Is Cymbalta a new antidepressant that works in a special way?

Cymbalta (generic name: duloxetine) is an antidepressant that helps the body increase serotonin at low doses, norepinephrine at moderate doses, and dopamine only at higher doses, as the table shows. Cymbalta is called an SNRI, which stands for serotonin and norepinephrine reuptake inhibitor. Right now, because there is only one other modern antidepressant calling itself an SNRI (the other is Effexor), it makes Cymbalta seem special. However, when you read about the older tricyclic antidepressants and MAOIs, you will realize there are many antidepressants that increase both serotonin and norepinephrine.

In addition to its use in depression, Eli Lilly and Company promotes Cymbalta for the treatment of chronic pain such as fibro-myalgia and the nerve pain that accompanies diabetes. Because it increases norepinephrine, Cymbalta works better for this pain than the mainly serotonin antidepressants like Celexa or Lexapro. It is sometimes used as a preventative treatment for migraine headaches. Low doses of older, cheaper, norepinephrine-stimulating tricyclic antidepressants (such as Norpramin and Pamelor) can also reduce the pain of diabetes or migraine; chronic pain in the neck, shoulders, and lower back; and foot pain caused by nerve damage or alcoholism, although they are not specifically licensed for this use.

Cymbalta’s side-effect profile resembles some of the older tricyclic antidepressants. At sixty milligrams per day, patients report nausea, sleepiness, constipation, and dry mouth. In one study, nausea was the most common reason patients gave for wanting to stop their Cymbalta. There is little evidence that Cymbalta causes weight gain. Perhaps the nausea caused by Cymbalta makes food seem less attractive. Cymbalta is also associated with sexual side effects including decreased interest in sex and delayed time to orgasm.

Cymbalta is available in 20, 30, and 60-milligram tablets. The usual dose is 40 to 60 milligrams per day, and there is little to be gained by increasing the dose over 60 milligrams per day. After you stop taking it, Cymbalta stays in your body for one and a half days.

Carefully discuss a prescription for Cymbalta with your doctor. There are other antidepressants that increase serotonin and norepinephrine just as well, are cheaper, and have less annoying side effects.