Bead counting Bead counting is an informal way of taking less than the smallest capsule strength by opening a capsule that contains small beads and taking only some of them. It is outside the product licence and the dose is only approximate. Duloxetine’s prescribing information says its capsules should not be opened. It should only be done with a prescriber’s agreement, after licensed options such as a lower strength or a liquid have been considered.
Also called: Counting beads, Weighing the beads.
Written by Alena Kozlova, PhD , from published studies and prescribing information.
Definition medically reviewed by Dr. Jason Tan , Consultant Psychiatrist, on October 28, 2026, this definition only. Next review: October 28, 2027.
This page describes US products. Strengths and label wording differ in other countries.
Which antidepressants come as capsules with beads? Duloxetine (Cymbalta) and extended-release venlafaxine (Effexor XR) capsules both hold small coated pellets, which people call beads. The smallest US strengths are 20 mg for duloxetine and 37.5 mg for venlafaxine, which can be more than the last steps need. The table below lists the antidepressants sold as capsules in the US; this page is about the duloxetine and venlafaxine capsules only.
Antidepressants sold as capsules in the US Why do people count beads? Capsules cannot be cut like tablets, so taking out some of the beads is one way people get a lower dose from them at home.
What people on Reddit say
Bead counting came up almost only on the forums for the two capsules on this page. Of 1,185 people who described coming off an SSRI or SNRI on Reddit, 83 said they opened capsules and counted or removed beads to lower their dose: 44 on r/effexor and 38 on r/cymbalta. People who write about coming off are not typical of everyone who tapers, so these counts show what happens, not how often.
From public Reddit posts, counted by withClaro. These are self-reports, not a clinical study.
Is bead counting accurate? Not very: the dose is an estimate, so agree any bead count with your prescriber first. People who do this report that beads differ in size, so the same count may not give the same dose, and some weigh the beads on a jewelry scale instead. Either way the error matters most at the small doses where people use it.
What do the labels say about opening capsules? Some labels allow opening a capsule, as long as all of its contents are taken. The Effexor XR label allows opening the capsule and sprinkling all of it on a spoonful of applesauce, and Drizalma Sprinkle, a form of duloxetine, can be opened the same way. The Cymbalta label says to swallow the capsule whole. No US label describes taking out part of the beads.
The beads should not be crushed or chewed, for different reasons. Each duloxetine bead has a coating that keeps stomach acid away from the drug, which acid breaks down, and venlafaxine’s coating controls how slowly it is released, so crushing it could release more of the dose at once.
What do you do with the beads you don’t take? No US label says. The Effexor XR label covers only sprinkling the whole capsule on a spoonful of applesauce and swallowing it straight away, and the Cymbalta label gives no advice on an opened capsule. Before you start, ask your pharmacist whether the rest can be kept and how, or how to get rid of it.
What can you use instead of counting beads? A compounding pharmacy can make capsules in strengths that are not sold, on prescription. A compounded liquid is another option, though duloxetine breaks down in stomach acid. In the capsule, the coating on each bead protects it, so a liquid made from duloxetine needs special preparation. Each of these is something to arrange with your prescriber.
What to do Talk to your prescriber before opening capsules, and ask whether a compounding pharmacy can make the lower doses you need. If you do count beads, agree with them how you will count or weigh them and what to watch for after each step: dizziness, nausea, brain zaps or poor sleep in the first days can mean a step came out larger than planned. If you feel much worse or have thoughts of harming yourself, contact your prescriber now rather than at your next appointment, and for thoughts of self-harm call or text 988 in the US or your local emergency number.
Read the duloxetine taper guide
How withClaro helps Each step logged with how you feel after it, so a step that came out too big shows up A PDF report you can share with your prescriber Get the withClaro app on the App Store
Related terms Sources U.S. Food and Drug Administration. Effexor XR (venlafaxine extended-release capsules): prescribing information. FDA / DailyMed, 2025. Eli Lilly and Company. Cymbalta (duloxetine delayed-release capsules): prescribing information. Eli Lilly, 2023. U.S. Food and Drug Administration. Drizalma Sprinkle (duloxetine delayed-release capsules): prescribing information. FDA / DailyMed, 2024. Horowitz MA, Taylor D. The Maudsley Deprescribing Guidelines. Wiley, 2024. All glossary terms