Does Cymbalta cause tremors? (3+ facts)

In this article, we will discuss Cymbalta-induced tremors. We will also discuss the research findings and case studies related to Cymbalta-induced termors, along with tips to deal with tremors. 

Does Cymbalta cause tremors? 

Yes, Cymbalta is associated with tremors. Cymbalta (duloxetine) is an antidepressant which belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRI) and acts by increasing the level of serotonin, norepinephrine and dopamine in the prefrontal cortex of the brain. (1)

An increase in these neurotransmitters helps treat symptoms of depression and anxiety disorders. Cymbalta also helps in the management of chronic pain by acting on neurons of the dorsal horn in the spinal cord and is used in treating various pain syndromes. (1)

Cymbalta is associated with some common side effects, such as nausea, vomiting, constipation, dizziness, diarrhoea, drowsiness, dry mouth, weight loss, insomnia, fatigue, tremors, etc. The side effects caused by Cymbalta vary in occurrence and severity among individuals. (1)

If you are experiencing tremors and it is affecting your quality of life, make sure you visit your physician for proper management. Your physician may adjust your dose or change your drug accordingly to minimise your side effects. 

What does the research suggest? 

A study which assessed antidepressant-induced extrapyramidal symptoms reported that, among 89 cases, 66% of the case studies were treated with duloxetine. 34% of the individuals suffered from tremors, 14% from dyskinesia, and 8% from tardive dystonia. Extrapyramidal symptoms such as dyskinesia, tardive dystonia, akinesia, dystonia and akathisia are movement disorders caused by the use of certain drugs. (2,3)

A 19-year-old female patient with no history of seizures or tremors was treated with 30mg of duloxetine for her anxiety. She was admitted to the hospital with complaints of dystonia after 10 hours of duloxetine consumption, which was then treated with biperiden. (4)

In another case study, a 45-year-old woman diagnosed with depression and cluster B personality disorder was treated with olanzapine 10mg and mirtazapine 30mg during her hospitalisation. She was prescribed an additional drug, duloxetine 60mg/day, on her discharge. (3)

After 15 days, during follow-up, she complained of rigidity, restlessness and hand tremors. The drugs given were withheld; biperiden 4mg/day was given to the patient, and the tremors subsided. (3) This effect was seen in the patient because of the interaction between olanzapine and duloxetine. 

What are the treatment options for duloxetine-induced tremors? 

Dloxetine-induced extrapyramidal symptoms (movement disorder) and tremors have been reported in many case studies. It can be mitigated by discontinuation of the drug, by reducing the dose of the drug, or by replacing duloxetine with another drug. 

Remember that discontinuation of any antidepressant should be done according to a physician’s guidance to avoid withdrawal symptoms and worsening of your condition. Drugs such as trihexyphenidyl and biperiden can be used to treat tremors, stiffness and abnormal movements.  

What are the factors that can contribute to tremors? 

Tremors can be caused by other reasons, such as: 

Neurological disorders: Conditions such as Parkinson’s disease, essential tremors, multiple sclerosis, etc. can cause tremors. 

Drug interaction: Concomitant use of drugs which inhibit CYP1A2 enzyme, such as olanzapine, carbamazepine, isoniazid, etc., will increase the concentration of duloxetine in the body and can enhance the risk of tremors and other side effects. (3)

Medication: Drugs such as antipsychotics, bronchodilators (salbutamol, albuterol), lithium, valproate and other antidepressants such as amitriptyline can cause tremors. 

Caffeine: Caffeine can cause tremors infrequently in some individuals who are at risk of getting tremors (5)

Medication withdrawal: if you are discontinuing or switching any antidepressant or antipsychotic, you may experience tremors. 

Metabolic disorder: metabolic disorders such as vitamin E deficiency, hypothyroidism, Wilson’s disease, etc can be associated with tremors. (6)

Toxins: Buildup of certain toxic chemicals in your body, such as heavy metals (lead, mercury, arsenic), which can accumulate via food, air and water can cause tremors. 

Brain injury: Any trauma, injury or disease affecting the brain, such as infection (meningitis) or stroke, can cause tremors. 

Vitamin deficiency: If your body is deficient in certain vitamins, it can cause neurological symptoms, which include tremors. 

What to do if duloxetine causes tremors? 

The first thing you must do is visit your physician. Tremors are common side effects associated with the use of a drug that acts on the brain. Drug-induced tremors usually subside when the drug of cause is discontinued or when the dose of the drug is reduced. 

It is essential that you talk to your physician before deciding to stop your medication or change it because sudden discontinuation of antidepressants can worsen your tremors and increase the risk of side effects. If the tremors do not subside even after discontinuation of the medication, get yourself evaluated for any underlying disease to find the cause of the tremors.

Avoid taking OTC medication without a physician’s guidance since some medications interact with the drug and can worsen your tremors. Attend regular follow-ups so that your doctor can monitor your progress and manage your treatment more effectively. 

Make a few lifestyle changes and avoid the stress, caffeine, etc, which can contribute to tremors. Limit the use of alcohol and nicotine as they may interact with medication and worsen your tremors.

You can consider a few physical therapies which help improve muscle control and coordination. Practice meditation, yoga, and exercise; they help you manage stress. 

In my experience as a clinical pharmacist, drugs used to treat mental illnesses, such as antidepressants and antipsychotics, are associated with tremors. This can be effectively treated with the help of medication such as trihexyphenidyl (Thp) or by adjusting the dose. 

Dose adjustments should be done carefully and by a certified practitioner to avoid side effects. If you are experiencing any side effects, make sure you talk to your doctor and get the right treatment. 

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