Does duloxetine make you nervous? (+5 alternatives)

In this article, we will discuss whether duloxetine makes you nervous. We will also discuss the factors contributing to nervousness and the coping strategies to help you manage this side effect while taking duloxetine.

Does duloxetine make you nervous?

Yes, duloxetine can make you nervous. Increased nervousness, panic attacks, agitation and restlessness can be associated with duloxetine use. Duloxetine may cause nervousness that can range from mild and transient to more pronounced and persistent, requiring immediate intervention. 

Duloxetine is a medication commonly prescribed for depression and anxiety. Duloxetine works by increasing the levels of serotonin and norepinephrine in the brain. While these chemicals play a crucial role in mood regulation, imbalances in these neurotransmitters can sometimes lead to anxiety and nervousness.

Moreover, duloxetine can cause increased activity in the amygdala, a region in the brain responsible for processing emotions, including fear, anxiety and nervousness.

Duloxetine can sometimes cause some individuals to feel worse initially. This can include increased nervousness and agitation. As your body adjusts to the medication, these side effects usually subside within a few weeks.

Other potential initial side effects of duloxetine include increased anxiety and agitation, nausea, dizziness, insomnia, sleepiness, fatigue, headache, constipation and loss of appetite. (1)

However,  it’s important to note that individual responses to medication vary, and not everyone who takes duloxetine will experience this side effect.


What does the research suggest?

Numerous clinical trials have demonstrated duloxetine’s ability to alleviate anxiety symptoms and nervousness, with many patients experiencing a 50% or greater reduction in their anxiety levels. 

Studies suggest that nervousness and anxiety occur in approximately 5-10% of individuals taking duloxetine. (2)

Out of 2,995 people taking duloxetine in clinical trials, 8 patients reported nervousness and agitation as side effects. This represents a small percentage of users, roughly 0.27%. (1)

The results of the research suggest that the benefits of duloxetine outweigh its risks. Despite the potential for side effects, the benefits of duloxetine in effectively managing anxiety, nervousness and depressive symptoms can often outweigh the risks for many individuals. 

How to manage nervousness caused by duloxetine?

While duloxetine can be an effective treatment for anxiety and depression, it may initially cause nervousness and agitation in some individuals. Here are some general strategies to manage nervousness caused by duloxetine:

  • Communication with your healthcare provider: Discussing your concerns with your healthcare providers allows them to assess the severity of the symptoms and recommend appropriate adjustments.


  • Dosage adjustment: Your healthcare provider may consider adjusting the dosage of duloxetine to find the right balance between managing symptoms and minimizing side effects.


  • Additional interventions: Depending on the specific situation, your healthcare provider may recommend additional interventions, such as cognitive behavioral therapy (CBT) and other forms of psychotherapy. These therapeutic approaches can help develop coping mechanisms for managing anxiety and nervousness.


  • Lifestyle modifications: Adopting stress-reducing techniques such as regular exercise, adequate sleep, mindfulness, deep breathing and social support can promote calmness and reduce nervousness.


  • Consideration of alternatives: If nervousness persists, your healthcare provider may explore alternative medications or treatment options that are better suited to your individual needs.


  • Consider supplements: While more research is needed, promising findings suggest that some supplements like magnesium, omega-3 fatty acids, L-theanine, lavender and chamomile can help manage nervousness and stress. Make sure to consult your healthcare provider before taking any supplements to avoid potential interactions with your medication.(3)


Managing side effects like nervousness takes time and patience. Be consistent with your medication, lifestyle modifications and coping strategies. Make sure to consult your doctor regularly to monitor your progress and adjust your treatment plan as needed.

What factors can contribute to nervousness while using duloxetine?

Several factors can contribute to nervousness while using duloxetine. These factors include (4):

  • Individual sensitivity: Some individuals are more sensitive to the effects of duloxetine than others. This sensitivity can make them more prone to experiencing side effects like nervousness and agitation.


  • Underlying anxiety disorder: Pre-existing anxiety disorders or other mental health conditions can be exacerbated by duloxetine, increasing the risk of nervousness and anxiety.


  • Medication interactions: Taking duloxetine with other medications, such as stimulants or other antidepressants, can increase the risk of side effects, including nervousness.


  • Dose-dependent effects: The dosage of duloxetine can influence the likelihood and severity of side effects. Higher doses may increase the risk of nervousness. It’s important to start with a low dose and gradually increase it as needed.


  • Withdrawal effects: Abruptly stopping duloxetine can lead to withdrawal symptoms, including nervousness, anxiety and insomnia. It’s crucial to taper off the medication slowly under the supervision of your healthcare provider.


  • Underlying medical conditions: Certain medical conditions, such as thyroid problems or heart disease, can interact with duloxetine and contribute to nervousness.


  • Lifestyle factors: Lack of sleep, poor diet and excessive stress can all worsen anxiety and contribute to nervousness while taking duloxetine. 


  • Age:  Older adults may be more susceptible to experiencing side effects from duloxetine.


What are the alternative approaches available if duloxetine causes nervousness?

If someone experiences nervousness as a side effect of duloxetine and it becomes problematic, healthcare providers may consider alternative medications or other treatment approaches. Several alternative options can be considered, depending on your specific needs and the severity of your symptoms. Potential alternatives include:

Other antidepressants

  • Selective serotonin reuptake inhibitors (SSRIs): SSRIs like sertraline, fluoxetine, citalopram and escitalopram are commonly prescribed for depression and anxiety and may be less likely to cause nervousness than duloxetine.


  • Tricyclic antidepressants: TCAs like amitriptyline and nortriptyline can be effective for treating anxiety and depression. However, TCAs tend to have more side effects than SSRIs.


  • Atypical antidepressants: These include bupropion and mirtazapine. They can effectively treat anxiety and depression, but they have different side effect profiles. Atypical antidepressants are less likely to cause nervousness than duloxetine.

Non-pharmacological interventions

  • Psychotherapy: Cognitive-behavioral therapy (CBT), supportive counseling and problem-solving psychotherapy can be effective in managing anxiety and depression and can be considered as primary treatments or as complementary strategies.


  • Lifestyle changes: Lifestyle modifications such as exercise, a healthy diet, adequate sleep and stress managment techniques can play an important role in managing nervousness. (5)


In summary, duloxetine can make you nervous. Although duloxetine is prescribed to treat anxiety and depression, it can sometimes cause side effects such as nervousness and agitation. These side effects are generally temporary and can fade away within a few weeks.

I suggest you report all the side effects you are experiencing to your healthcare provider. In my opinion, it is crucial to discuss coping strategies and alternative approaches with your healthcare provider to help you find the most effective treatment plan.


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De Berardis D, Serroni N, Carano A, Scali M, Valchera A, Campanella D, D’Albenzio A, Di Giuseppe B, Moschetta FS, Salerno RM, Ferro FM. The role of duloxetine in the treatment of anxiety disorders. Neuropsychiatr Dis Treat. 2008 Oct;4(5):929-35.


Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:4


Mofatteh M. Risk factors associated with stress, anxiety, and depression among university undergraduate students. AIMS Public Health. 2020 Dec 25;8(1):36-6


Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry. 2013 Jun;12(2):137-48.

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