Or maybe everything really is bipolar! Or maybe the medication is not the important thing. When we have medications with multiple indications, we often infer that the medication must work differently in each condition. Unless the doses are radically different e. In fact, it may be more parsimonious to say that disorders are more fundamentally alike than they are different, or that our drugs are being used for their placebo effect.
We can now add chronic pain to the long list of conditions responsive to psychoactive drugs. Since chronic pain patients will most likely be taking regular analgesic medications in addition to Cymbalta, the efficacy of Cymbalta might be diminished. It will be interesting to see how this plays out. Table 4. Harstall C, Ospina M. How prevalent is chronic pain?
Pain: Clinical Updates. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. A population-based survey of chronic pain and its treatment with prescription drugs.
American Pain Foundation. Acute pain. American Academy of Pediatrics. The assessment and management of acute pain in infants, children, and adolescents.
McCarberg B. Contemporary management of chronic pain disorders. J Fam Pract. A clinical guide to neuropathic pain. McGraw-Hill: Philadelphia; Mechanisms of neuropathic pain. Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Towards a theory of chronic pain. Prog Neurobiol. Ren K, Dubner R. Neuron-glia crosstalk gets serious: role in pain hypersensitivity. Curr Opin Anaesthesiol. Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management.
Ann Intern Med. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Annu Rev Neurosci. Bad news from the brain: descending 5-HT pathways that control spinal pain processing. Trends Pharmacol Sci. Preclinical and early clinical investigations related to monoaminergic pain modulation.
Duloxetine: A review of its pharmacology and use in chronic pain management. Reg Anesth Pain Med. The dual transporter inhibitor duloxetine: a review of its preclinical pharmacology, pharmacokinetic profile, and clinical results in depression. Curr Pharm Des.
Efficacy of duloxetine, a potent and balanced serotonin-norepinephrine reuptake inhibitor in persistent pain models in rats. J Pharmacol Exp Ther. Efficacy of duloxetine, a potent and balanced serotonergic and noradrenergic reuptake inhibitor, in inflammatory and acute pain models in rodents. Synergistic interactions between the dual serotonergic, noradrenergic reuptake inhibitor duloxetine and the non-steroidal anti-inflammatory drug ibuprofen in inflammatory pain in rodents.
Duloxetine vs. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med. A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain.
A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Do not take the herbal remedy St John's wort while you're being treated with duloxetine, as this will increase your risk of side effects.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements. Duloxetine is a type of antidepressant known as a serotonin-noradrenaline reuptake inhibitor SNRI.
SNRIs are thought to work by increasing the amount of mood-enhancing chemicals serotonin and noradrenaline in the brain. You may see an improvement after 2 to 4 weeks. Improvements for nerve pain may take longer. Do not stop taking duloxetine after a week or two just because you feel it's not helping your symptoms. Antidepressants like duloxetine help to gradually lift your mood so you feel better.
You may notice that you sleep better and get on with people more easily because you're less anxious. Do not expect to feel better overnight, though.
Some people feel worse during the first few weeks of treatment before they begin to feel better. If you're taking it for nerve pain or urinary incontinence, you may also notice some of these feelings. For depression or anxiety - once you're feeling better, it's likely that you'll continue to take duloxetine for several more months.
Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed or anxious. Stopping your medicine too soon can make depression and anxiety come back. For nerve pain or urinary incontinence - if duloxetine is helping your symptoms, you can continue taking it long term. Your doctor may check that you're still having relief from the pain or urinary incontinence every few months.
If you have been feeling better for 6 months or more, your doctor may suggest coming off duloxetine. Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking duloxetine for a long time.
This is to help prevent any extra side effects you might get as a reaction to coming off the medicine. Do not stop taking duloxetine suddenly or without talking to your doctor first.
Taking antidepressants, including duloxetine, is just one of many ways to treat depression and anxiety. If duloxetine is not working for you, speak to your doctor - there may be other treatments you can try.
If you start to have problems with your weight while taking duloxetine, talk to your doctor or pharmacist. During the first few days of taking duloxetine, it might be best to stop drinking alcohol until you see how the medicine affects you. There's no firm evidence to suggest that taking duloxetine will reduce fertility in either men or women. But speak to a pharmacist or your doctor before taking it if you're trying to get pregnant. Speak to your doctor if you're planning to get pregnant while taking duloxetine.
Duloxetine will not affect any type of contraception, including the combined pill or emergency contraception. Some people cannot concentrate properly while they're taking duloxetine. When you first start taking duloxetine, it's a good idea to stop driving and cycling, and avoid using machines or tools, for the first few days until you know how this medicine makes you feel.
Cannabis can affect the levels of duloxetine and make you more likely to get side effects. Talk to your doctor if you think you might use recreational drugs while taking duloxetine. Page last reviewed: 31 January Next review due: 31 January Duloxetine On this page About duloxetine Key facts Who can and can't take it How and when to take it Side effects How to cope with side effects Pregnancy and breastfeeding Cautions with other medicines Common questions.
Like any medication, Cymbalta has potential side effects and other considerations that you must weigh before deciding to take it. Common side effects include:. Though less common, Cymbalta may also cause:. Serious side effects are not common, but they can have major consequences. The most serious side effects associated with Cymbalta include:. According to prescribing information for Cymbalta provided by the manufacturer, Cymbalta causes an increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
It is recommended that you, your family, and your caregivers monitor for agitation, irritability, unusual changes in behavior, and suicidality. Report any of these immediately to your healthcare provider. Taking Cymbalta either along with or within 14 days of stopping monoamine oxidase inhibitors a type of antidepressant is contraindicated. Certain medications may increase or decrease the effect of Cymbalta, or cause different side effects. Several categories of medications have been proven to interact with Cymbalta, including the following:.
Cymbalta comes as a delayed-release capsule in , , and milligram mg strengths. It is usually recommended that you start with an initial dose of 30 mg per day and increase to the target dose of 60 mg daily within a week. Take your prescription according to directions on the label. Be sure to swallow the capsule whole without crushing, splitting, chewing, or opening it.
You can take Cymbalta with or without food, but eating something can help prevent stomach upset. Do not stop taking Cymbalta abruptly or without first discussing discontinuation with your healthcare provider. Doing so may cause you to experience withdrawal effects including dizziness, nausea, vomiting, headaches, tingling, fatigue, irritability, anxiety, insomnia, diarrhea, or hyperhidrosis too much sweating.
While Cymbalta is an approved treatment for chronic musculoskeletal pain, not everyone tolerates the medication or experiences the same degree of pain relief from it; some do not experience pain relief at all.
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