One year on duloxetine (30 mg), mostly good but no without side effects
There is so much doom and gloom on this sub, and I understand that everyone responds differently. However I feel a lot of people give up fast, catastrophize, or panic-quit because of overthinking the bad posts. Fair warning that my post will be a bit lengthy to relate my experience as best as possible.
Male, 50
I was prescribed 30 mg of duloextine for "unexplained body pain" about one year ago. I've been experiencing this pain for about 10 years. It seems to be inflammation, pain, and migraines aggravated by allergic reactions to pollen, dust, and mold, but no allergist/immunologist or orthopedist has been able to help. They've sent me to physical therapy multiple times, have prescribed muscle relaxers, allergy shots, low dose naltrexone and gabapentin. Nothing has worked well. Gabapentin at least has helped calm things down enough at night than I could sleep just "ok."
The first week was difficult. The first day I took it in the mid-morning and by the afternoon I was sweating and having hot flashes. I could not sleep at all that night. The second day I tried to take it at night. This was even worse and could not sleep again. My anxiety was through the roof about this and was very concerned about continuing. Day three I skipped just in an attempt to get a night's sleep which worked. Day four I went back to morning in the hopes it wouldn't be as bad at night. A huge key here was night four was the first day I also took my gabapentin with it (900 mg). That really seemed to be the key to calming everything down for sleep. Honestly it was like how I felt the doctors had described what gabapentin was supposed to do from the beginning.
That was the beginning of this medicine really working well for me. Pain that I'd felt nearly every day for the last several years was nearly gone. I didn't even realize I had a baseline level of pain in my head every day. Now it was just gone. I couldn't believe it. I had been walking around with a constant pain in my head that had become so normal I didn't even realize it was there. My back pain, groin pain, and feet/hand pain was all gone. I know a lot of people say the medicine was "demotivating," but to me I was finally feeling satisfied for the first time in years. Yes a lot of my motivation to occupy myself with the next thing like working out, chores, dinner, browsing the web, watching tv wasn't there. The first month I was also pretty drowsy every afternoon, and it was hard to stay awake. These two things mostly resolved about one to two months in.
My wife said she noticed a huge difference in my mental state. I was more like I was 20 years ago, less angry, less irritable, less impatient. She was right. The smallest things that would bother me were now no big deal. One of the things I realized once everything started clicking well was that in the past several years I had probably never yawned as a sign of tiredness. Now I was yawning and feeling drowsy at appropriate times. Falling asleep, which had always been difficult even as a child, was a breeze.
The bad:
About five to six months in I started gaining weight. I was probably a little underweight prior to starting and I was riding a peloton six or seven days a week. After starting duloxeine and feeling "satisfied" I stopped working out as much, maybe 2-3 days a week at this point. Nothing else changed though, and I'm not sure what happened at the five to six month mark that kicked this off. Unfortunately this has continued to today where I've gained about 20 pounds since starting. I'm even working out more now, about four to five times a week, walking more at work, and eating less (intentionally). I've seen others say they have a "carb craving," but I've never had that. I have wondered if this is somehow counteracting testosterone. This by far has been the most upsetting side effect.
Constipation started fairly early. I've always been a very regular person. For the past 20 years it's pretty much been 10 AM every day I have a movement and I'm done for the day. This was difficult to work through and uncomfortable. I tried prunes and added fiber, but their efficacy was debatable. They certainly didn't hurt, but I expected them to work better. About eight months in I added a once daily probiotic (Nature Made 15 billion CFU), and returned to taking a magnesium oxide supplement at lunch. Things are not normal, but they are much improved since adding the probiotic.
I have been getting "hot flashes" and excessive sweating since starting. I don't know if there is much that can be done about this. Taking it in the morning has eliminated evening hot flashes, but it has made weekend afternoon naps difficult. I was already someone who sweats a lot, but now it's in overdrive. It's very difficult to wear "dri-fit" or synthetic type clothing now. They really cause the sweat to stink, and it sticks to the clothing. I've mostly taken to wearing cotton only over the summer. The cotton at least never smells bad.
About eight months in I had blood work done which showed elevated liver values. I should be getting a recheck of this in the next couple of months.
I was never a huge drinker, but I liked to have a healthy amount of drinks on vacation (2-4 in the evenings). Never to the point of getting drunk or out of control. On vacation seven months in I started the first day drinking what I normally would, and had a "blackout" event. Pretty much the first time that's ever happened. Even when younger and I would get drunk, I never blacked out. This was disturbing, and I've pretty much decided alcohol just isn't a good idea. This is not a big deal to me, as alcohol it not that important in my life, but I would be lying if I said I'm not going to miss that first drink on vacation.
More recently I started getting acid reflux which I've never had. I assume it's related only because my diet has not really changed (in terms of what I eat).
The neutral:
The duloxetine has brought down my libido which was incredibly, incredibly high. I still have no issues getting an erection or having sex. I have had a few instances of going "soft" during sex, but have been able to recover and finish. Finishing is a bit more difficult, but not in a bad way. I can go longer than previously which is a good thing. I'm no longer upset or stewing about not having sex (which was a marriage issue).
There are some days where the duloxetine just is not enough to overcome whatever environmental factors cause my pain. So I have had days where I feel like I used to before starting the medicine.
One year analysis:
I'm going to say 60% good, 35% bad, 5% neutral. I absolutely hate the weight gain and that nothing seems to help. I don't like that acid reflux has now popped up. I'm concerned about the liver values, and will see at the end of the month where that stands. I spoke with one of my doctors about moving to venlafaxine in the hope of mitigating the worst of the side effects (the recent beginning of acid reflux tipped the scale on this). He said it was possible, but reminded me that it works in much the same way so there's no telling (especially as far as the liver is concerned).
I've only missed either three or four days of taking the duloxetine. I had no "withdrawal" symptoms on these days.
One more note about sleep issues. The 900 mg of gabapentin was very helpful. The one other thing I added (about six months in) was 200 mg magnesium glycinate and 500 mg vitamin c towards the end of my dinner meal. This has worked really, really well.
Thanks for reading.