Switching from cymbalta to zoloft (What to expect)

In this blog, we are going to talk about switching from cymbalta to zoloft. They both are antidepressants which help relieve the symptoms of depression and several other mental health conditions. 

This blog will also cover factors that lead to the discontinuation of treatment with cymbalta and switch to zoloft. 

What should be expected when switching from cymbalta to zoloft? 

Zoloft and cymbalta are both antidepressants. They do have different mechanisms of action but they produce the same effects, that is, increase the availability of active neurotransmitters to fight against depression. 

If your treatment with cymbalta fails to provide adequate therapeutic response or it causes way too many side effects in you, then your doctor recommends another antidepressant. 

Zoloft is the most common choice of antidepressant, along with Prozac. These agents are widely used as a first line of depression treatment. When you doctor switch your antidepressant from cymbalta to zoloft, remember the following things:

• The new drug will not start working overnight. Your body will take its time to adapt to zoloft. Just give it a few weeks, be consistent and maintain a healthy lifestyle. 
•  Zoloft may cause some side effects in you when the treatment is started. This is common with antidepressants but these side effects usually begin to subside within 2 to 3 weeks of treatment. 
• If your doctor stops cymbalta, you might suffer from withdrawal symptoms. It is best to taper off cymbalta while slowly increasing the dose of zoloft. This technique maintains the amount of neurotransmitters in your body. If they get too low, you will suffer from withdrawal symptoms. If they get too high, you will be subjected to the symptoms of serotonin syndrome. 

Which factors lead to the discontinuation of treatment with cymbalta? 

Following factors can lead to the discontinuation of treatment with cymbalta:

Insufficient therapeutic outcome 

If cymbalta does not provide relief from the symptoms of depression, your doctor might try to change your dose, hoping to achieve a better outcome. 

In case that doesn’t work, your doctor recommends switching to another antidepressant, usually zoloft or prozac, aiming to achieve a better therapeutic response. 

Side effects 

Intolerance is one of the major issues with antidepressants. Some people show signs of allergic reactions just hours after taking cymbalta. For such people, it is pointless to continue treatment with duloxetine and the antidepressant is switched. 

Incompatibility with other prescription medications 

This reason is common for people who live on more than one prescription medication. In such a scenario, it is extremely important to rule out drug interactions. 

If your doctor determines that cymbalta is interacting, in some way, with other prescription medications, your doctor will suggest switching to another antidepressant. 

Difference between cymbalta and zoloft’s mechanism to reduce the symptoms of depression 

Zoloft, brand name for sertraline, belongs to the class of selective serotonin reuptake inhibitors (SSRIs). These drugs inhibit the reuptake of serotonin from the synaptic cleft (space between a neuron and its target cell). 

So the neuron here releases serotonin and oftentimes there’s some leftover within the synaptic cleft that is retaken by transporters. 

With zoloft, these transporters are blocked, so the reuptake of neurotransmitter (serotonin) is prevented, which leaves more serotonin within the synaptic cleft to bind to its target cells and produce its effect.

In short, zoloft increases the availability of serotonin in your brain, which is a neurotransmitter (a chemical) released by our brain which is responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

Cymbalta, a generic name for duloxetine, belongs to the class of serotonin norepinephrine reuptake inhibitors (SNRIs), which inhibits the reuptake of both serotonin and norepinephrine. 

Norepinephrine is another excitatory neurotransmitter which is responsible for a lot of physiological functions like contraction of skeletal and cardiac muscles etc. 

Uses of zoloft and cymbalta 

Zoloft is used for the following health conditions:

• Mild to moderate depression 
• Post Traumatic Stress Disorder (PTSD) 
• Panic Attacks 
• Obsessive compulsive disorder (OCD) 
• Premenstrual Dysphoric Disorder (PMDD) 
• Social Anxiety Disorder

Off label uses include:

• Generalised anxiety disorder (GAD) 
• Irritable bowel syndrome (IBS) 
• Migraine 
• Pain induced by diabetic neuropathy. 

Cymbalta is used for the following health conditions:

• Major depression
• Generalised anxiety disorder (GAD) 
• Fibromyalgia induced pain
• Skeletal muscle pain

Off label uses include:

• Urinary incontinence 
• Peripheral Neuropathy associated with Chemotherapy 

Side effects of cymbalta

Common side effects include:

• Drowsiness/fatigue/sleepiness/hypersomnia
• Decreased salivation leading to dry mouth 
• Vertigo 
• Loss of appetite 
• Excessive sweating
• Constipation or diarrhoea 
• Weight gain or loss
• Abdominal pain

Serious side effects include:

• Urinary problems 
• Vision problems 
• Low sodium levels 
• Orthostatic Hypotension. 
• High doses can cause serotonin syndrome, associated with chills, fever, confusion, delirium, cloudiness, convulsions etc. 
• It can cause liver damage associated with abdominal pain, excessive itching, yellowing of eyes and skin etc. 
• Allergic reaction to the drug, which includes breathing issues, skin rashes associated with itching, redness, blisters, blue-purple patches, burning sensation etc. 
• It can cause manic behaviour in some patients, associated with aggressiveness, anger, improper behaviour, chills, sweating, hyperventilation etc. 

Side effects of zoloft

Common side effects of zoloft include:

• Loss of appetite
• Tiredness
• Feeling angry or agitated
• Weight gain
• Inability to digest food
• Nausea
• Diarrhoea
• Loss of libido
• Sweating/Night sweats
• Tremors or shaking
• Insomnia
• Decreased sex drive
• Impotence
• Inability to ejaculate

Zoloft, sometimes, causes serious side effects. Consult your healthcare provider as soon as you can if these symptoms occur:

• Seizure/convulsions
• Eye pain with vision problems
• The inability to have an erection
• Hypothyroidism (low thyroid gland function)
• Bone marrow failure associated with low blood counts
• Thrombocytopenia
• Neutropenia 
• Abnormal behaviour/mania 
• Suicidal thoughts
• Feeling guilty all the time
• Extrapyramidal symptoms
• Low sodium levels, associated with psychological symptoms like confusion, agitation, inability to understand surroundings, memory loss etc.
• It can cause elongation of QT interval, causing increased heartbeat or arrhythmia

Best switching strategies 

Antidepressants need a proper switching strategy to prevent the complications related to withdrawal syndrome or serotonin syndrome (if you start the next one too early). Let’s take a look at four antidepressant switching strategies: 

Direct switch 

Here, you stop one antidepressant and directly switch to another. This strategy is only applicable if you’re switching to a drug which belongs to the same class of antidepressants. You can also switch from SSRI to SNRI (Serotonin-norepinephrine reuptake inhibitors) through this strategy. 

Cross taper 

Here, you taper off one antidepressant while gradually increasing the dose of the next one, over a few weeks period. This is the preferred method when you switch to a drug that’s in a different antidepressant class.

Taper and switch right away

Here, you gradually taper off your current drug. As soon as you have completely stopped the first drug, you start taking the next one. 

Taper and switch, after washing out the first drug completely 

Here, you gradually taper off the first drug and wait a couple of weeks, usually 1-6 weeks, for your body to completely wash out the drug from your system, even traces. This strategy is most commonly used in case of Monoaminoxidase inhibitors (MAOI), to prevent serotonin syndrome. 

Conclusion 

In this blog post, we discussed switching your antidepressant from cymbalta to zoloft. These meds belong to different classes of antidepressants. 

They can increase the amounts of excitatory neurotransmitters to help fight against depressive symptoms. This blog covered the comparison between these two agents, their side effects, mechanism of action and uses.

FAQs: switching from cymbalta to zoloft

How do I switch from duloxetine to sertraline?

The best switching strategy for replacing duloxetine with sertraline is cross tapering. Your doctor will taper off duloxetine while starting zoloft from the lowest effective dose. Gradually the dose of duloxetine is decreased, while the dose of zoloft increases until the former drug is stopped completely. It is not recommended to stop using duloxetine abruptly. 

Can you replace Cymbalta with Zoloft?

Yes, you can, only if your doctor deems fit. It is necessary to monitor the side effects and tolerance associated with every antidepressant to come up with the best one for you. If cymbalta does not suit you well or produce intolerable side effects then your doctor might recommend switching from cymbalta to zoloft. 

How is Cymbalta different from Zoloft?

Cymbalta and zoloft belong to different classes of antidepressants. Cymbalta (duloxetine) is a serotonin-norepinephrine reuptake inhibitor, while zoloft (sertraline) is a selective serotonin reuptake inhibitor. 

Zoloft does not play any part in increasing the quantity of norepinephrine in your system. It is serotonin focused. Cymbalta, on the other hand, increases the amounts of both serotonin and norepinephrine. 

These two neurotransmitters are involved in different physiological functions, which creates the difference in functions of the two drugs. 

What is the #1 antidepressant?

Prozac and zoloft are most commonly prescribed antidepressants. They work quite well for a large sum of people and are well tolerated, but this is not the case with everyone. Some people are allergic to these meds and show signs of allergic reactions soon after taking them. 

So, it completely depends on how your body treats the med and it is hard to tell if these antidepressants would act like #1 antidepressant for you. Always stick to the drug and dose suggested by your healthcare provider.

How do I wean off 100mg of Zoloft?

When tapering off 100mg zoloft, the dose is reduced to 50mg, for a period of 7 to 9 days. A few days are required by your body to adjust to a 50mg dose. 

When your body gets stable at 50mg, then your dose is further lowered down to 25mg, for a week or two. Again, this time period is necessary to make your body comfortable with the reduced dose, as it was used to taking 100mg. 

25mg is considered the lowest dose when it comes to tapering off zoloft, but if your body gets unstable, it is recommended to taper it further down to 12.5 mg. 

What happens if you stop taking sertraline all of a sudden? 

Abrupt withdrawal of zoloft leads to withdrawal or discontinuation syndrome. When you start taking antidepressant, it increases the amount of serotonin in your body. 

Over time, your body gets used to this increased amount of serotonin. When you suddenly stop using it, it creates an unannounced serotonin deficiency, to which your body reacts in a negative way. You may suffer from the following symptoms:

• Chills
• Fever
• Diarrhoea
• Vomiting 
• Nausea
• Headaches 
• Excess sweating/night sweats
• Disturbed sleep, insomnia, nightmares
• Dizziness or vertigo
• You might feel something called brain zaps, which feels like a shock firing in your brain 

References 

• Arash Mowla et al. Clin Drug Investig. (2016) – Comparing the Effects of Sertraline with Duloxetine for Depression Severity and Symptoms: A Double-Blind, Randomized Controlled Trial https://pubmed.ncbi.nlm.nih.gov/27071759/
• Madelaine M Wohlreich et al. (2005) – Immediate switching of antidepressant therapy: results from a clinical trial of duloxetine https://pubmed.ncbi.nlm.nih.gov/16402760/ 
• Duloxetine – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-91490-2114/duloxetine-oral/duloxetine-sprinkle-capsule-oral/details
• Welmoed E E Meijer et al. Pharmacoepidemiol Drug Saf. 2002 – Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands. https://pubmed.ncbi.nlm.nih.gov/12512241/
• G MacQueen et al. CNS Drug Rev. Spring 2001 – The selective serotonin reuptake inhibitor sertraline: its profile and use in psychiatric disorders https://pubmed.ncbi.nlm.nih.gov/11420570/
• D Murdoch et al. Drugs. 1992 – Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder https://pubmed.ncbi.nlm.nih.gov/1281075/
• A L McRae et al. Expert Opin Pharmacother. 2001 – Review of sertraline and its clinical applications in psychiatric disorders https://pubmed.ncbi.nlm.nih.gov/11336629/