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Cymbalta vs Wellbutrin
Introduction
For patients with major depressive disorder (MDD) or other types of depression, certain drugs can help stabilize emotional lows and manage symptoms by altering the concentrations of compounds in the brain linked to mood, known as neurotransmitters. Cymbalta and Wellbutrin are two such drugs often prescribed for depression. Both impact different neurotransmitters in the brain but have comparable mood-stabilizing effects on patients with depression. Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI), affecting both levels of serotonin and norepinephrine. Wellbutrin, however, is classified as a norepinephrine-dopamine reuptake inhibitor (NDRI) and nicotinic acetylcholine (NACH) receptor antagonist primarily impacting levels of norepinephrine and dopamine.
Cymbalta vs Wellbutrin Side By Side
| Attribute | Cymbalta | Wellbutrin |
|---|---|---|
| Brand Name | Cymbalta | Wellbutrin |
| Contraindications | Contraindicated for those currently on or recently discontinuing MAO inhibitors. Increased risk of suicidal thoughts in people under 24 during initial treatment phases. | Contraindicated for those currently on or recently discontinuing MAO inhibitors. Increased risk of suicidal thoughts and behaviors. |
| Cost | For brand name, approximately $250 for 30 capsules of 20 mg. Generic Duloxetine costs can start at about $0.05 per day and not exceed approximately $0.90 daily on average. | For brand name, 60 tablets of Wellbutrin SR (100 mg) averages around $500. Generic Bupropion costs can be as low as approximately $0.25 to $0.80 per day. |
| Generic Name | Duloxetine | Bupropion |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, particularly in people under the age of 24. Serotonin Syndrome. | Severe allergic reactions, increased suicidal thoughts and behaviors, seizure. |
| Severe Drug Interactions | MAO inhibitors (MAOIs) | MAO inhibitors (MAOIs) |
| Typical Dose | 20–60 mg per day, with a typical starting dose for treating major depressive disorder in most adults being 40-60 mg/day. | Starts at 150 mg daily, can be increased to 300 mg/day; maximum dose up to 450 mg per day. |
What is Cymbalta?
Duloxetine (the generic name for Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) class of antidepressants, which marked significant progress following the introduction of selective serotonin reuptake inhibitors (SSRIs). Duloxetine was first approved by the FDA in 2004. Cymbalta increases levels of free serotonin and norepinephrine by preventing them from being reabsorbed, effectively "trapping" them in the brain for longer than usual. It is prescribed for the treatment of different forms of depression as well as anxiety disorders and certain types of pain. Unlike Prozac, Cymbalta influences both serotonin and norepinephrine neurotransmitters without any notable effect on dopamine which means it may have different side effects compared to other antidepressants that impact these three neurotransmitters.
Bupropion (generic name for Wellbutrin), unlike many other antidepressants including duloxetine, doesn't primarily affect serotonergic systems but works predominantly on dopaminergic and noradrenergic ones; hence its categorization as an atypical antidepressant or NDRI. This distinct mechanism often leads to dissimilar side effects profile when compared with SNRIs like Duloxetine.
What conditions is Cymbalta approved to treat?
Cymbalta is approved for the treatment of various conditions including:
- Major depressive disorder, also known as unipolar depression
- Generalized anxiety disorder (GAD)
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain
How does Cymbalta help with these illnesses?
Cymbalta helps to manage depression by increasing the amount of serotonin and norepinephrine available in the synapses of the brain. It achieves this by inhibiting their reabsorption into neurons, allowing these neurotransmitters to maintain higher levels for extended periods. Both serotonin and norepinephrine are chemicals that act as messengers in the brain and throughout the body; they play vital roles in mood regulation, cognition, memory, sleep patterns, along with other physiological functions. Depression is often associated with lower levels of these neurotransmitters; thus Cymbalta's ability to increase their availability can help mitigate depressive symptoms and stabilize patients' moods.
On a related note, Wellbutrin works differently than Cymbalta as it primarily affects dopamine - another essential neurotransmitter - rather than focusing on serotonin or norepinephrine. This unique mechanism may make Wellbutrin more suitable for certain individuals depending on their specific symptoms and medical history.
What is Wellbutrin?
Wellbutrin, the brand name for bupropion, is a norepinephrine-dopamine reuptake inhibitor (NDRI), which leads to an increase in levels of norepinephrine and dopamine in your brain by reducing their reabsorption. It also mildly blocks nicotinic receptors, thereby preventing acetylcholine's action on these receptors. First approved by FDA in 1986, Wellbutrin does not fall into the category of SSRIs or serotonin inhibitors like Cymbalta (also known as Duloxetine). As such, it doesn't inhibit serotonin uptake. This distinct mechanism means that its side effect profile diverges from those of typical SSRIs like Cymbalta - notably it tends to avoid inducing sedation and is less likely to cause weight gain or sexual dysfunction. The effects generated through manipulating dopamine and norepinephrine can be especially beneficial when treating depression patients who haven't responded well to standard SSRI antidepressants like Cymbalta.
What conditions is Wellbutrin approved to treat?
Wellbutrin is a medication that has received FDA approval for the following conditions:
- Major depressive disorder (MDD), providing necessary support to individuals struggling with persistent feelings of sadness and hopelessness.
- Seasonal affective disorder (SAD, also known as "winter depression"), effectively managing symptoms related to changes in seasons, primarily experienced during fall and winter months.
How does Wellbutrin help with these illnesses?
Dopamine is a neurotransmitter that plays roles in various processes within the body, including motivation, reward, and motor control. Similar to norepinephrine, low levels of dopamine have also been implicated in depression.
Wellbutrin works by increasing the levels of both norepinephrine and dopamine available in the brain. This dual-action approach may help alleviate some symptoms of depression more effectively for certain individuals than SSRI antidepressants like Cymbalta which primarily target serotonin.
Additionally, Wellbutrin's impact on acetylcholine could contribute to its effectiveness as an antidepressant. Its unique mechanism makes it a viable option when patients do not respond well to typical SSRI antidepressants or even SNRIs such as Cymbalta. Sometimes it may be combined with these other classes of drugs for a more comprehensive treatment strategy.
How effective are both Cymbalta and Wellbutrin?
Both duloxetine (Cymbalta) and bupropion (Wellbutrin) have well-established histories of efficacy in treating patients with depression, having both been approved by the FDA for this indication. They act on different neurotransmitters, which can lead to them being prescribed under varying circumstances. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI), while bupropion primarily affects dopamine and norepinephrine.
The effectiveness of duloxetine and bupropion was directly studied in a double-blind clinical trial; their comparative efficacy in managing symptoms of depression showed promising results. Interestingly, no significant differences were observed in the various metrics used to measure treatment success between patients receiving either drug.
A comprehensive review from 2010 highlighted that duloxetine has proven effective at reducing depressive symptoms starting as early as the first week of treatment. Its side effect profile is generally favorable compared to other antidepressants within its class, although it does carry a risk of high blood pressure due to its impact on noradrenaline levels. Despite this, it's often well-tolerated across diverse populations including older adults.
On the other hand, a 2016 meta-analysis indicated that bupropion seems more effective than placebo at treating depression and appears similar in efficacy to many common antidepressants. Bupropion tends not be considered as an initial line therapy but rather after or alongside SSRIs or SNRIs like Cymbalta have been tried. As such, data supporting its use as standalone treatment isn't quite as robust compared to drugs like duloxetine.
Nonetheless due to unique pharmacology including lack of sexual side effects commonly seen with SSRI/SNRIs - an aspect explored further during a 2008 study comparing these two medications - Wellbutrin may be particularly beneficial for those who haven't responded optimally to first-line treatments or need specific adverse effects avoided.
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At what dose is Cymbalta typically prescribed?
Oral dosages of Cymbalta range from 20–60 mg per day, but studies have indicated that a typical starting dose for treating major depressive disorder in most adults is 40-60 mg/day. Children and adolescents may be started on lower doses, typically around 30 mg/day. In either population, dosage can be increased after a few weeks if there is no response or as recommended by the healthcare provider. The maximum dosage that should not be exceeded in any case is 120mg/day.
At what dose is Wellbutrin typically prescribed?
Wellbutrin therapy usually initiates at a daily dosage of 150 mg, taken in the morning. After three days, if tolerated well, the dose can be increased to 300 mg/day; this is split into two separate doses of 150 mg each spaced about 8 hours apart. A maximum dose of up to 450 mg per day divided into three equal doses (each being approximately 150mg) and separated by an interval of about six hours may be considered if there's no satisfactory response after several weeks at the lower dosage. As with any medication regimen, it's important that patients adhere strictly to their physician's instructions.
What are the most common side effects for Cymbalta?
Common side effects related to Cymbalta use include:
- Nausea
- Dry mouth
- Sleepiness/drowsiness
- Fatigue (general weakness and tiredness)
- Insomnia (difficulty falling asleep or staying asleep)
- Constipation
- Loss of appetite
- Sweating more than usual
- Decreased weight and loss of appetite
- Diarrhea, vomiting, abdominal pain or discomfort -Tremor (uncontrollable shaking in a part of the body) -Impotence or decreased libido (sex drive) -Unusual bleeding or bruising
Additionally, some patients may experience abnormal dreams. Respiratory tract infection symptoms such as pharyngitis can also be seen. If you notice any unusual physical changes while taking this medication, it's important to consult with your healthcare provider immediately.
Are there any potential serious side effects for Cymbalta?
Comparatively, Cymbalta has been associated with several side effects which are less common but more serious. Some of these include:
- Increased thoughts about suicide or self-harm, particularly in people under the age of 24 during the initial stages of treatment or when changing dosage
- Allergic reactions such as skin rash, itching or hives, swelling of the face, lips or tongue
- Changes in vision like blurring and difficulty focusing; eye pain or swelling and seeing halos around lights
- Altered heartbeat patterns including fast pounding heartbeats, fluttering sensation in your chest coupled with shortness of breath and sudden dizziness leading to feeling faint
- Hyponatremia - low sodium levels indicated by symptoms like headache, confusion slurred speech severe weakness vomiting loss coordination feeling unsteady.
- Severe nervous system reaction may occur where you experience rigid muscles high fever sweating confusion fast uneven heartbeats tremors resulting in fainting.
These drugs also carry a risk for Serotonin Syndrome: This condition can be life-threatening and symptoms may include agitation hallucinations fever excessive sweating shivering accelerated heart rate muscle stiffness twitching loss coordination nausea vomiting diarrhea.
If you notice any such signs while on Cymbalta therapy seek immediate medical attention.
What are the most common side effects for Wellbutrin?
When comparing Cymbalta to Wellbutrin, it's important to note that side effects can vary between these two medications. With respect to Wellbutrin, some of the possible side effects may include:
- Dry mouth
- Sweating
- Insomnia or other sleep problems
- Nausea, stomach pain
- Dizziness or headaches
- Increased heart rate
- Weight fluctuation (either loss or gain)
- A sore throat and potential sinus congestion
- Muscle aches and joint pains
In some rare cases, individuals might experience ringing in their ears, blurred vision, increased urination frequency or even signs of agitation and hostility. Remember that everyone reacts differently to medication; hence not every listed effect is guaranteed to occur. Always consult with your healthcare provider for personalized advice.
Are there any potential serious side effects for Wellbutrin?
While Wellbutrin is generally well-tolerated, it does have potential side effects that patients should be aware of. Below are some symptoms suggestive of serious adverse reactions:
- Severe allergic reaction signs: hives, itching, fever, swollen glands, difficulty breathing or swallowing due to swelling in your face or throat
- Mental health changes: increased suicidal thoughts and behaviors
- Neurological disturbances like a seizure (convulsions)
- Mood alterations such as confusion and unusual behavioral changes
- Vision problems including blurred vision, tunnel vision or seeing halos around lights
- Cardiac irregularities like fast or uneven heartbeats
- Signs of a manic episode which can include racing thoughts, feeling unusually energetic or irritable; engaging in reckless behavior; talking more than usual; experiencing severe sleep disturbances.
If you experience any of these symptoms while taking Wellbutrin, contact your healthcare provider immediately.
Contraindications for Cymbalta and Wellbutrin?
Both Wellbutrin and Cymbalta, like most antidepressant medications, may exacerbate symptoms of depression in certain individuals. If you find your depression intensifying or notice an increase in suicidal ideation, thoughts, or behaviors while taking these medications, please seek immediate medical attention.
Wellbutrin and Cymbalta are contraindicated for those who are currently on monoamine oxidase (MAO) inhibitors (MAOIs) or have recently stopped using them. Always inform your healthcare provider about any medication you're taking; typically it would take around 14 days after discontinuing MAOIs before starting on Wellbutrin or Cymbalta to avoid harmful interactions. In the case of some long-acting MAOIs like phenelzine (Nardil), a washout period of up to 5 weeks might be required.
How much do Cymbalta and Wellbutrin cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Wellbutrin SR (100 mg) averages around $500, which works out to about $16–32 per day, depending on your dose.
- The cost for 30 capsules of Cymbalta (20 mg) averages approximately $250, working out to roughly $8.34/day.
Thus if you are in the higher dosage range for Wellbutrin (i.e., 300 mg/day or more), then brand-name Cymbalta is less expensive on a per-day treatment basis. It's essential to keep in mind that cost should not be the primary consideration when determining which of these drugs is right for you.
Regarding generic versions; Bupropion and Duloxetine - costs are significantly lower:
-
Bupropion (generic Wellbutrin) with doses starting from 100mg/day can cost as low as approximately $0.25 to $0.80 per day or between $0.50 and $1.50 a day if typical dosages ranging from 200 to 450mg daily are taken.
-
Duloxetine Hcl (generic Cymbalta), available in packs from sizes ranging from 15 up till even a thousand capsules with strengths such as twenty milligrams has costs beginning at just about five cents each day provided one goes for bulk purchasing upfront option, not exceeding approximately ninety cents daily on average otherwise.
Popularity of Cymbalta and Wellbutrin
Duloxetine, also known by its brand name Cymbalta, was prescribed to roughly 10 million people in the USA in 2020. This accounted for about 21% of prescriptions for serotonin-norepinephrine reuptake inhibitors (SNRIs), a class of antidepressant drugs that includes duloxetine. It has been a preferred choice among SNRIs due to its efficacy not only in depression but also pain syndromes such as diabetic neuropathy and fibromyalgia.
Bupropion, available under the brand name Wellbutrin amongst others, was estimated to have been prescribed to approximately 5.8 million individuals across the US within the same year. Bupropion represented just over 12% of all antidepressant prescriptions nationwide and continues to be one of the most commonly used "atypical" antidepressants (those not classified as an SSRI or other broad classes). Its prevalence has gradually increased since 2013 due to effectiveness particularly with treatment-resistant depression and less sexual side effects compared with some other types.
Conclusion
Both Cymbalta (duloxetine) and Wellbutrin (bupropion) have proven records of usage in patients with depression, backed by numerous clinical research studies indicating their effectiveness over placebo. In some cases, these drugs may be used together but this requires careful consideration by a physician due to potential drug interactions. Their different mechanisms of action contribute to the circumstances under which they are prescribed; Cymbalta works primarily on serotonin and norepinephrine, while Wellbutrin operates mainly on norepinephrine and dopamine.
Cymbalta is often considered a first-line treatment option for major depressive disorder as well as generalized anxiety disorder, whereas Wellbutrin is usually recommended either as an addition to another antidepressant or in patients who haven't responded well to other treatments or need to avoid common sexual side-effects associated with SSRIs/SNRIs like Cymbalta.
Both medications are available in generic form providing significant cost benefits particularly for those paying out-of-pocket. Starting therapy with either Cymbalta or Wellbutrin might necessitate an adjustment period where effects aren't immediately noticeable.
The side effect profiles are somewhat similar between the two medicines; both generally being well-tolerated but differing in areas such as sexual dysfunction - an area where Wellbutrin tends to fare better than Cymbalta. Patients should closely monitor their moods when starting treatment and seek immediate medical help if they notice worsening depression symptoms or have suicidal thoughts.
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Refrences
- Stahl, S. M., Pradko, J., Haight, B. R., Modell, J. G., Rockett, C. B., & Learned-Coughlin, S. (2004, August 13). A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor. The Primary Care Companion For CNS Disorders. Physicians Postgraduate Press, Inc.http://doi.org/10.4088/pcc.v06n0403
- Rosso, G., Rigardetto, S., Bogetto, F., & Maina, G. (2012, January). A randomized, single-blind, comparison of duloxetine with bupropion in the treatment of SSRI-resistant major depression. Journal of Affective Disorders. Elsevier BV.http://doi.org/10.1016/j.jad.2011.07.026
- Frampton, J. E., & Plosker, G. L. (2007). Duloxetine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200721070-00004
- El Mansari, M., Ghanbari, R., Janssen, S., & Blier, P. (2008, December). Sustained administration of bupropion alters the neuronal activity of serotonin, norepinephrine but not dopamine neurons in the rat brain. Neuropharmacology. Elsevier BV.http://doi.org/10.1016/j.neuropharm.2008.07.028
- Fornaro, M., Martino, M., Mattei, C., Prestia, D., Vinciguerra, V., De Berardis, D., … Fornaro, P. (2014, August). Duloxetine-bupropion combination for treatment-resistant atypical depression: A double-blind, randomized, placebo-controlled trial. European Neuropsychopharmacology. Elsevier BV.http://doi.org/10.1016/j.euroneuro.2014.04.004