Duloxetine antidepressant safety side effects and risks by Ray Sahelian, M.D.
June 20 2015

Duloxetine, an inhibitor of serotonin and norepinephrine reuptake, is a prescription medication approved for the treatment of major depressive disorder. Duloxetine is used to treat mental depression and used for pain caused by nerve damage associated with diabetes. Duloxetine belongs to a group of medicines known as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). These medicines are thought to work by increasing the activity of chemicals called serotonin and norepinephrine in the brain. This medicine is available only with your doctor's prescription.

Serotonin noradrenaline reuptake inhibitor
Duloxetine Cymbalta is an antidepressant of the class of serotonin noradrenaline reuptake inhibitors. The efficacy of duloxetine 60 mg/day has been demonstrated in the acute and long term treatment of major depression. The level of effectiveness of duloxetine is particularly high and associated with a shorter latency of action. Duloxetine also exhibits antinociceptive properties independently of the antidepressant effect.

Duloxetine side effects, common
The side-effect profile of duloxetine is similar to selective serotonin reuptake inhibitors with mainly nausea being being the most common duloxetine side effect.

Prog Neuropsychopharmacol Biol Psychiatry. 2010. Duloxetine related hypersexuality: a case report.

J Clin Psychopharmacol. 2015. Dry Eye Related to Commonly Used New Antidepressants. Antidepressants may have an impact on the course of eye dryness. The aim of this study was to investigate the effects of commonly used new antidepressants on eye wetting. Fifty-four patients using new antidepressants and 57 controls were recruited. The Beck Depression Scale and Beck Anxiety Scale questionnaires were completed by the patients, and drug use time and dosages were recorded. The Schirmer test was performed without prior instillation of topical anesthesia to the ocular surface, and the wetting result was recorded for each eye. Escitalopram, duloxetine, and venlafaxine were used by 27, 13, and 14 patients, respectively. The patients using selective serotonin reuptake inhibitors (SSRIs) displayed lower wetting measurements (≤5 mm) compared with those using serotonin-norepinephrine reuptake inhibitors, which was independent of the duration of antidepressant usage. Although SSRIs do not have anticholinergic adverse effects except paroxetine, we found that both SSRIs and serotonin-norepinephrine reuptake inhibitors increased the risk for eye dryness. The lower Schirmer test results of the SSRIs may be associated with a mechanism other than the anticholinergic system.

Duloxetine for diabetic neuropathy pain
The drug duloxetine is useful in treating diabetes -related pain, but it may worsen control of blood sugar levels. Duloxetine is one of only two drugs approved for the treatment of diabetic peripheral neuropathic pain, a common problem in diabetic patients. Dr. Thomas Hardy from Eli Lily, Indianapolis, and colleagues pooled data from three clinical trials to investigate changes in weight, sugar levels, and cholesterol levels in patients with diabetic peripheral neuropathic pain treated with duloxetine. Short-term treatment with duloxetine was associated with a modest increase in fasting sugar levels, but not with significant increases in hemoglobin A1c, a measure of long-term sugar control. With longer duloxetine treatment, however, there was a significant rise in hemoglobin A1c, indicating impaired sugar control. There were also small changes in cholesterol levels among duloxetine -treated patients. Weight declined with short-term duloxetine treatment, but increased slightly with long-term treatment. Diabetes Care, 2007.
   Comments: It appears that duloxetine is not an appropriate drug for long term treatment of diabetes associated neuropathic pain.

Use by elderly for depression
Duloxetine in the management of elderly patients with major depressive disorder: an analysis of published data; Mancini M, Gianni W, Amore M; Expert Opinion on Pharmacotherapy 2009
The objective of this review is to summarize the available know-how on the use of duloxetine in elderly population. An extensive literature search was performed in Medline and Embase. A total of four articles meeting search criteria were identified in the Medline and Embase databases. In the short-term controlled studies, treatment with duloxetine was associated with significantly greater improvement in cognitive function, depression and health state compared with placebo, as well as in rate of patients achieving response or remission. Overall pain and back pain also improved in patients receiving duloxetine. Duloxetine given in elderly patients with MDD provides rapid and sustained antidepressant efficacy and seems to be as safe as in younger patients.