Health care providers prescribe serotonin and norepinephrine reuptake inhibitors, or SNRIs, for the treatment of depression, anxiety and chronic pain due to diabetic neuropathy and fibromyalgia. Cymbalta most likely prevents the reuptake of both serotonin and norepinephrine at all doses, while other SNRIs may need higher dosing to attain the similar results, according to Dr. Stephen M. Stahl and colleagues in the September 2005 issue of "CNS Spectrum."
Desvenlafaxine
Health care providers prescribe desvenlafaxine for the treatment of depression. Desvenlafaxine, also a SNRI, does not have a food and drug administration approved indication for anxiety or chronic pain, as does Cymbalta. Currently only sold under the brand name Pristiq, desvenlafaxine does not require a slow taper up in dose to prevent side effects, as does Cymbalta. The options for dosing desvenlafaxine include 50 mg or 100 mg once a day. Doses greater than 100 mg produced side effects, most commonly nausea, according to Drs. Maria Teresa C. Lourenco and Sidney H Kennedy in an expert opinion paper published in the 2009 issue of "Neuropsychiatric Disease and Treatment." Desvenlafaxine has also been studied for the treatment of chronic pain associated with fibromyalgia according to Lorenco and Kennedy.
Venlafaxine
The U.S. Food and Drug Administration approved venlafaxine for the treatment of both depression and anxiety. Like Cymbalta, venlafaxine is also a SNRI, but requires tapering to a higher dose in order to block the reuptake of norepinephrine. Therefore, at lower doses, velafaxine affects only serotonin in a similar manner to that of selective serotonin reuptake inhibitors, or SSRIs, according to Dr. Stahl and colleagues in a 2005 article in "CNS Spectrum." The article also state that all SNRIs have similar efficacy for anxiety and improved efficacy for depression and pain management over SSRIs. Dr. Martin A. Katzman and Leslie Jacobs state in a 2007 expert opinion paper published in "Neuropsychiatric Disease and Treatment" that venlafaxine successfully treats both symptoms of various anxiety disorders and depression, and is well tolerated as side effects dissipate over the course of treatment.
Milnacipran
The U.S. Food and Drug Administration approved milnacipran for the treatment of chronic pain associated with fibromyalgia. Milnacipran does not have an indication for the treatment of depression or anxiety as does Cymbalta, but it demonstrated efficacy for the treatment of anxiety and depression while maintaining tolerability, according to Stahl and colleagues. Health care providers prescribe milnacipran twice a day for maintenance, while Cymbalta may be prescribed once or twice daily.
References
- "CNS Spectrum"; SNRIs: Their Pharmacology, Clinical Efficacy, and Tolerability in Comparison With Other Classes of Antidepressants; Stephen M. Stahl; Sept 2005
- "Neuropsychiatic Disease and Treatment"; Desvenlafaxine in the Treatment of Major Depressive Disorder; Maria Teresa C. Lourenco; 2009
- "Neuropsychiatric Disease and Treatment"; Venlafaxine in the Treatment of Panic Disorder; Martin A. Katzman; 2007
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