The combination of antidepressant medication and psychotherapy is recommended for depression treatment, according to a study in the May 18, 2000, issue of "The New England Journal of Medicine." Cymbalta, generic name duloxetine, and Elavil, generic name amitryptyline, are two such antidepressants approved by the Food and Drug Administration for the treatment of depression.
Types of Antidepressants
According to the "PDR Drug Guide for Mental Health Professionals," Cymbalta is a relatively new type of antidepressant called a serotonin-norepinephrine reuptake inhibitor, or SNRI. Amitryptyline is another type of antidepressant called a tricyclic antidepressant. Tricyclic antidepressants are the oldest type of antidepressant medication, first given to patients in the 1950s.
How They Work
Antidepressants alter levels of biochemicals in the brain, called neurotransmitters, that contribute to symptoms of depression. Cymbalta increases the levels of the neurotransmitters serotonin and norepinephrine in the brain, according to the "PDR Drug Guide for Mental Health Professionals." Amitryptyline also affects these neurotransmitters.
Off-Label Uses
According to the May 8, 2006, issue of "Archives of Internal Medicine," many antidepressants are often prescribed for medical conditions on an off-label basis, meaning the FDA has not approved use of these drugs to treat these ailments. Cymbalta is often used on an off-label basis to treat stress urinary incontinence, diabetic peripheral neuropathy, generalized anxiety disorder, fibromyalgia and chronic fatigue syndrome.
Amitriptyline is also frequently prescribed for off-label uses, according to the "Archives of Internal Medicine." Some of these off-label uses include insomnia, post-traumatic stress disorder, migraine, diabetic peripheral neuropathy, chronic pain and chronic fatigue syndrome.
Side Effects
Antidepressants may cause side effects, according to the "PDR Guide." Sometimes, antidepressants increase the risk of suicidal thoughts and behavior, so monitoring for worsening of depressive symptoms and suicidal thinking or behavior is crucial for people who start taking antidepressants.
Individuals taking Cymbalta may experience nausea, dry mouth, headache, insomnia or dizziness, according to the "PDR Guide." Cymbalta may cause sexual dysfunction in some people. Sudden discontinuation of Cymbalta may cause temporary symptoms, such as depressed mood, irritability, anxiety and headache.
Some side effects of amitriptyline include rapid heart rate, blurred vision, dizziness, dry mouth, nausea, constipation and changes in weight, according to the "PDR Guide." An overdose may cause death. Sudden discontinuance of amitriptyline after prolonged use may cause such symptoms as headache, dizziness or nausea. Occasionally, a gradual reduction in dose produces temporary symptoms, such as restlessness, irritability and sleeping difficulties.
Contraindications
Individuals are advised to not take Cymbalta or amitriptyline if they have taken a type of antidepressant called a monoamine oxidase inhibitor, or MAOI, within the past two weeks, according to the "PDR Guide." Cymbalta and amitriptyline should not be administered to people with glaucoma, as Cymbalta may dilate the pupil and amitriptyline may increase pressure on the eye in individuals with glaucoma. People taking thioridazine, or Mallaril, are advised to not take Cymbalta. Hypertension, or high blood pressure, may occur if amitriptyline is taken with epinephrine, according to the "PDR Guide." Increased side effects of amitriptyline may occur with those also taking cimetidine, or Tagamet.
References
- "Archives of Internal Medicine"; Off-label Prescribing Among Office-Based Physicians; May 8, 2006
- "The New England Journal of Medicine"; A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy and their Combination for the Treatment of Chronic Depression; May 18, 2000
- "PDR Drug Guide for Mental Health Professionals, 3rd Edition"; Thomson Reuters; 2007.
