Cymbalta is not just a depression medicine
Cymbalta is the unique depression medicine that, outside the United States, is not used to treat depression. Also known by its generic name duloxetine, Cymbalta is used almost as often to treat urinary incontinence and nerve pain as it is used to treat depression. These uniquely generalized benefits of Cymbalta rank high on the plus side of any weighing of Cymbalta pros and cons.
Not Just Depression Medicine
Cymbalta (duloxetine) was invented by the same team of scientists who invented Prozac (fluoxetine). For the first 10 years of its development, determining the right medical applications for this new drug proved problematic. There were quality control problems at the Eli Lilly plant that made it, long since corrected, and clinical trials took an unusually long time to determine the effective dose for treating depression. In the process of these clinical trials, however, Eli Lilly scientists Joseph Krushinski, David Robertson, and David Wong noticed some very interesting side effects.
Cymbalta seemed to relieve the pain and fatigue caused by fibromyalgia. It proved to be useful enough in controlling stress incontinence in women (leaking bladder caused by having to wait too long) to be licensed for this application in the European Union. It was helpful in relieving the pain caused by peripheral neuropathy, and also helpful in treating major depressive disorder.
Depression Medicine, not Depression Cure
All of the studies of Cymbalta, however, found that it was helpful but less than a cure. In treating major depressive disorder, Cymbalta is about as useful as similar serotonin reuptake inhibitors (SSRIs) invented at about the same time, namely Prozac (fluoxetine), Luvox (fluvoxamine), and Paxil (paroxetine). These are drug designed to keep levels of the mood-lifting neurotransmitter serotonin constant in the brain.
Cymbalta, Prozac, Luvox, and Paxil have not proved themselves in clinical trials to relieve major depressive disorder as well as the newer Lexapro (escitalopram), Effexor (venlafaxine), and Remeron (mirtazapine). The medical journals question the wisdom of prescribing Cymbalta when so many other treatments for depression are available.
The reason for prescribing Cymbalta is exemplified by a typical testimonial like this:
"I was on Zoloft for generalized anxiety disorder and major depression for several years. The problem was that I also suffered from nerve pain, joint pain, and muscle pain every day and every night. Sometimes the pain was really bad. Switching to Cymbalta has relieved a lot of my joint pain. Not all of it, but enough that I feel tremendously better and for the first time in years, I am able to go about my life. The only side effect I have with Cymbalta is hot flashes, about one a day. I'm OK with that for the pain and depression relief I'm finally getting."
Cymbalta probably is not the drug of choice for major depressive disorder. When major depressive disorder is complicated by pain, however, it can be an extremely useful medication. Sometimes Cymbalta is used with other antidepressants to get the desired effect. Consider this also-typical user testimonial.
"I think Wellbutrin saved my life. I wasn't able to get up and get going, however, until my doctor added Buspar and Cymbalta to my meds."
If you are looking for a treatment for major depressive disorder, it's very important that only one doctor prescribes all your medications. Taking too many medications in the SSRI class sometimes causes a rebound condition in which serotonin levels in the brain build up so high that depression becomes detached euphoria and then mania. It's a bad idea to take St. John's wort with Cymbalta for the same reason.
Pros and Cons of Cymbalta for Other Conditions
Clinical testing of Cymbalta for other conditions also found that it is usually helpful, but never a complete cure. Testing of Cymbalta as a treatment for stress incontinence in medicine found that it reduces incidents of having to rush to the bathroom by an average of 57 per cent—not 100 per cent. In women who lost weight, learned pelvic floor exercises, and also took Cymbalta, however, the net effects were greater.
Similarly, Cymbalta is not a complete cure for fibromyalgia or nerve pain. Tests conducted by its manufacturer, Eli Lilly, found that women with fibromyalgia reported that it reduced their rating of fibromyalgia pain by about 50 per cent. The big advantage of Cymbalta over other medications for fibromyalgia, however, was that it acted by raising the threshold of pain, not by changing the action of other parts of the nervous system. Unlike other treatments for fibromyalgia, Cymbalta did not cause dry mouth, dry eyes, or dribbling urination.
Antidepressants are a common treatment for the pain caused by diabetic nerve damage, or diabetic neuropathy. Cymbalta, oddly enough, seems to relieve the pain caused by diabetic neuropathy in women but not in men. In women, pain relief occurs even if the user is not also depressed. Under the best circumstances, however, Cymbalta only relieves diabetic nerve pain. It does not completely stop it.
Eli Lilly is currently testing Cymbalta as a treatment for chronic fatigue syndrome.
Major Downside to Cymbalta as Depression Medicine?
All drugs for depression are associated with side effects. The medications for depression before Prozac, Paxil, Luvox, and Cymbalta had a side effect that itself caused a great deal of depression. The pre-Prozac antidepressants caused significant weight gain, making their users either "fat and happy" or at least fat.
The side effects of Cymbalta are most noticeable when it is added to a cocktail of other drugs also used to treat depression. Some Cymbalta users refer to their experience as a "coffee buzz gone out of control." This is a sign of serotonin syndrome, caused by too much medication in the SSRI class.
Other users of Cymbalta have reported nausea and vomiting so severe they had to be hospitalized for dehydration. This is also due to serotonin buildup, only in the digestive tract, not the in the brain. In addition to these symptoms related to excessive serotonin, Cymbalta may also cause:
- Anxiety, nervousness, and agitation
- Blurred vision
- Clenching of teeth and tightening of the jaw muscles
- Cold hands or cold feet
- Decreased appetite and/or weight loss
- Decreased sex drive or difficulty achieving orgasm
- Feelings of depersonalization
- Difficulty passing urine, having to go all the time
- Disturbances of the gastrointestinal tract, such as constipation, diarrhea, indigestion, nausea, vomiting, and, in some cases, profuse bleeding
- Hot flashes (even in men)
- Hypomania (serotonin syndrome)
- Impotence or delayed ejaculation
- Increase in blood pressure or speeding up heart rate
- Increased perspiration
- Inflammation of the liver or hepatitis that can progress to cirrhosis if left untreated
- Jaundice of the skin and eyes
- Loss of sensation of touch
- Orthostatic hypotension (feeling faint when moving from seated position to standing position)
- Taste disturbances
- Vivid dreams and nightmares
Not everyone who uses Cymbalta will have all, or necessarily any of these side effects. And even if you do, the answer is usually to change the dosage of Cymbalta or to consider a combination of drugs in the right dosage.
No pharmaceutical treatment for major depressive disorder or the other conditions Cymbalta treats will work overnight. Don't add supplements and medications on your own, and allow a period of months to get the choice of medications and their dosages right for lasting relief.