When you’re living with lupus, new symptoms can arise out of nowhere. This can sometimes makes it hard to determine if these symptoms are connected to the disease itself, the treatments you’re using, or a totally unrelated reason. Such is the case for some people who take duloxetine (Cymbalta).

“What’s been your experience with Cymbalta?” one MyLupusTeam member asked. “I have extreme fatigue.”

Duloxetine belongs to a class of medications known as selective serotonin-norepinephrine reuptake inhibitors (SNRIs). Duloxetine works by boosting the brain’s levels of serotonin and norepinephrine, which affect mood regulation. The U.S. Food and Drug Administration initially approved duloxetine to treat depression symptoms in major depressive disorder, but it can also help manage generalized anxiety disorder and certain types of chronic (long-term) musculoskeletal and neuropathic pain associated with medical conditions like lupus.

Fatigue — one of the common side effects of duloxetine — is a symptom most people with lupus already know all too well. Here are some reasons you may feel more tired than usual on duloxetine and how to address any serious side effects.

Potential Links Between Cymbalta and Fatigue

Many people taking duloxetine experience of fatigue, but it doesn’t affect everyone the same way. Sometimes, this side effect improves with time. One member of MyLupusTeam shared, “I took my first dose of Cymbalta yesterday and was extremely tired last night and today. After 8.5 hours of sleep last night, I feel like I haven’t slept in days. I’m dizzy from being so exhausted.”

A year later, they posted an update explaining how they managed to overcome the fatigue. “The first thing I did was start taking it in the evening … . The fatigue let up after about eight to 12 weeks. It has helped with some of the chronic aches I have in my chest and helps pretty significantly with depression.”

Duloxetine’s impacts on brain function and sleep could contribute to fatigue. You may also be more tired because of medical conditions you already have.

The neurotransmitters serotonin and norepinephrine play crucial roles in regulating wakefulness and energy levels. An increase in serotonin and norepinephrine can potentially disrupt this delicate balance, resulting in fatigue.

Duloxetine can affect sleep patterns for some people. It may cause difficulty falling asleep or staying asleep, leading to poor sleep quality. As a result, these sleep disturbances may contribute to daytime fatigue and drowsiness.

Each person’s response to medications can vary. Some individuals may be more prone to fatigue as a side effect of duloxetine due to their unique biochemistry or preexisting conditions. Fatigue is also common in the conditions duloxetine is prescribed to treat, such as depression and chronic pain. People with lupus frequently report fatigue, brain fog, and trouble sleeping. In addition, fibromyalgia is not unusual in people with lupus and can cause tiredness.

“I’ve been on it for years, and I think it helps me,” said a MyLupusTeam member about duloxetine. “I was tired before it, and I’m tired now. So I never thought it was the Cymbalta, just lupus!” they explained.

Managing Duloxetine’s Side Effects

If you experience fatigue while taking duloxetine, it’s crucial to discuss your concerns with a health care professional. They can evaluate your overall health, assess whether fatigue is a side effect of the medication, and make necessary adjustments to your treatment plan.

In some cases, health care providers may recommend lifestyle changes to manage fatigue, such as improving your sleep routine, exercising regularly, and trying to reduce stress. Additionally, they may adjust the dosage or explore alternative medications if fatigue continues and significantly affects your quality of life. Oftentimes, fatigue can be improved by simply taking the medication in the evening or at bedtime, or supplementing with extra vitamin B12.

You should never discontinue or modify your medication regimen without proper medical guidance. Abruptly stopping duloxetine can lead to withdrawal symptoms and other potential complications.

A MyLupusTeam member advised, “Cymbalta was horrible for me. I was very tired, but please don’t just stop it like I did. The withdrawal was horrible. Maybe give it a few days and see if the fatigue goes away. If not, speak to your doctor.”

Your health care provider can give you individualized medical advice on safe discontinuation or switching medications if needed. They may suggest selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac).

Living with lupus can be tough because new symptoms may pop up unexpectedly. It’s not always easy to know if these symptoms are linked to the disease, the treatments you’re receiving, or something unrelated. Regularly checking in with your doctors and sharing any changes you notice will help you better understand and manage the challenges of lupus.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 people with lupus come together to ask questions, give advice, and share their stories.

Did you experience tiredness, sleepiness, or other adverse effects while taking duloxetine? Did you see positive effects on your mental health, or did you end up switching to another type of antidepressant? Post your thoughts in the comments below, or start a conversation by sharing on your Activities page.