No appetite, need advice
May 28, 2014 11:54 AM   Subscribe

I just started Cymbalta (again) and I have zero appetite. Like it's almost 3 pm and I haven't eaten a thing all day.

What to do when you don't want to eat? I have a question into my pdoc but I don't want to give up on the Cymbalta just yet. I've been on it less than a week and this didn't happen before. It was incredibly helpful before with my chronic pain and seems to be helping a little bit now.

I have no desire to eat. Yesterday wasn't this bad. I had a peanut butter sandwich for lunch and a dish of homemade baked beans for dinner. Today, nothing but some green tea (no sugar/honey/whatever).

The doc insisted on starting me at 60 mg whereas I had always taken 30 before. She said she never saw anyone who did well on 30 and didn't believe me when I said I did. (Yes, I may be changing doctors but getting appointments is difficult enough without dealing with Medicaid.)

Tips or tricks appreciated. Should I concentrate on calorie dense foods? A good multivitamin? Assume Ensure and the like are not in my budget (see Medicaid above).

And I'm fat. Like really fat, so living off the fat of the land, so to speak, isn't a problem. I'm more worried about vitamins/minerals and the like.

Bonus question for those who have taken it: Does it help with anxiety? Mine has sky rocketed, but I think it's mostly related to borderline hypoglycemia (been running between 80 and 85 pretty consistently the last few days).
posted by kathrynm to Health & Fitness (12 answers total) 2 users marked this as a favorite
I take 30mgs of Cymbalta for a pain condition. I started it about six weeks ago and also completely lost my appetite, but it came back after a week or maybe ten days. When I wasn't hungry, I just ate smaller meals at my usual time (even just a tablespoon of peanut butter on a graham cracker for instance). I can't speak to the anxiety aspect of your question, but I will say that I *am* having decent results at 30mgs and my dr is happy to keep me on the lowest possible dose. Good luck!
posted by katie at 12:10 PM on May 28, 2014

SNRI's will take at least a couple weeks, probably more than a month, before they really start to work and the side effects you are experiencing to subside. Appetite loss is not uncommon with an SNRI. I would expect your appetite to return in a week or so (from my experience with Cymbalta). Cymbalta is a serotonin-norepinephrine reuptake inhibitor, and it's the increase in norepinephrine that's affecting your appetite. The first few weeks you're on a reuptake inhibitor, the neurons in your brain are literally growing more receptor sites to receive the increased neurotransmitters in the synaptic cleft - and until this all balances out, the side effects can be wonky.

In the meantime, do try to eat nutrient rich foods if you can. Can you make smoothies? I find smoothies to be the easiest nutrient delivery system when I'm not feeling like eating.

Opinions will vary on multivitamins. If you really aren't eating much, it might be a good idea, at least to make sure you're getting the requisite amount of vitamin C and iron.

60 mg a day is bog standard for a Cymbalta dose.

Cymbalta is prescribed off-label for anxiety, but is not a super common treatment for anxiety. Because it's an SNRI it sort of depends on the person how it affects anxiety. Generally, an increase in serotonin will reduce your anxiety, while an increase in norepinephrine can increase your anxiety. So some increased anxiety on Cymbalta is not terribly uncommon. However, not eating will definitely increase your anxiety too. So I would start there and give the meds a few weeks and see how you feel.

FWIW, green tea on an empty stomach makes me feel horrible and suppresses my appetite in a bad way. See if you can at least get some bananas/protein shakes (if ensure is too costly, maybe just getting some whey?)/peanut butter.
posted by Lutoslawski at 12:11 PM on May 28, 2014

Mushy stuff appeals to me when I don't have an appetite.

Peanut Butter

Simple, easy to eat and helps keep blood sugars even. Don't worry too much about vitamins. You'll be fine for the week to ten days it will take you to feel like eating. Just snack regularly on things that don't take a lot of effort or time to eat. Not too many carbs. (If you can manage it.)
posted by Ruthless Bunny at 12:23 PM on May 28, 2014

When I was taking medication that had a major side effect of appetite suppression, my doctor told me to at the very least try to get a good healthy breakfast in my body, either before taking meds or at the same time as the meds, and that taking a vitamin was not a terrible idea. She suggested smoothies, since I had no problem drinking things, and that worked out pretty well, and she also suggested calorie and nutrient dense snacks, like apple slices with peanut butter or carrots and hummus or a handful of trail mix -- things I could have a few bites of and then put away without a lot of fuss.
posted by palomar at 12:24 PM on May 28, 2014

This happened to me on Wellbutrin, and it did go away after about a month. When I don't have an appetite I like stuff that doesn't need chewing, so blended soups and juice and broth and stuff like that. You can just bolt it down without really thinking about it.
posted by showbiz_liz at 12:25 PM on May 28, 2014

Cymbalta helped me a lot for anxiety - it helps people a lot who have psychosomatic issues which I do. It didn't affect my appetite but it did give me low-level stomach issues.

Any time you're on a new SSRI/SNRI expect the first couple weeks to be weird. If you still aren't hungry in a month then I'd be concerned.
posted by radioamy at 12:36 PM on May 28, 2014

I completely lost my appetite on Cymbalta for about a month, and ended up losing twenty pounds (which is rather unhealthy, in retrospect, but I wanted to lose weight at the time and welcomed the boost). The two things that kept me from completely keeling over were oatmeal and consciously reminding myself to eat. The oatmeal wasn't exactly appetizing, but at that point, nothing was.

If I had it to do over again, I'd focus on denser foods with relatively inoffensive flavors and textures that involved zero prep: full-fat yogurt, cheese, peanut butter on a spoon, nuts, canned chickpeas, whatever takes the least amount of time and effort to get from your pantry to your stomach. I'd also set myself regular reminders to eat something every few hours.

Some vitamins can upset your stomach unless you eat them with food, so that might motivate you to eat breakfast regularly. Or it might make you less inclined to eat if you forget to eat breakfast, so be on guard for that.

Your appetite will come back on its own in a few weeks; in the meantime just worry about getting enough calories in you in the easiest, most boring way possible.
posted by Metroid Baby at 12:42 PM on May 28, 2014

Are you taking it with food?

I just started it this week, and my doctor stressed that I should only take it after I've eaten breakfast. If you take it after breakfast, you'll at least have one good meal.

If ensure is too costly, you can look around for some protein powders to mix with milk. I'm not sure what your budget is, but some of them can be around $1/serving, which as a meal replacement isn't terrible.
posted by inertia at 1:40 PM on May 28, 2014

Everyone is giving you great ideas about what foods to eat. I'd just second the advice to eat something (whether you want to or not) at regular mealtimes. I've lost my appetite for a long period of time before. It was emotionally discomfiting because normally I *love* food. I tried to remind myself at each meal "this will pass" and aimed for eating at least 200 calories. (I know that seems tiny but some days it was all I could handle and I got by okay. I tried to be gentle with myself about this too. That number seemed to be about what worked for keeping me relatively even-keeled. YMMV.)
Try to get a mix of carbs, protein and or fat in there. So the graham cracker with peanut butter is a great idea or
-an apple with some nuts
-cereal with milk
-toast with any topping you like (I feel like toast is universally soothing)
-greek yogurt or cottage cheese with some fruit
-scrambled egg in a tortilla with cheese
The main thing is to give your body fuel at the regular intervals it's come to expect, even if all you can manage is few hundred calories. I hope your appetite returns soon.
posted by purple_bird at 2:48 PM on May 28, 2014

I also had issues with my appetite on Cymbalta, and one thing that helped was that I kept my regularly scheduled meal-times as closely as possible, even if I didn't actually eat much more than some nuts or drink a protein shake. It helped "train" my stomach into expecting food at certain times, while also keeping me from not starving.

Also, the first week or two I felt like I was either going to throw up or crap myself with each dose. Normally I don't have side effects but that was... alarming.

Cymbalta did not help with my anxiety, although I was technically taking it for fibromyalgia (didn't help with that either).
posted by sm1tten at 5:06 PM on May 28, 2014

I haven't taken this particularly, but when I've got anxiety-related appetite problems, part of what I've started doing is just planning out the day's food ahead of time and setting timers. Ensure is gross, anyway. Plan well in advance of having to actually cook, when you're not really thinking about eating it, you're just trying to pick out balanced foods. You're used to eating for hunger; this is eating for sustenance. It's qualitatively different, but it's still important.
posted by Sequence at 5:55 PM on May 28, 2014

So I went out and got some yogurt and stuff to make smoothies. I'm also putting in entries in my todo list to eat at least breakfast, lunch and dinner.

I had some peanut butter on bananas a bit earlier and my anxiety has calmed down some.

Thanks everyone. AskMeFi rocks.
posted by kathrynm at 6:11 PM on May 28, 2014

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