Cymbalta, also known by its generic name of duloxetine HCl, is an oral medication for the treatment of major depressive disorder. It belongs to the class of drugs known as selective serotonin norepinephrine reuptake inhibitors (SSNRIs). SSNRIs increase the levels of serotonin and norepinephrine in the brain. According to the National Institute of Mental Health, major depressive disorder affects around 14.8 million American adults.
Efficacy
According to the manufacturers of Cymbalta, the drug's efficacy in the treatment of major depressive disorder was established in four short-term and one maintenance trial in adults. In all four studies, Cymbalta demonstrated superiority over placebo as measured by improvement in the 17-item Hamilton Depression Rating Scale (HAMD-17) total score. The data also showed that there was no differential responsiveness between treatment outcome and age, gender and race.
Side Effects
According to the manufacturers of Cymbalta, the most common side effect seen in clinical trials was nausea. However, the manufacturer states that patients were "not bothered enough" about this to stop taking the drug. Prescription guidelines warn that some patients may experience weight changes, a decreased sex drive, drowsiness, constipation and sleep problems.
Administration
Cymbalta is prescribed in capsule form. According to prescription guidelines, the capsule should be swallowed whole and should not be crushed or broken open. Although doctors will advise patients on the correct dosage, prescription guidelines advise that patients should take a total of 40 mg to 60 mg per day in two separate doses. Some doctors may advise their patients to take a higher dose. While studies found that taking 120 mg of Cymbalta per day was effective, there was no evidence to show that doses greater than 60 mg/day bring any further benefits.
Contraindications
Cymbalta should not be taken with certain other medications. Patients taking monoamine oxidase inhibitors (MAOIs) should not use Cymbalta because of the risk of a potentially fatal drug interaction between the two medicines. MAOIs include isocarboxazid, phenelzine and selegiline. According to Mayo Clinic, duloxetine may also cause serious conditions, including serotonin syndrome or neuroleptic malignant syndrome if used with other medicines such as linezolid, lithium, tryptophan, St. John's Wort and some pain drugs.
Other Considerations
Prescription guidelines warn that antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents and young adults with major depressive disorder. In a 2008 case study published in "Clinical Practice and Epidemiology in Mental Health," the lead author, Bilal A. Salem, reports two cases of suicidal attempts that occurred concomitantly with the use of Cymbalta. The author stated that in both cases there was "an emergence of suicidality in apparently nonsuicidal patients after starting or increasing Cymbalta."
