Does Cymbalta cause tics? (+7 factors)

In this brief article, we will discuss whether Cymbalta causes tics. This article will also explore the treatment approaches for managing this side effect and alternatives to Cymbalta if it causes tics. 

Does Cymbalta cause tics?

Yes, Cymbalta can potentially cause tics, but it is considered to be a rare side effect. While uncommon, some individuals using Cymbalta have reported experiencing tic-like movements as a side effect. 

Cymbalta is an antidepressant that belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). It increases the levels of serotonin and norepinephrine in the brain. These two neurotransmitters play critical roles in regulating mood, movement and impulse control.

Tics are sudden, involuntary, repetitive movements or sounds that occur without the person’s intention. Tics typically last less than a second and occur unexpectedly. They are often more pronounced under stress or anxiety.

An imbalance in serotonin and norepinephrine levels can disrupt neural circuits in the brain responsible for motor control, potentially contributing to tics. Additionally, increased levels of these two neurotransmitters can lead to overactivity in the basal ganglia, resulting in involuntary movements like tics. (1)

However, the precise mechanism by which Cymbalta might induce tics remains unclear.

Cymbalta can cause both motor and vocal tics, causing symptoms such as facial twitches, eye blinking, nose wrinkling, repetitive movements or words, coughing and grunting.

It’s important to note that everyone experiences medications differently and tics can involve various parts of the body and range in complexity and severity. 

What does the research suggest?

Studies have shown an association between antidepressant treatments, including SNRIs like Cymbalta, and an increased risk of developing tics. However, the exact mechanism and prevalence are not fully understood.

Tics are reported in approximately 0.3- 1% of individuals taking Cymbalta. 

A clinical trial was conducted on a patient with Tourette syndrome (TS), a neurodevelopmental disorder characterized by motor and vocal tics. The patient reported a substantial reduction in symptoms after the initiation of Cymbalta 40 mg/day. Clinical results suggest that Cymbalta can cause rapid improvement in involuntary movements and vocalization. (2)

However, limited clinical studies have investigated Cymbalta’s effect on tics in TS patients. Some studies have shown a modest reduction in tic severity, while others haven’t demonstrated significant results.

What factors contribute to experiencing tics while using Cymbalta?

The specific factors contributing to the occurrence of tics while using Cymbalta can vary among individuals. The factors that may trigger tics while using Cymbalta can be influenced by the following:

• Individual sensitivity: Some individuals are more sensitive to the effects of Cymbalta than others. This sensitivity can make them more susceptible to experiencing side effects like tics.

• Underlying conditions: Tics can be a symptom of various medical conditions, including Tourette’s syndrome (TA), attention deficit- hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Cymbalta can exacerbate tics in these conditions.

• Brain chemistry: Abnormalities in the levels of certain neurotransmitters, such as serotonin and dopamine, have been linked to tics.

• Dosage: Starting with a high dosage of Cymbalta or rapidly increasing the dosage can increase the likelihood of experiencing side effects like tics.

• Drug interactions: Taking Cymbalta with other medications, such as stimulants, other antidepressants, or antipsychotics, can increase the risk of side effects, including tics.

• Age: Younger and older adults can be more susceptible to experiencing side effects from Cymbalta, including tics.

• Genetics: Some genetic factors may increase the risk of experiencing tics while taking Cymbalta. 

• Lifestyle factors: Lack of sleep, poor diet and excessive stress can worsen the side effects of Cymbalta such as anxiety and tics. (3)

What are the treatment approaches for managing tics? 

Several treatment options are approved for managing tics. The healthcare provider will offer the best approach depending on the individual’s specific needs and the severity of the symptoms. Some of the treatment approaches include (4):

Medications

• Alpha-2-agonists: These medications include clonidine and guanfacine. They work by stimulating alpha-2 receptors in the brain, which can help reduce the frequency and severity of tics. They are often used as first-line treatment options for tics.

• Antipsychotics: These medications, such as haloperidol, pimozide and risperidone, can significantly reduce tic severity. They are usually reserved for more severe cases or when other medications are ineffective.

• N-acetylcysteine: This supplement shows promising results in reducing tic severity, although more research is needed.

Non-medication options

• Habit reversal training (HRT): This therapy helps individuals identify and replace their tic behaviors with more appropriate responses. 

• Comprehensive behavioral intervention for tics (CBIT): This intensive therapy combines HRT with other components like exposure and response prevention to address the psychological aspects of tics.

• Botulinum toxin injections: These injections can temporarily paralyze specific muscles involved in tic movement, offering relief for focal tics.

What are the alternatives to Cymbalta if it causes tics?

If Cymbalta is causing tics or if there are concerns about its side effects, alternative medications may be considered. Several alternative treatment options can be considered depending on the individual’s specific needs and the reason for taking Cymbalta. Alternatives to Cymbalta can include:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs, including fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), can be effective in treating depression or anxiety without causing tics. However, citalopram (Celexa) has been associated with tics.

• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Other SNRIs apart from Cymbalta, like venlafaxine (Effexor) or levomilnacipran (Fetzima), might offer similar benefits without triggering tics.

• Atypical antidepressants: These medications include bupropion (Wellbutrin) and mirtazapine (Remeron). They are effective in treating depression and anxiety and have shown less potential to cause tics.

• Tricyclic antidepressants (TCAs): TCAs like amitriptyline (Elavil) and nortriptyline (Pamelor) can be effective for some individuals and may pose a lower risk of tics compared to SSRIs or SNRIs.

• Cognitive behavioral therapy (CBT): This therapy can help individuals manage their tics by identifying triggers and developing coping mechanisms.

• Relaxation techniques: Techniques like mindfulness meditation, yoga and deep breathing can help reduce anxiety and stress, which can exacerbate tics.

Based on my research, I can conclude that Cymbalta can cause tics but rarely. There are several factors that can trigger tics while using Cymbalta. If you experience tics, it is crucial to consult your healthcare provider before making any changes to your medication regimen. Your healthcare provider will help you identify the best treatment option or alternative to Cymbalta based on your individual needs, medical history and the reason for taking Cymbalta.

References