Today’s article seeks to answer a simple query? Can you take CBD oil with Cymbalta? In order to successfully answer this question, we first need to understand what Cymbalta is, how it works, and what it’s used for. From there, we can answer the query with minimal guesswork. And, understand how safe or risky it is to take Cymbalta with CBD oil.
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What Is Cymbalta And What Is It Used For?
Cymbalta is an SNRI antidepressant. SNRI stands for Serotonin Norepinephrine Reuptake Inhibitor. This means that Cymbalta blocks Serotonin and Norepinephrine from being reabsorbed into your neurons. This makes these two chemical messengers more abundant in your brain and body. The main active ingredient in Cymbalta is a chemical compound called Duloxetine. This is used to treat conditions such as:
- Major depressive disorder
- Generalized anxiety disorder
- Fibromyalgia
- Diabetic neuropathy
- Osteoarthritic pain
- Chronic musculoskeletal pain
In theory, if Serotonin and Norepinephrine are made more abundant in your system then this may improve your mood and energy levels, reduce pain, and may assist in restoring your interest in daily living. However, according to the medical community, it’s not clear how Cymbalta actually works. What seems to be evident is that it triggers a change in the way serotonin and norepinephrine interact with your central nervous system (CNS).
What Are The Side Effects Associated With Cymbalta?
Cymbalta has a wide range of side effects associated with it. Its side effects can be categorized into the following groups namely common side effects, serious side effects, allergic reactions, worsening side effects, severe side effects, and exclusive side effects. In addition to the different groups of side effects, Cymbalta can also give you Serotonin Syndrome. This is a condition where you have too much serotonin in your system causing a lot of unwanted symptoms.
The ‘common’ side effect profile of Cymbalta includes:
- Dry mouth
- Constipation
- Nausea
- Loss of appetite
- Tiredness and drowsiness
- Dizziness and lightheadedness
- Increased sweating
- Increased blood pressure
The ‘serious’ side effect profile of Cymbalta includes:
- Confusion
- Easy bruising or bleeding
- A decline in sexual interest and ability
- Muscle cramps and weakness
- Tremors (shaking a lot)
- Difficulty urinating
- Liver problems
- Abdominal or stomach pain
- Persistent nausea and vomiting
- Jaundice (yellowing eyes and skin)
- Bloody or dark urine
- Bloody or black stool
- Vomit that resembles ground coffee
- Seizures
- Eye pain, swelling, and redness
- Widened pupils
- Seeing halos or rainbows around lights
- Blurred vision
The ‘allergic reaction’ side effect profile of Cymbalta includes:
- Hives or rash
- Itching, and swelling (face, tongue, and throat)
- Severe dizziness
- Trouble breathing
- Swelling in your face, lips, tongue, or throat
The ‘worsening’ side effect profile of Cymbalta includes:
- Worsening depression
- Worsening anxiety
- Worsening panic attacks
- Suicidal thoughts and self-harm
- Insomnia (trouble sleeping)
- Impulsiveness and restlessness
- Irritability and agitation
- Hostility and aggressiveness
- Mental and physical hyperactivity
The ‘severe’ side effect profile of Cymbalta includes:
- A light-headed feeling (like you might pass out)
- Vision changes, eye pain or swelling, eye redness
- Easy bruising, unusual bleeding
- Painful or difficult urination
- Seizures
- Manic episodes i.e. racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative
- Right-sided upper stomach pain, itching, dark urine, yellowing of the skin or eyes (signs of liver problems)
- Headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady (signs of low levels of sodium in the body)
- Severe skin reaction – fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling
Regarding ‘exclusive’ side effects, there are two groups of people that his section applies to namely sensitive people and young adults under 25 years. If you’re under the age of 25, you may experience the following side effects:
- Loss of appetite and weight loss
- Worsening depression
- Worsening anxiety
- Worsening panic attacks
- Suicidal thoughts and self-harm
- Trouble sleeping (insomnia)
- Impulsiveness and restlessness
- Irritability and agitation
- Hostility and aggressiveness
- Mental and physical hyperactivity
If you are sensitive to Cymbalta (or drugs in general), then you may experience the following ‘exclusive’ side effects:
- Bleeding
- Dizziness and lightheadedness
- Loss of coordination and increased risk of falling
- Salt imbalance (hyponatremia)
Lastly, on top of the six groups residing in the side effect profile of Cymbalta, you can also get serotonin syndrome. The symptoms associated with serotonin syndrome include:
- Agitation
- Hallucinations
- Fever, sweating, and shivering
- Sped-up heart rate
- Muscle stiffness and twitching
- Loss of coordination
- Nausea and vomiting
- Diarrhea
Doctors advise carers and guardians to keep a close eye on you for any changes in behavior. If your carer or guardian notices a negative change in behavior, they are to report it to your doctor immediately. So much for Cymbalta making you feel better.
What Are The Withdrawal Symptoms Associated With Cymbalta?
Before we get into the safety aspect of taking CBD oil with Cymbalta, we need to address the withdrawal symptoms. You may have been taking Cymbalta for many years and are looking to wean off with the help of cannabis therapy. Or you may be looking to reduce the impact of withdrawal symptoms. Regardless of your motive, there is a way of approaching without causing harm to yourself. And, we’ll get into it in this article. However, you first need to understand what happens if you just stop taking Cymbalta abruptly.
Cymbalta is a synthetic drug, which means it has withdrawal symptoms. The longer you take it, the more intense your withdrawal symptoms will be. According to a 2005 analysis of clinical trial data, researchers found that 44.3% of those who stopped taking duloxetine (Cymbalta) experienced withdrawal symptoms. The patients in the various studies were using duloxetine for treating major depressive disorder. The researchers recommend that to reduce the dose no less than 2 weeks before discontinuation of duloxetine treatment. If not abrupt discontinuation of duloxetine will result in a withdrawal profile similar to other SNRI and SSRI antidepressants currently available.
Cymbalta’s withdrawal effects profile includes:
- Dizziness
- Severe nausea
- Vomiting
- Headaches
- Paresthesia (tingling skin sensation)
- Irritability
- Nightmares
- Fatigue
- Insomnia
- Vertigo
- Anxiety
Now that we understand what we are dealing with regarding Cymbalta, we can now move to the question of the day. We can now assess the safety aspect of taking CBD oil with Cymbalta and work out how to do so with minimal risk.
Can You Take CBD Oil With Cymbalta?
From a safety perspective, the simple answer is no. It’s not safe to take CBD oil with Cymbalta. The risk of something going wrong is very high. Specifically, you’re looking at drug interactions that could cause intensified negative side effects, exposure to a wider range of negative side effects, increased risk of getting serotonin syndrome, and increased risk of liver failure.
However, not all hope is lost. If your goal is to wean yourself off Cymbalta using CBD oil. If your goal is to reduce the impact the side effects have on you, then there is an approach you can adopt. It will require you to be very disciplined and strategic, but the fruit will be worth the labor. First, we need to understand the risks involved. This will provide context for the recommended approach outlined later in this article.
How RISKY Is It To Take CBD Oil With Cymbalta?
What you need to know is that up to 80% of all pharmaceutical drugs are broken down in your liver. This is done by a group of enzymes called Cytochrome P450 (CYP450). The drugs your liver breaks down include Cymbalta as well as the cannabinoids CBD and THC.
When you take CBD oil with Cymbalta, you are most likely going to induce a mechanism called “competitive inhibition”. This is where the cannabinoids in your CBD oil and Cymbalta compete for the same metabolic enzymes in your liver. This will most likely block Cymbalta from being broken down. If Cymbalta is not broken down, this makes it more abundant in your system. This then causes you to experience either intensified side effects of Cymbalta, a wider range of Cymbalta’s side effects, serotonin syndrome, or liver failure.
The first risk you face is either intensified side effects or a wider range of Cymbalta’s side effects. When Cymbalta is blocked from being metabolized, more of the serum is made abundant in your system. The more Cymbalta you have abundant in you, the more intense or multiplied your side effects will be. Again, this happens due to a mechanism the scientific community calls “competitive inhibition”. However, this mechanism is more commonly called the “grapefruit effect“. Thus, if you take CBD oil with Cymbalta, your side effects may get worse by intensification or by variety.
The second risk you face is that you’ll get serotonin syndrome. Serotonin syndrome happens when you have an overabundance of serotonin in your system. Serotonin is a chemical messenger (neurotransmitter) that your body produces and is needed for your nerves and brain cells to function. Antidepressants such as Cymbalta are known to cause serotonin syndrome. MayoClinic describes serotonin syndrome as an event that occurs when you increase the dose of medication or add a new drug to your regimen. Having too much serotonin in your system causes a range of symptoms previously highlighted in this article.
The third, and possibly, final risk you face is that you may experience liver failure. Liver failure is described as a loss of liver function caused by a multitude of reasons. Some of the causes of liver failure related to our topic include prescription drug use, herbal supplements, toxins, and overwhelming liver function to name but a few. Liver failure occurs when liver cells are damaged and can no longer perform their function. The symptoms of liver failure include:
- Jaundice (yellowing of your skin and eyeballs)
- Pain in your upper right abdomen
- Abdominal swelling
- Nausea
- Vomiting
- Malaise (general sense of feeling unwell)
- Disorientation (or confusion)
- Sleepiness
So those are the risks involved with taking CBD oil with Cymbalta. So far, the presumption is that you’d be taking them at relatively the same time. But, what if your goal is to wean yourself off Cymbalta, or reduce the impact of side effects? Is there a safe way to do it with CBD oil? I’m happy to report that there is and that is what the next section of the article is.
How Can You SAFELY Take CBD Oil With Cymbalta?
The medical community is split as to whether there’s a safe way of taking CBD oil with any antidepressant. Anti-cannabis medical professionals argue that SNRIs, such as Cymbalta, and cannabis both have psychoactive effects in humans. It’s their belief that taking them together may cause negative psychoactive effects. Either that or they just don’t care for cannabis therapy altogether.
However, pro-cannabis medical professionals argue that cannabis is generally safe to take with SNRIs provided you’re strategic and careful with your approach. If not, you’re at risk of experiencing the adverse effects caused by drug interactions we’ve already covered in this article. So, how can one be careful and strategic to prevent adverse effects from drug interactions? How can you safely prevent the grapefruit effect? Pro-cannabis medical professionals generally recommend you follow these steps:
- Space out the time between your drug administrations (1 – 3 hours generally)
- Microdose your cannabis therapy treatment (especially at the beginning)
- Slowly increase your cannabis therapy dosage over time
- Track and record your treatment actions and results in a personal journal
- Find and consult with a pro-cannabis medical professional (if you have access to one)
This first strategy is to space out the time between your different drug administrations. Due to the fact that Cymbalta and CBD oil are broken down by the same metabolic enzymes, pro-cannabis doctors recommend spacing out the time between administrations. This prevents Cymbalta from being blocked from metabolism by the cannabinoids present in your CBD oil. And, it also prevents your liver from being over-taxed with work. The general time frame doctors recommend is about 1 – 3 hours between administrations. This gives your liver enzymes enough time to do their job and be available for the next medication.
The second strategy pro-cannabis doctors recommend is a strategy called Micro-dosing. Microdosing is the practice of taking a minimal amount of a given substance to achieve your desired results. With respect to CBD oil, people consume very small amounts throughout the day to achieve results such as reduced anxiety and reduced depression. Doses can be as low as 2 – 3 milligrams per serving with the average dose range being around 3 – 10 milligrams per serve. Microdosing enables you to experience the benefits of CBD oil without getting ‘high’ if the THC concentration is too high.
The third strategy pro-cannabis doctors recommend is to slowly increase your dosage over time. In a practical setting, this means increasing your CBD oil dosage slightly every couple of days while paying close attention to the effects you experience. For example, if you start feeling lethargic or dizzy after a dose increase, then you should reduce your dosage slightly to a point where you do not feel dizzy or lethargic anymore. Then you can stay at the reduced dosage level for a few days before attempting to increase your dosage again.
The fourth strategy pro-cannabis doctors recommend is to track and record your actions and results in a personal journal. A personal journal is one of the most valuable tools at your disposal on the road to recovery. You want to track everything from the type of CBD oil you take, the concentration levels, dose amounts, dosage frequency, and the effects experienced. This enables you to keep a close eye on how your body responds to your cannabis therapy whether positive or negative. And, of course, make notes.
The fifth and final strategy is to consult with a pro-cannabis medical professional. Be it a doctor or a nurse, you’re always better off working with a professional. This strategy can be challenging for a lot of patients as cannabis laws are still in a legal grey area in a lot of regions of the world. However, because of the Internet, you have access to doctors around the world. Your only challenge is to find one who will consult with you and provide guidance along your journey.
What Are The Side Effects Associated With CBD Oil?
Seeing that we’ve looked at the extensive list of side effects associated with Cymbalta, it’s only fair we put CBD oil under the same scrutiny. Thus, to answer this question, we need to look at the results of a 2017 clinical review journal and a 2020 meta-analysis systematic review. The results from these reviews will help you understand just how safe cannabis therapy for depression and anxiety is compared to Cymbalta.
In the year 2020, researchers conducted a systematic review and meta-analysis of the adverse effects of CBD (cannabidiol) in patients with varying conditions. The researchers looked at randomized placebo-controlled clinical trials lasting longer than 7 days. They reviewed 12 clinical trials with a total of 803 participants to glean data from. The researchers found the following negative side effects:
- Somnolence (i.e. sleepiness or drowsiness)
- Diarrhea
- Sedation
- Abnormal liver function
- Pneumonia
The researchers pointed out that:
When the researchers excluded the childhood epilepsy studies, they found that the only negative side effect associated with CBD treatment was diarrhea. The researchers concluded their analysis by stating that:
In 2017, researchers set out to update results established in 2011 regarding the safety and side effects of CBD. The researcher’s focus in this review was on clinical studies and potential interactions CBD has with other drugs. The majority of the clinical studies reviewed in their update were for the treatment of epilepsy and psychotic disorders. In these studies, the most common negative side effects reported were:
- Tiredness
- Diarrhea
- Appetite or weight fluctuations
The researchers stated that:
The researchers concluded their review by stating that CBD’s safety profile is already established in a multitude of ways as being very favorable for patients. Thus, various areas of CBD research should be extended to close knowledge gaps and have a completely well-tested compound for mainstream use.
In Closing…
It is very risky to take CBD oil with Cymbalta, especially if you do it at the same time. However, you can take CBD oil with Cymbalta provided you are strategic and careful with your approach. If you do take them at the same time, you are may induce ‘competitive inhibition’ (the grapefruit effect), which can cause intensified side effects, a wider variety of side effects, serotonin syndrome, and/or liver failure.
Patients are turning to CBD oil to either reduce the impact of the negative side effects or to assist with weaning off Cymbalta altogether. Hence, there should NOT be any doubt in your mind that you will be able to achieve positive results provided you are strategic and careful. Specifically, if you use the strategies recommended by pro-cannabis doctors earlier in this article. Your two main challenges will be finding a pro-cannabis doctor in your area and finding a suitable CBD oil solution that will assist you in getting results.
Regarding finding a pro-cannabis doctor, you will have to do some leg work because, for every single pro-cannabis doctor in practice, there are 100 anti-cannabis doctors. However, don’t let this discourage you. Pro-cannabis doctors do exist and you can find them. You just have to look and be persistent until you find one willing and able to work with you. The option of doing Zoom consultations is more real than ever now.
Citations
- Bibi, Z. Role of cytochrome P450 in drug interactions. Nutr Metab (Lond) 5, 27 (2008). https://doi.org/10.1186/1743-7075-5-27
- Perahia DG, Kajdasz DK, Desaiah D, Haddad PM. Symptoms following abrupt discontinuation of duloxetine treatment in patients with major depressive disorder. J Affect Disord. 2005 Dec;89(1-3):207-12. doi: 10.1016/j.jad.2005.09.003. Epub 2005 Nov 2. PMID: 16266753.
- Chesney, E., Oliver, D., Green, A. et al. Adverse effects of cannabidiol: a systematic review and meta-analysis of randomized clinical trials. Neuropsychopharmacol. (2020). https://doi.org/10.1038/s41386-020-0667-2
- Iffland K, Grotenhermen F (2017) An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies, Cannabis and Cannabinoid Research 2:1, 139–154, DOI: 10.1089/can.2016.0034.
