Does Cymbalta make you tired all the time? (3+ facts)

In this article, we will answer the question, “Does Cymbalta make you tired all the time?” We will also discuss the research findings about Cymbalta-induced fatigue and tiredness, along with the other factors contributing to tiredness and some measures to manage it. 

Does Cymbalta make you tired all the time?

Yes, Cymbalta can make you feel tired. Cymbalta is associated with the common side effect of fatigue, which can make you feel tired or worn out all the time. However, the severity of side effects caused by Cymbalta varies between individuals. Some may experience it to a greater extent, and some may not. 

If you are experiencing chronic fatigue after taking Cymbalta, make sure you consult your physician for further management. Your physician may decrease your dose or switch to another antidepressant. Avoid abrupt discontinuation of the drug because of the side effects, as it may cause withdrawal symptoms and worsen your condition. 

What does the research suggest? 

In a study, the efficacy of duloxetine in treating depression was evaluated; the study concluded that duloxetine was effective in treating depression along with the physical symptoms associated with depression, such as back pain, headaches, GI disturbance, etc. Duloxetine treatment was associated with adverse events such as fatigue, dizziness, insomnia, nausea and drowsiness. (1)

A case study reported hyponatremia induced with duloxetine treatment. A 78-year-old man complained of fatigue, poor orientation and loss of energy after two doses of duloxetine. Upon investigation, it was found that the patient had low sodium and chloride levels in their blood. (2)

Low levels of electrolytes were managed by daily water restriction and saline therapy, and duloxetine was discontinued. After one week of duloxetine discontinuation, the symptoms of fatigue resolved. (2)

Duloxetine (Cymbalta) is also used to treat symptoms of fibromyalgia. Studies have shown that duloxetine was effective in treating fatigue associated with fibromyalgia. (3) However, responses to the drug vary between individuals, and some may benefit from duloxetine treatment while some may experience side effects such as tiredness.

How does Cymbalta make you feel tired? 

Cymbalta is an antidepressant which belongs to a class of serotonin-norepinephrine reuptake neurotransmitters (SNRIs). Cymbalta acts by inhibiting the reuptake transporters of serotonin and norepinephrine, which increases their levels in the brain. Norepinephrine transporter inhibition also increases the level of dopamine in the brain. (4)

An increase in this neurotransmitter helps treat symptoms of depression and anxiety disorder. Cymbalta also plays a role in reducing pain by inhibiting the neurons of the dorsal horn in the spine from sending signals to the brain, hence reducing pain perception. (4)

Pharmacological research studies have found that neurotransmitters such as serotonin and dopamine play a role in fatigue. The central fatigue hypothesis suggests that an increase in the ratio of serotonin to dopamine levels is associated with fatigue, tiredness and lethargy, and a low level of this ratio is said to improve motivation and arousal. (5)

Antidepressant-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) can cause hyponatremia (low level of sodium), and this is accompanied by fatigue and lethargy. The exact mechanism of antidepressant-induced SIADH is not clear. However, serotonin and norepinephrine can have an influence on SAIDH. (2)

What are the factors contributing to tiredness while taking Cymbalta?

There are various factors which can contribute to tiredness while taking Cymbalta, such as: 

• Drug acting on CNS: Drugs which act on CNS, like stimulants, other antidepressants, opioids, antipsychotics, anticonvulsants, etc., may cause side effects such as fatigue and lethargy. 
• Concomitant use of drugs: Using CNS-acting drugs along with Cymbalta, which have a synergistic effect, can increase the risk of tiredness. 
• Dosage: Some individuals report tidiness with an increased dose of Cymbalta. Many studies have reported side effects, such as tiredness, with a 120mg dose of duloxetine. (6)
• Underlying condition: Certain medical conditions, such as anemia, chronic disease, fibromyalgia, metabolism disorders, vitamin deficiency etc., can contribute to tiredness. 
• Sleep disturbance: Inadequate sleep can deprive you of proper rest, which can contribute to tiredness.
• Dehydration: Medication can sometimes cause dehydration, and dehydration can lead to a feeling of tiredness.
• Poor nutrition: Inadequate nutrients in your diet and vitamin deficiency can cause tiredness. 
• Chronic fatigue syndrome (CFS): This condition is usually characterised by persistent fatigue, which does not subside even after a proper rest. 
• Caffeine and stimulants use: Excessive dependence on caffeine and stimulants can cause tiredness.  

What are the measures to reduce Cymbalta-induced tiredness? 

Suppose you are experiencing extreme tiredness after starting your treatment with Cymbalta. Consult your physician for proper management. Your physician may reduce the dose of Cymbalta or switch to another antidepressant. Do not alter the course of treatment without proper guidance. 

• If you are feeling tired in the morning because of the drug, try taking it in the evening instead of the morning, which will help mitigate daytime tiredness. 
• Get yourself evaluated for any underlying condition which may contribute to tiredness and fatigue. 
• Ensure you get adequate sleep. Create a proper sleep schedule and follow it every day. 
• Since dehydration can contribute to tiredness, make sure you are well-hydrated throughout the day. 
• Adopt a healthy lifestyle, have a balanced diet, and practice regular breathing exercises and meditation to help you with your stress. 

What are the alternatives to Cymbalta if it causes tiredness?

If you are experiencing any side effects with the use of Cymbalta, which is affecting your day-to-day activities, you can choose to shift to other antidepressants such as: 

• SSRI: citalopram, escitalopram, fluoxetine, paroxetine, sertraline. 
• SNRI: venlafaxine, milnacipran, desvenlafaxine, levomilnacipran. 
• Tricyclic antidepressants: amitriptyline, amoxapine, nortriptyline, imipramine. 
• Atypical antidepressants: bupropion, mirtazapine, trazodone. 
• Monoamine oxidase inhibitors (MAOIs): isocarboxazid, selegiline. 

You can also consider other non-pharmacological therapies, such as cognitive behavioural therapy and psychotherapy, along with the medication to treat your illness more effectively. 

In my experience as a pharmacist, tiredness associated with the use of Cymbalta is a common side effect and can be managed by dose reduction. If you are still experiencing fatigue after treatment with Cymbalta for depression or fibromyalgia, it may indicate an inadequate response to the medication.

If you notice any unwanted changes after taking Cymbalta, make sure you consult your physician for further management. Avoid reducing the dose of Cymbalta or discontinuing the drug without a physician’s guidance, as it may cause withdrawal symptoms and worsen your condition. 

References