Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)
How it works:
Boosts the effects of two neurotransmitters found in the brain called serotonin and norepinephrine.
What makes it unique:
This medication boosts serotonin and norepinephrine to a similar degree. This is effective for neuropathic pain as well. Neuropathic pain is commonly seen in patients with diabetes.
Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Blood pressure can be increased with this medication, especially as the dose increases. Duloxetine can also cause sweating, urinary retention, and insomnia.
Rare side effects include hyponatremia, seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.
How effective is it:
(1) A study was conducted to compare Duloxetine against Venlafaxine XR. 1,754 patients were analyzed. No statistically significant difference was found between the two in regards to response or remission from depression.
(2) A review of 22 studies was conducted to compare Duloxetine to Venlafaxine and Fluoxetine. Fluoxetine was similar to Duloxetine in tolerability and efficacy. Venlafaxine was superior to Duloxetine in all aspects except in dropout rate.
This is a commonly seen medication. I see it just as much for diabetic neuropathy or neuropathic pain as I see it for depression. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.
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1. Vis PM, van Baardewijk M, Einarson TR. Duloxetine and venlafaxine-XR in the treatment of major depressive disorder: a meta-analysis of randomized clinical trials. Ann Pharmacother. 2005 Nov;39(11):1798-807.
2. Eckert L, Lançon C. Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons. BMC Psychiatry. 2006 Jul 24;6:30.