to low sodium levels
- Increased blood pressure
- Severe skin reactions
- Sexual problems
- Glaucoma
For those experiencing initial side effects, in the short term, the challenge is getting through them while waiting (1 to 4 weeks usually) for the therapeutic benefits to begin. In the long term, the focus is on maintaining stability and managing any lingering side effects, while not stopping the medication abruptly.
Talking to Your Doctor About Cymbalta and Safe Alternatives
Successful treatment means that the benefits of improved mental health or physical pain control outweigh the risks and side effects. Weighing the benefits versus the risks is an important step to discuss with your doctor, as it’s highly individual. And the presence of other medical problems may affect the use of this medicine [2] [3].
If you have concerns about some of the common side effects or some severe ones, by discussion with your doctor, you may consider these alternatives:
Other Medication Classes
- Other SNRIs. Similar mode of action with slightly different side effects
- SSRIs: Selective Serotonin Reuptake Inhibitors. Different side effects.
- Atypical antidepressants: Some are good for depression but not anxiety. Less risk of sexual side effects. Some can cause weight gain and sedation.
- Specifically for Chronic Pain: Several choices are available.
Non-Medication Therapies
These are often recommended as first-line therapy or alongside medication.
Psychotherapy (Talk Therapy): Cognitive Behavioral Therapy (CBT) can be very effective for depression, anxiety, and some chronic pain management.
Exercise and Physical Therapy: This is a key component of treatment for chronic musculoskeletal pain.
Medical Procedures: To manage pain, injections or nerve blocks may be used.
Complementary Approaches
- Mindfulness Meditation: Helps with anxiety, depression, and pain perception.
- Acupuncture: May help reduce and manage certain types of pain.
Evidence-Based Mental Health Treatment in Utah
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Sources
[1] Dhaliwal JS, Spurling BC, Molla M. Duloxetine. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-
[2] Johnston B. 2024. Duloxetine (Cymbalta, Drizalma Sprinkle) – Uses, Side Effects, and More. WebMD.com
[3] MedLinePlus.com. Duloxetine.