Antidepressant Duloxetine Eases Joint Pain Caused by AIs

Perhaps that explains why I have had such mild SEs, including slight joint discomfort, on letrozole. Since 1999 I have been taking bupropion (Wellbutrin XL, 300mg). They are similar—duloxetine is a selective norepinephrine reuptake inhibitor (SNRI), whereas bupropion is a selective dopamine reuptake inhibitor (SDRI). The first generation, SSRIs (prevent reuptake of serotonin) like Prozac et al, keep the brain's endorphin receptors from letting go of serotonin and putting it back into circulation where it doesn't do any good. All three endorphins—serotonin, dopamine and norephinephrine—are the “feel-good" hormones that, when latching on to their respective receptors in the brain, positively stimulate the brain's pleasure centers. Dopamine & norepinephrine seem to be more potent in that regard, and by that effect can reduce cravings for pleasurable but ultimately harmful substances (opioids & opiates, sugar, nicotine but not necessarily alcohol). When the pleasure centers are stimulated, perception of pain can be lessened, and secretion of stress hormones like cortisol and adrenaline—which promote release of inflammatory cytokines—is greatly reduced. Therefore, inflammation is lessened as well.

I suspect that many PCPs, in conjunction with psychiatrists, might be willing to consider Wellbutrin as well as Cymbalta for their patients experiencing debilitating joint pain on AIs. (Bupropion is also marketed at a higher price than Wellbutrin as Zyban, for smoking cessation). SSRIs, OTOH, should be limited to only clinically-depressed patients because of the danger of serotonin syndrome.

ChiSandy, I've been taking Wellbutrin XL for a number of years, well before my BC diagnosis. I wish it had been a help for the joint pain I experienced while on Anastrazole. It came close to crippling me. Using supplements of Vitamin D, fish oil, magnesium and a natural joint pain remedy that included Boswellia along with acupuncture and Claritin for bone pain kept me mobile, at least to a limited extent.

My Cymbalta experience is new. After I read this press release in January, I went to my doctor and asked for a prescription. I had already stopped taking one AI because of joint pain, and had to take a month-long break with my current one, letrozole, because of joint pain. I have taken 3-4 different antidepressants during my adult life, and am familiar with the side effects. To avoid the power of suggestion with regard to side effects, I did not research Cymbalta online beforehand. I read the information from the pharmacy that came with pills. To reduce side effects, I begin dosing a half dose every other day, for a week, then every day. Weird, yes, but it seems to help.

Within 2 weeks on a half dose, Cymbalta had reduced my joint pain. But my weight kept climbing and I had some "bedroom side effects" that are common to anti-depressants. I decided to slowly back off the doses, then talk to my doctors switch to Wellbutrin.

Things were fine until 72 hours after my last Cymbalta dose. Then I had intense skull pain that never stopped -- I can't call it a headache, it was worse than a migraine. I also had hot flashes that people standing beside of me could feel, and crying fits (even on Valentine's Day!). I finally Googled "taper off Cymbalta" at 1 a.m. I was so shocked by what I read (including the FDA stuff, TexJerseyGirl), that I woke my husband to tell him.

Cymbalta has severe withdrawal side effects and the manufacturer has been criticized by the FDA for not being honest about the severity. The manufacturer has also been criticized for not making a taper-dose tablet that can be split. Only capsules are made.

I found out that patients are resorting to counting the balls in the capsules, and reducing the number by tiny amounts, week by week, so they can taper off without feeling terrible.

Some patients haven't been able to taper at all. I was on the drug less than 6 weeks total, and never even reached the full dose, and still have been unable to taper without extreme pain.

IMO this is terrible: a drug that can help serious medical problems, but it creates even worse problems, for patients who are already suffering greatly from depression or from cancer, or both.

I am back on Cymbalta at a taper dose. My MO says to talk to my palliative pain doctor about safe tapering. I'm upset that my MO knows my drug sensitivity and didn't disclose the known problems with Cymbalta. I'm disappointed that the pharmacy info was weak; basically a warning not to stop it abruptly. I have learned that Wellbutrin interacts with my pain medicine, so I can't switch to W. at this time.

I'm sharing my story because I know joint pain affects so many of us on AIs, and the promise of a reduction is tempting. I believe MOs should caution women about Cymbalta. Unlike other medications the problems don't stop when you stop taking the meds. The worst problems are just beginning.

Does anyone have any taper tips for Cymbalta? Thanks.