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Anxiety and Stress Disorders

Effects of Cymbalta

07/13/2007

Question:

Before I approach my GP for script for Cymbalta for my chronic gray outlook on life I am doing a little research--I am currently on Plavix and am concerned that Cymbalta may act as a `blood thinner` of sorts. I recall an article indicating(very general) that some antidepressants can dramatically increase the activity of some blood thinners. Is this true of Cymbalta?

Answer:

Cymbalta (duloxetine) is a relatively new antidepressant that works in a relatively unknown way.  While it inhibits norepinephrine and serotonin reuptake (as do many antidepressants), its exact mechanism of action remains unknown.

There have been no significant reported interactions between plavix and cymbalta.

However, before you go to your GP and ask specifically for Cymbalta, I would ask you why you want this specific drug.  Most depression specialists consider Cymbalta a second line drug -- one to use if there are reasons not to use a first line drug, or if other drugs have been unsuccessful or not tolerated.  As a new drug, much less is known about Cymbalta's safety than with other older and more established drugs, such as the SSRIs (selective serotonin reuptake inhibitors, such as fluoxetine, sertaline and others), bupropion (wellbutrin) or venlafaxine (effexor).  Cymbalta is being more actively advertised to both doctors and the public, but that does not necessarily make it the best drug for you.  Cymbalta is also a great deal more expensive than many of the older drugs, several of which are available (in America, anyway) in generic forms.  I would encourage you, to first talk with your doctor about your depression and make sure that is the proper diagnosis, and then to work with your physician to find the best drug for you -- not necessarily the newest, best advertised or the one that worked for your colleague at work.  You are a unique individual, and deserve to find what is right for you.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati