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Cymbalta vs Effexor
Introduction
For patients suffering from major depressive disorder (MDD), generalized anxiety disorder, or other mental health disorders, there are medications that can help manage and mitigate symptoms by adjusting the levels of specific neurotransmitters in the brain. Cymbalta and Effexor are two such drugs commonly prescribed for these conditions. Both of these medications influence various neurotransmitters within the brain and serve to stabilize mood fluctuations experienced by patients with these disorders. Specifically, Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), influencing levels of both serotonin and norepinephrine in the brain. On a similar note, Effexor also belongs to the SNRI class but has been found to affect serotonin levels at lower doses while affecting both serotonin and norepinephrine at higher doses.
Cymbalta vs Effexor Side By Side
| Attribute | Cymbalta | Effexor |
|---|---|---|
| Brand Name | Cymbalta | Effexor |
| Contraindications | Should not be taken with MAO inhibitors or within five weeks of discontinuing MAO inhibitors. | Should not be taken with MAO inhibitors or within five weeks of discontinuing MAO inhibitors. |
| Cost | For the brand name, around $240 for 30 capsules of 60 mg. Generic (Duloxetine) costs about $15-$25 for thirty 60mg capsules. | For the brand name, about $210 for 30 tablets of 75 mg. Generic (Venlafaxine ER) costs around $10 to $20 for thirty 75mg tablets. |
| Generic Name | Duloxetine | Venlafaxine |
| Most Serious Side Effect | An increase in suicidal thoughts or behaviors, severe skin reactions, vision issues, cardiovascular symptoms, symptoms indicating low sodium levels, severe nervous system response. | Aggravated depression or suicidal thoughts, seizures, changes in behavior or mood, vision changes, pounding heartbeats or fluttering in your chest, symptoms of serotonin syndrome. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | 20-60 mg/day, with a maximum dose of 120 mg/day. | Starts at 75 mg/day, can be increased to 150 mg/day, with a maximum recommended dose of 375 mg/day. |
What is Cymbalta?
Duloxetine (the generic name for Cymbalta) and Venlafaxine (the generic name for Effexor) both belong to a newer class of antidepressants known as serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications were developed after the first wave of selective serotonin reuptake inhibitors (SSRIs), such as Prozac. Duloxetine was approved by the FDA in 2004, while Venlafaxine received approval earlier, in 1993. Both drugs increase levels of serotonin and norepinephrine in the brain by preventing their reabsorption into neurons, effectively allowing them to remain active longer. They are prescribed for various forms of depression and anxiety disorders. While they affect the same neurotransmitters, there can be differences between them regarding side effects and efficacy due to unique pharmacological properties inherent to each drug.
What conditions is Cymbalta approved to treat?
Cymbalta is approved for the treatment of multiple mental and physical health conditions:
- Major depressive disorder (MDD), also referred to as unipolar depression
- Generalized anxiety disorder (GAD)
- Diabetic peripheral neuropathy, which is nerve damage caused by diabetes
- Fibromyalgia, a chronic pain condition
- Chronic musculoskeletal pain due to conditions such as osteoarthritis.
How does Cymbalta help with these illnesses?
Cymbalta, like Effexor, helps manage depression by increasing the amount of both serotonin and norepinephrine available in the synapses of the brain. These two neurotransmitters play a crucial role in mood regulation, cognition, memory, sleep patterns among other things. Cymbalta does this by inhibiting their reabsorption into neurons enabling them to remain longer in the synaptic cleft thus extending their beneficial effects. It's believed that individuals with depression have relatively lower levels of these neurotransmitters. Therefore, by increasing serotonin and norepinephrine levels, drugs like Cymbalta can limit depressive symptoms and help patients stabilize their mood and manage their condition more effectively.
What is Effexor?
Effexor, also known by its generic name venlafaxine, is a serotonin-norepinephrine reuptake inhibitor (SNRI). This means it increases the levels of both serotonin and norepinephrine in the brain by preventing their reabsorption. Venlafaxine was first approved by the FDA in 1993. Since Effexor is an SNRI and not an SSRI antidepressant like Cymbalta (duloxetine), it works slightly differently in that it has a stronger influence on norepinephrine than SSRIs do. The enhanced effect on norepinephrine can be beneficial for treating patients with depression who have not responded well to typical SSRI drugs such as Cymbalta or Prozac. However, its side-effect profile may be different from those of SSRIs; common side effects include nausea, dry mouth, dizziness and sleepiness but unlike many SSRIs, weight gain is less commonly associated with Effexor use.
What conditions is Effexor approved to treat?
Effexor is a medication that has been approved for the treatment of various conditions, including:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (SAD)
- Panic disorder
It's important to note that while both Cymbalta and Effexor are classified as serotonin-norepinephrine reuptake inhibitors (SNRIs), they may work differently in your body and can have different side effects. Always consult with your healthcare provider for personalized advice.
How does Effexor help with these illnesses?
Effexor, similar to Cymbalta, is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI). These medications work by increasing the levels of serotonin and norepinephrine in the brain through inhibition of their reabsorption into nerve cells. Both these neurotransmitters are responsible for mood regulation among other things. Effexor differs slightly due to its additional potential impact on dopamine levels, especially at higher doses. This unique feature may be beneficial in patients who haven't responded adequately to typical SSRI or SNRI antidepressants like Cymbalta. Therefore, it's often chosen when a more potent effect on multiple neurotransmitter systems is desired or needed.
How effective are both Cymbalta and Effexor?
Both duloxetine (Cymbalta) and venlafaxine (Effexor) are effective in treating depression, with both being approved by the FDA within a decade of each other. As serotonin-norepinephrine reuptake inhibitors (SNRIs), they share similar mechanisms of action but may be prescribed under different circumstances depending on an individual's specific needs and responses to medication. A double-blind clinical trial in 2007 compared these two drugs directly, finding that while both significantly improved symptoms of depression, Cymbalta showed slightly higher rates of response and remission.
A review conducted in 2012 highlighted that duloxetine is effective from the first week of treatment for major depressive disorder, generalised anxiety disorder, diabetic peripheral neuropathic pain and stress urinary incontinence. Its side effect profile was found to be comparable or better than other antidepressants like selective serotonin reuptake inhibitors (SSRIs) and some tricyclics. Duloxetine has also been shown to improve sleep quality without causing sedation - a significant advantage considering insomnia is often associated with depression.
On the other hand, Effexor has demonstrated efficacy not only against depressive disorders but also panic disorder as per a meta-analysis study from 2016. Like most SNRIs though it may have dose-dependent hypertension as a side effect which makes careful monitoring necessary during treatment. Though considered highly effective for many patients battling depression or anxiety disorders due to its dual-action mechanism affecting norepinephrine as well as serotonin levels; research indicates it should generally be chosen after SSRIs because discontinuation can cause severe withdrawal symptoms known colloquially as 'brain shivers'. Nonetheless given its unique pharmacological characteristics Effexor might serve better those who haven't responded sufficiently well towards SSRIs or bear particular need avoiding typical SSRI induced side effects like sexual dysfunction or weight gain.
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At what dose is Cymbalta typically prescribed?
Oral dosages of Cymbalta range from 20-60 mg/day for treating major depressive disorder in most people. It's recommended to start with a dosage of 30-60mg once daily. Children and adolescents may be started on lower doses as determined by their healthcare provider. In either population, the dosage can be increased after a few weeks if there is insufficient response. The maximum dose that should not exceed under any circumstances is 120 mg/day. As with all medications, it's important to follow your doctor's instructions when determining what dose is right for you or a loved one.
At what dose is Effexor typically prescribed?
Effexor treatment typically begins at a dose of 75 mg/day, administrated in two or three divided doses. If needed, the dosage can be increased to 150 mg/day and divided into two or three doses throughout the day. The maximum recommended dose is 375 mg/day, partitioned into three separate doses of 125 mg each which are spaced evenly apart during the day. This higher dosage might be considered if there's no positive response to treatment after several weeks at a lower dosage.
What are the most common side effects for Cymbalta?
Common side effects of Cymbalta and Effexor can include:
- Anxiety
- Nervousness
- Insomnia or difficulty sleeping
- Somnolence, which is sleepiness or drowsiness during the day
- Asthenia, a feeling of general weakness and fatigue
- Tremors or unintentional trembling/shaking movements
- Decreased appetite leading to weight loss (anorexia)
- Nausea
- Dyspepsia, a burning sensation or discomfort in the upper abdomen
- Diarrhea
-Vasodilation resulting in flushing and headaches
-Dry mouth
-Decreased libido (sex drive)
-Problems with ejaculation including abnormal ejaculation
-Impotence
-Skin rash
-Increased Sweating
-Unusual dreams
-A syndrome resembling flu symptoms
-Throat inflammation leading to sore throat (pharyngitis)
-Inflammation of sinus cavities causing pain/pressure (sinusitis)
-Yawning excessively
It's important to note that not all people will experience these side effects and they often lessen over time as your body gets used to the medication. Also remember that each person’s reaction can be different so it's essential to keep an open dialogue with your healthcare provider about any changes you notice while taking either drug.
Are there any potential serious side effects for Cymbalta?
While Cymbalta and Effexor are both effective antidepressants, they can occasionally have severe side effects. It is essential to be aware of these potential risks:
- An increase in suicidal thoughts or self-harming behaviors, particularly in those under 25
- Signs of a serious allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions such as fever, sore throat, burning eyes, skin pain or a red/purple rash that blisters and peels
- Vision issues including blurred vision or tunnel vision; eye pain/swelling; seeing halos around lights
- Cardiovascular symptoms like fast/pounding heartbeats; fluttering sensation in chest; dizziness (as if about to faint)
- Symptoms indicating low sodium levels: headaches/confusion/slurred speech/severe weakness/vomiting/unsteadiness/loss of coordination
- A severe nervous system response might include rigid muscles/high fever/sweating/confusion/fast-or uneven heartbeats/tremors/dizziness (feeling as though you may pass out)
If any signs of serotonin syndrome occur - agitation/hallucinations/fever/sweating/shivering/fast heart rate/muscle stiffness/twitching/ loss of coordination/nausea/vomiting/diarrhea - it's crucial to seek medical help immediately.
What are the most common side effects for Effexor?
Effexor, similarly to Cymbalta, can cause a variety of symptoms. Its side effects may include:
- Dry mouth and throat discomfort
- Auditory disturbances such as tinnitus (ringing in the ears)
- Vision problems including blurring
- Gastrointestinal issues like nausea, vomiting, stomach pain, decreased appetite or constipation
- Sleep-related problems including insomnia
- Neurological symptoms such as tremors, sweating and feelings of anxiety or nervousness
- Increased heart rate
- Mental confusion or agitation; occasional hostility has been reported too.
- Skin reactions like rash
- Weight loss is also possible due to reduced appetite
- Patients have reported increased frequency of urination
- Headaches and dizziness are common complaints
- Some patients might experience muscle aches or joint pains.
Always remember that each individual's reaction to medication is unique and these potential side effects do not affect everyone.
Are there any potential serious side effects for Effexor?
Effexor, like any other medication, carries potential risks and side effects. Some of the more severe ones include:
- Symptoms indicative of a serious allergic reaction such as difficulty breathing or swelling in your face, lips, tongue or throat
- Aggravated depression or suicidal thoughts
- Seizures (convulsions)
- Changes in behavior or mood that are unusual for you
- Vision changes including blurred vision and seeing halos around lights
- Pounding heartbeats or fluttering in your chest; -Signs suggestive of serotonin syndrome: agitation, hallucinations, fever, sweating profusely, shivering or shaking uncontrollably (tremors), muscle stiffness/twitching/cramps, fast/irregular heartbeat.
If you experience any of these symptoms while taking Effexor it is important to contact your doctor immediately.
Contraindications for Cymbalta and Effexor?
Both Cymbalta and Effexor, like many other antidepressants, could potentially exacerbate symptoms of depression in certain individuals. Should you notice a worsening of your depression or an increase in suicidal thoughts or behaviors while taking these medications, please seek immediate medical assistance.
Neither Cymbalta nor Effexor should be taken if you are currently on monoamine oxidase (MAO) inhibitors or have recently discontinued use. Always inform your healthcare provider about any medications you're taking; MAOIs require approximately five weeks to completely eliminate from your system to prevent hazardous interactions with both Cymbalta and Effexor.
How much do Cymbalta and Effexor cost?
For the brand name versions of these drugs:
- The price for 30 capsules of Cymbalta (60 mg) averages around $240, which works out to approximately $8/day.
- The price for 30 tablets of Effexor XR (75 mg) is about $210, working out to roughly $7/day.
Thus, if you are on a regular dose of Cymbalta (i.e., 60 mg/day), then brand-name Effexor XR can be slightly less expensive on a per-day treatment basis. However, cost should not be your primary determinant when choosing between these two medications. Both have different profiles and may work differently depending on your individual condition and response.
In terms of generic options:
- Duloxetine (the generic version of Cymbalta) costs significantly lower at around $15-$25 for thirty 60mg capsules, translating to about $0.50 - $0.83 per day.
- Venlafaxine ER (the generic form of Effexor XR) also has reduced prices with an average cost ranging from as low as $10 up to around $20 for thirty 75mg tablets – or approximately $.33 - $.66 daily.
Remember that while generics offer affordable alternatives without compromising efficacy; each person's reaction differs so it is crucial to consult with your healthcare provider before making any changes in medication.
Popularity of Cymbalta and Effexor
Duloxetine, also known under the brand name Cymbalta, was prescribed to about 10 million people in the US in 2020. Duloxetine accounts for approximately 21% of SNRI (Serotonin and Norepinephrine Reuptake Inhibitor) prescriptions in the country. It is often used to treat major depressive disorder, generalized anxiety disorder, fibromyalgia and neuropathic pain.
Venlafaxine, sold under brand names such as Effexor among others, was prescribed to around 8 million people in the USA during that same year. Venlafaxine makes up around 17% of all SNRI prescriptions within the United States and is primarily used for treatment of depression, generalized anxiety disorder and social phobia. The use of both these medications has remained relatively steady over recent years.
Conclusion
Both Cymbalta (duloxetine) and Effexor (venlafaxine) have an established history of use in patients with depression, each backed by numerous clinical studies demonstrating their efficacy over placebo treatments. They may be combined under certain circumstances, but this requires careful physician consideration due to potential contraindications. Both drugs act on the neurotransmitters serotonin and norepinephrine, but they are typically prescribed differently: Cymbalta is often considered for first-line treatment of major depressive disorder as well as generalized anxiety disorder, while Effexor might be used when standard SSRI medications fail or in cases where a patient needs to avoid specific side-effects common with SSRIs.
Both medications are available in generic form which can represent significant cost savings especially for patients who must pay out of pocket. Just like Prozac and Wellbutrin, both Cymbalta and Effexor may require a period of adjustment; effects might not become apparent immediately after starting therapy.
The side effect profiles between these two drugs bear similarities - generally well-tolerated yet with some differences. While both can cause sexual dysfunction, weight changes and sleep problems among others, it's been noted that venlafaxine could lead to high blood pressure at higher doses unlike duloxetine. As always though, any worsening mood symptoms or thoughts about self-harm should prompt immediate medical attention regardless of the medication being taken.
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Refrences
- Stahl, S. M., Grady, M. M., Moret, C., & Briley, M. (2005, September). SNRIs: The Pharmacology, Clinical Efficacy, and Tolerability in Comparison with Other Classes of Antidepressants. CNS Spectrums. Cambridge University Press (CUP).http://doi.org/10.1017/s1092852900019726
- Kusturica, J., Zulić, I., Loga-Zec, S., Mulabegović, N., Loga, S., & Kapić, E. (2002, February 20). Frequency and characteristics of side effects associated with antidepressant drugs. Bosnian Journal of Basic Medical Sciences. Association of Basic Medical Sciences of FBIH.http://doi.org/10.17305/bjbms.2002.3575
- Frampton, J. E., & Plosker, G. L. (2007). Duloxetine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200721070-00004
- Dhillon, S. (2012, December 14). Duloxetine. Drugs & Aging. Springer Science and Business Media LLC.http://doi.org/10.1007/s40266-012-0040-1