Bipolar Disorder Medication Spotlight: Cymbalta (Duloxetine)
With this post, we continue our sort-of-biweekly series on medications used to treat bipolar disorder and related symptoms. A few weeks ago, we began our coverage of the SSNRI antidepressants with Effexor (venlafaxine).
SSNRIs are Selective Serotonin and Norepinephrine Reuptake Inhibitors. They work by increasing the levels of two brain chemicals, serotonin and norepinephrine, in the synapses between brain cells. Like serotonin (described in our Prozac post), norepinephrine is important in regulating mood and anxiety, along with alertness and concentration.
The potential benefits versus side-effects profile for Cymbalta is similar to that of Effexor and other medications in this class. To avoid redundancy, we encourage you to reference our post on Effexor for benefit/side-effect information regarding SSNRI’s. Here, we cover potential benefits and side effects related specifically to Cymbalta.
Cymbalta has FDA indications for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder. Additionally it is approved for treating diabetic peripheral neuropathy (DPN) and fibromyalgia. Symptoms of DPN include a burning or tingling sensation in the extremities, typically the hands and feet, which develops in individuals with diabetes. Fibromyalgia is a disorder that presents with chronic pain and severe fatigue. Cymbalta may also be useful in treating other pain syndromes, such as chronic pain related to depression.
Some studies also support the use of Cymbalta in reducing the symptoms of stress incontinence – the involuntary passing of urine associated with coughing, sneezing, laughing, exercising, or other activities that apply pressure to the bladder.
Cymbalta can be taken once or twice a day with the daily adult dose ranging from 20 mg to 120 mg. Follow your prescriber’s recommendations on dose and when to take it.
Remember: Any antidepressant can take 2-3 weeks or even longer to become fully effective; it may take several weeks to work up to a therapeutic dose. This means that your depression may not lift for several weeks. I often tell patients that however they feel in the first two weeks is unlikely to be how they feel in a month – so if they are feeling some early side effects, hold on because they will likely get better.
Patience is important in getting these medications to work, but if you have any concerns about how you are feeling, contact your doctor. You will most likely have a follow-up visit with your doctor within a month or less of starting the medication; this is a good time frame for checking in to see if benefits have started or if side effects have faded or persisted.
Potential Side Effects
Like most medications in its class, Cymbalta can potentially cause any of several negative side effects, including increased suicidal ideation (especially in children and teenagers), increased risk of mania, anxiety or agitation, worsening depression, and serotonin syndrome. For a more comprehensive list of side effects related to SSNRI’s as a whole refer to “Bipolar Disorder Medication Spotlight: Effexor (Venlafaxine).”
Cymbalta is metabolized by the liver and therefore can interact with many other common medications including blood thinners, some antibiotics, and some pain relievers. If you are being prescribed Cymbalta, be sure to tell your prescriber about all of your other medications, including over the counter (OTC) products, such as ibuprofen. Also, because of Cymbalta’s effect on the liver, it should not be used in people who drink a lot of alcohol – which stresses the liver. Alcohol intake should be kept in moderation for someone taking Cymbalta.
Cymbalta can cause withdrawal symptoms such as nausea, vomiting, and agitation if it is discontinued abruptly. If you need to stop Cymbalta, consult with your prescriber about the safest way to do this.
Since Cymbalta is the newest of the antidepressants, I have not had extensive experience with it, but the response has been positive in the people that have started using it. Fatigue and stomach upset were the most common early side effects, but these usually resolved within a few weeks. I have reserved Cymbalta for people who have not tolerated or responded well to older antidepressants and/or if they have significant pain issues associated with their depression or anxiety. Cymbalta is being marketed heavily as an antidepressant that also treats physical pain, and in my limited experience it has reduced pain in some patients.
For more information from the manufacturer, visit Lilly’s Cymbalta page.
If you’ve taken any form of Cymbalta for bipolar depression or other conditions or are a doctor who has prescribed it, please share your experiences, insights, and observations.
Fink, C. (2009). Bipolar Disorder Medication Spotlight: Cymbalta (Duloxetine). Psych Central. Retrieved on October 28, 2016, from http://blogs.psychcentral.com/bipolar/2009/06/bipolar-disorder-medication-spotlight-cymbalta-duloxetine/