THE GOOD DRUG GUIDE
"...It is possible that duloxetine (Cymbalta, Xeristar, Yentreve), licensed by the FDA in autumn 2004, and milnacipran (Ixel, Dalcipran, Toledomin), available in Europe, may be more effective than Weyth's older venlafaxine (Effexor) for a segment of the population that can benefit from dual serotonin-noradrenaline reuptake inhibition. In early January 2005, Eli Lilly and Company and Boehringer Ingelheim announced that duloxetine (Cymbalta, Xeristar) had been granted a product license in the European Union too for the treatment of major depression.
Pain-ridden depressives in particular may respond well to this class of drug. Many depressed people suffer from poorly-defined aches and pains, persistent fatigue, and shoulder-, neck- and back-pain. Duloxetine relieves both the somatic and emotional symptoms of depression. Unlike venlafaxine, duloxetine exerts its more balanced serotonin and noradrenaline reuptake inhibition throughout the dosage range. Duloxetine also weakly inhibits the reuptake of dopamine, and shows minimal affinity for the histamine and cholinergic muscarinic receptors. Its side-effect profile appears to be relatively benign.
Yet an authentic mental health wonderdrug remains elusive. Early expectations that duloxetine would show superior efficacy in melancholic depressives have not yet been convincingly borne out in controlled clinical trials. Ill-served by mainstream medicine, victims of melancholic and retarded depression may actually do better on dual noradrenaline-dopamine reuptake inhibitors such as delicensed nomifensine (Merital) and/or mu opioid agonists/kappa opioid antagonists such as buprenorphine (Temgesic, Buprenex, Subutex).
Duloxetine itself will probably prove a blockbuster product. It will most likely be marketed for everything from stress urinary incontinence, social phobia and generalised anxiety disorder, diabetic peripheral neuropathic pain and possibly irritable bowel syndrome. But alas it takes time to separate genuine therapeutic advance from drug company hype, typically not until the patents expire... "
Eli Lilly and Co.
Duloxetine: hope or hype?
Duloxetine and depression
Duloxetine (Cymbalta) from Eli Lilly
Duloxetine and urinary incontinence
Duloxetine for pain-ridden depressives
Trial of duloxetine for major depression
Duloxetine versus venlafaxine (Effexor)