Duloxetine is sold under the brand name "Cymbalta".
Duloxetine is the most recently approved of the non-tricyclic antidepressants able to increase both serotonin and norepinephrine function. It is FDA approved for Major Depression, Generalized Anxiety Disorder, and Diabetic Peripheral Neuropathy.
Duloxetine reversibly blocks the recycling of serotonin and norepinephrine (at all doses) from outside the nerve to inside the nerve. This increase in serotonin and norepinephrine in the gap between nerves in the central nervous system (the synapse) leads to alterations in serotonin and norepinephrine function that have been associated with improvements in depression, anxiety disorders and some pain associated with depression.
Each of these serotonin/norepinephrine reuptake inhibitors (SNRIs for short) has its own personality, if you will. Duloxetine can cause an initial nausea that is improved by taking it with food. It seems to be a well tolerated antidepressant with possibly increased robustness of action for some patients who suffer from more serious depressions and for patients who suffers from physical pain along with their depression.
Duloxetine is processed for elimination from the body (“metabolized”) in the liver to inactive metabolites. The half life of duloxetine is about 12 hours. If it is stopped abruptly (we do not recommend) significant withdrawal symptoms can occur (that are time limited).
Possible adverse effects can include nausea, insomnia, sexual dysfunction (less often in women than in men), agitation, diarrhea, constipation and others.
All antidepressants have a warning from the FDA against new onset suicidal “thoughts and behaviors”. There is no evidence children taking antidepressants are suiciding; quite otherwise, there is very good evidence that children treated for depression suicide less often than children who are depressed who are not treated with antidepressants.
People who regularly drink large amounts of alcohol should not take duloxetine. There are case reports of such people experiencing significant elevations of hepatic enzymes that suggest possible damage to the liver.
Duloxetine reduces the effectiveness of the CYP2D6 system in the liver. Other medications eliminated via this system should be combined with duloxetine cautiously if at all.
If you miss a dose of duloxetine do not add the missed dose to the next dose. Take the duloxetine regularly as prescribed.
