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Elavil vs Cymbalta
Introduction
For patients diagnosed with major depressive disorder (MDD) or other forms of depression, specific medications have been developed to alter the concentrations of neurotransmitters in the brain that are linked to mood. This alteration can help stabilize emotional lows and manage symptoms. Elavil and Cymbalta are two such drugs frequently prescribed for depression. Each impacts different neurotransmitters in the brain but both contribute towards mood stabilization in patients suffering from depression. Elavil, known officially as amitriptyline, is a tricyclic antidepressant (TCA), affecting levels of norepinephrine and serotonin by blocking their reuptake into cells within the brain. On the contrary, Cymbalta or duloxetine falls under a class called selective serotonin-norepinephrine reuptake inhibitors (SNRIs), which increase levels of serotonin and norepinephrine by slowing down their absorption back into cells.
Elavil vs Cymbalta Side By Side
| Attribute | Elavil | Cymbalta |
|---|---|---|
| Brand Name | Elavil | Cymbalta |
| Contraindications | Should not be taken with or shortly after taking MAO inhibitors. | Should not be taken with or shortly after taking MAO inhibitors. |
| Cost | For brand name: around $80 for 30 tablets of 25 mg. For generic (amitriptyline): starts as low as about $0.05 per day and typically does not exceed around $0.50 per day. | For brand name: about $235 for 30 capsules of 20 mg. For generic (duloxetine): daily costs usually range between roughly $1 and just under $5. |
| Generic Name | Amitriptyline | Duloxetine |
| Most Serious Side Effect | Thoughts of suicide or self-harm, signs of allergic reaction, changes in vision, cardiovascular issues, hyponatremia, severe nervous system reaction. | Signs of an allergic reaction, increased risk of suicidal thoughts, unusual changes in mood or behavior, severe nausea or vomiting, blurred vision, rapid heartbeat, difficulty urinating, occurrence of a manic episode. |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | 25–150 mg/day, with a starting dose often at 75 mg/day. | 30 to 60 mg per day, up to a maximum of 120 mg per day. |
What is Elavil?
Amitriptyline (the generic name for Elavil) was one of the first tricyclic antidepressants (TCAs) developed and was approved by the FDA in 1961. It works primarily by increasing levels of serotonin and norepinephrine, two neurotransmitters in the brain associated with mood regulation, while also blocking certain other neurotransmitter receptors which can help with symptoms of insomnia and anxiety. This makes it a useful drug for treating not only depression but also certain types of pain and sleep disorders.
On the other hand, Duloxetine (Cymbalta) is a newer class of antidepressant known as a serotonin-norepinephrine reuptake inhibitor (SNRI), which was approved by the FDA in 2004. Like Elavil, Cymbalta increases levels of serotonin and norepinephrine in the brain; however, it does so selectively to minimize side effects. In addition to treating depression, it's used for diabetic neuropathy pain management, fibromyalgia treatment and general chronic muscle or bone pain due its dual action on both mood-regulating neurotransmitters but also those involved in transmitting signals related to sensation including pain.
What conditions is Elavil approved to treat?
Elavil is approved for the treatment of various conditions, including:
- Major depressive disorder (MDD)
- Neuropathic pain associated with certain disorders
- Prevention of migraines
On the other hand, Cymbalta has been approved to treat:
- Generalized anxiety disorder (GAD)
- Major depression
- Nerve damage-associated pain in diabetes
- Fibromyalgia and chronic musculoskeletal pain
How does Elavil help with these illnesses?
Elavil helps manage depression by increasing the amount of serotonin and norepinephrine, two neurotransmitters in the brain. It does this by inhibiting their reabsorption into nerve cells, so levels can be maintained higher for longer periods of time. Serotonin is involved in mood regulation, while norepinephrine acts as both a stress hormone and neurotransmitter playing a role in attention and focus. These chemicals act as messengers in the brain and throughout the body, influencing various physiological functions such as mood, cognition, memory, sleep patterns among others. Individuals with depression often have relatively lower levels of these neurotransmitters. Therefore, by raising serotonin and norepinephrine levels, Elavil may help alleviate symptoms associated with depression thereby helping patients stabilize their moods.
What is Cymbalta?
Cymbalta is a brand name for duloxetine, an antidepressant that belongs to a class of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Duloxetine works by increasing the levels of both serotonin and norepinephrine in the brain through reducing their reabsorption. It was first approved by the FDA in 2004. Unlike Elavil (amitriptyline), which is a tricyclic antidepressant, Cymbalta does not have significant anticholinergic effects, meaning it doesn't block the action of acetylcholine at its receptors. This difference means that Cymbalta's side-effect profile can be less severe than that of Elavil, with fewer issues related to dry mouth, constipation or urinary retention - common side effects linked with anticholinergics like amitriptyline. The dual action on both serotonin and norepinephrine can provide benefits for patients suffering from depression or anxiety disorders who may not respond well to other types of medications such as typical SSRIs or tricyclics like Elavil.
What conditions is Cymbalta approved to treat?
Cymbalta is authorized by the FDA for treating a variety of conditions, including:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain
How does Cymbalta help with these illnesses?
Serotonin and norepinephrine are neurotransmitters that play significant roles in mental health, affecting mood regulation, anxiety levels, sleep patterns and overall sense of well-being. When these neurotransmitters are unbalanced or deficient, it can lead to conditions such as depression or anxiety disorders. Cymbalta works by increasing the availability of both serotonin and norepinephrine in the brain's synaptic space, thereby helping to balance mood and alleviate symptoms associated with depression and generalized anxiety disorder. Unlike Elavil which primarily focuses on serotonin reuptake inhibition, Cymbalta operates on both serotonin and norepinephrine making it an SNRI (Serotonin-Noradrenaline Reuptake Inhibitor). Due to its dual-action mechanism, Cymbalta may be more effective than single action antidepressants for certain patients. It might also be prescribed when a patient does not respond adequately to other types of antidepressants like SSRIs or TCAs (such as Elavil), or could be used in combination with them if needed.
How effective are both Elavil and Cymbalta?
Both amitriptyline (Elavil) and duloxetine (Cymbalta) are proven effective in treating depression, among other conditions. Elavil was approved by the FDA in 1961 while Cymbalta followed four decades later, being approved in 2004. Both act on neurotransmitters but do so differently; Elavil is a tricyclic antidepressant that inhibits the reuptake of norepinephrine and serotonin, whereas Cymbalta primarily prevents the reuptake of serotonin and norepinephrine, making it a dual-action drug.
In a double-blind clinical trial conducted in 2010 comparing amitriptyline to duloxetine for their efficacy in managing symptoms of depression, both drugs were found equally effective with similar safety profiles. The study also reported no significant differences between patients treated with either drug across various measures used to evaluate effectiveness against depression.
A meta-analysis report from 2007 highlighted that amitriptyline starts showing its therapeutic effects within two weeks from treatment onset. Beyond its successful action against depressive symptoms, it is also known for its analgesic properties which make it especially beneficial for those suffering from neuropathic pain or migraines along with depression. However, due to more pronounced anticholinergic side effects such as dry mouth or constipation compared to newer generation antidepressants like SSRIs or SNRIs including Cymbalta itself, amitriptyline often acts as a second- or third-line choice.
A review completed in 2018 suggested that duloxetine provides an effect comparable to placebo when employed solely as an anti-depressive medication but shines brightest when used concurrently with an SSRI or another first-line treatment option. It has been shown particularly effective at alleviating somatic complaints accompanying major depressive disorder such as chronic pain syndromes due to its unique pharmacology.
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At what dose is Elavil typically prescribed?
Oral dosages of Elavil generally range from 25–150 mg/day, however studies have shown that a starting dose of 75 mg/day is often effective for treating depression in most people. Elderly patients may be started on lower doses, such as 10-50 mg per day. In either population, dosage can be adjusted after several weeks if there is no adequate response. The maximum dosage should not exceed 150 mg/day under any circumstance. On the other hand, Cymbalta dosing typically begins at 60mg once daily but can vary based on the condition being treated and individual patient factors - always consult with a healthcare provider to determine the optimal treatment regime.
At what dose is Cymbalta typically prescribed?
Cymbalta treatment typically begins at a dosage of 30 to 60 mg per day, depending on the condition being treated. The dose can be increased up to a maximum of 120 mg per day if there is no response after several weeks; however, this should only be done under medical supervision. For some conditions such as diabetic peripheral neuropathy and chronic musculoskeletal pain, the recommended daily dose is 60 mg. Patients may take Cymbalta with or without food but should aim for consistent dosing times each day for optimal results. It's essential to remember that changes in dosages should always be guided by a healthcare provider due to potential withdrawal symptoms associated with abrupt cessation or reduction in dose.
What are the most common side effects for Elavil?
Common side effects of Elavil and Cymbalta include, but are not limited to:
- Drowsiness
- Dizziness
- Dry mouth
- Constipation
- Weight gain or loss
- Blurred vision
- Nausea
- General weakness (asthenia)
- Unusual sweating
- Insomnia
Some more serious side effects can also occur. For Elavil these can include tremors, persistent heartburn, changes in sexual desire or ability and severe nausea/vomiting/diarrhea. For Cymbalta: dark urine, change in the amount of urine, unusual bleeding/bruising and severe stomach/abdominal pain.
If you notice any other side effects not listed above contact your doctor immediately.
Are there any potential serious side effects for Elavil?
When comparing Elavil to Cymbalta, it's important to bear in mind that while both medications are used for depression and nerve pain, they can have different side effects. These may include:
- Thoughts of suicide or self-harm: This is a severe side effect experienced by some people taking these medications. If you experience this symptom, seek immediate medical attention.
- Signs of allergic reaction: While rare, an allergic reaction can occur with either drug. Symptoms like hives, difficulty breathing or swelling in the face or throat should be treated as emergency situations.
- Changes in vision: Both drugs could cause blurred vision and eye pain; however tunnel vision is rare but serious.
- Cardiovascular issues: Rapid heartbeats, chest fluttering, shortness of breath and sudden dizziness are severe symptoms that require immediate medical intervention.
- Hyponatremia (low sodium levels): This condition might manifest as headache, confusion slurred speech among others. It's crucial to contact your doctor if you suspect hyponatremia.
- Severe nervous system reaction: While extremely rare with either medication, watch out for very stiff muscles accompanied by high fever and confusion along with rapid heartbeat. -Serotonin syndrome - Although less common than other side effects mentioned above; agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting or diarrhea can also occur.
The occurrence of these side effects doesn't necessarily mean one drug is better than the other—it simply underscores the importance of closely monitoring any changes when starting a new medication under professional supervision.
What are the most common side effects for Cymbalta?
Cymbalta can potentially lead to a range of side effects including:
- Dry mouth, sore throat
- Nausea, vomiting, stomach pain, constipation or diarrhea
- Sleep problems (insomnia)
- Sweating more than usual
- Feeling nervous or jittery
- Increased heart rate
- Loss of appetite leading to weight loss
- Fatigue or drowsiness
- Headache, dizziness
- Blurred vision It's also important for patients to be aware that Cymbalta may increase the risk of suicidal thoughts and behavior in some individuals. It is essential to contact your healthcare provider immediately if you experience any unusual changes in mood or behavior while taking this medication.
Are there any potential serious side effects for Cymbalta?
While Cymbalta is generally well-tolerated, it can occasionally lead to serious side effects. If you experience any of these symptoms while taking Cymbalta, immediately contact your healthcare provider:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Increased risk of suicidal thoughts especially among individuals under the age of 25
- Unusual changes in mood or behavior such as agitation and restlessness
- Severe nausea or vomiting
- Blurred vision
- Rapid heartbeat and other signs indicative of high blood pressure such as severe headache, confusion and chest pain
- Difficulty urinating The occurrence of a manic episode characterized by racing thoughts, increased energy levels beyond normal limits leading to reckless behavior.
Remember that prompt medical attention is crucial when experiencing adverse reactions so don't hesitate to seek it when needed.
Contraindications for Elavil and Cymbalta?
Similar to Wellbutrin and Prozac, both Elavil (amitriptyline) and Cymbalta (duloxetine), along with most other antidepressant medications, may exacerbate symptoms of depression in certain individuals. If you notice your depressive symptoms worsening or a rise in suicidal ideation or behavior while taking these medications, it's crucial that you seek immediate medical attention.
Neither Elavil nor Cymbalta should be taken if you are currently using, or have recently used MAO inhibitors. This is because there needs to be an adequate break between the use of MAOIs and initiating treatment with either Amitriptyline or Duloxetine; typically around 5 weeks is suggested to allow complete clearance from your system and avoid potentially hazardous interactions. Always disclose all medications you're on to your healthcare provider for safety purposes.
How much do Elavil and Cymbalta cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Elavil (25 mg) averages around $80, which works out to approximately $2.60/day.
- The cost for 30 capsules of Cymbalta (20 mg) is about $235, or nearly $7.83/day.
Therefore, if you are in the higher dosage range for Elavil (i.e., 100 mg/day or more), then brand-name Cymbalta would be less expensive on a per-day treatment basis. However, it's worth noting that cost shouldn't be your primary consideration when deciding between these two medications.
Regarding generic versions of Elavil (amitriptyline) and Cymbalta (duloxetine):
- Amitriptyline is available in packages ranging from 10 up to several hundred tablets with dosages from 10mg up to 150mg each; costs start as low as about $0.05 per day and typically do not exceed around $0.50 per day.
- Duloxetine comes in packs varying from a few dozen up to several hundreds capsules with strengths spanning from 20mg up to 60mg each; daily costs usually range between roughly $1 and just under $5 depending on factors like pack size and dosage strength selected.
Popularity of Elavil and Cymbalta
Amitriptyline, in generic form as well as under the brand name Elavil, was estimated to have been prescribed to about 1.6 million people in the US in 2020. It accounted for roughly 3% of all antidepressant prescriptions in the country. Amitriptyline is a tricyclic antidepressant (TCA) and it has been around longer than many other types of antidepressants, though its usage has remained steady overall.
Duloxetine, including branded versions such as Cymbalta, was prescribed to approximately 10 million individuals within the USA throughout 2020. Duloxetine represents nearly 20% of SNRI prescriptions and just over 11% of total antidepressant prescriptions across the nation. The use of duloxetine has increased since its approval by FDA back in early-2004 due to both its effectiveness and broad applicability for several conditions like major depressive disorder, general anxiety disorder, fibromyalgia and neuropathic pain associated with diabetes.
Conclusion
Both Elavil (amitriptyline) and Cymbalta (duloxetine) are commonly used in the treatment of depression, with a wealth of clinical studies and meta-analyses attesting to their efficacy over placebo. Occasionally, these drugs may be used together under careful physician oversight due to potential interactions. Their differing mechanisms of action mean they can be utilized for different situations: Elavil is a tricyclic antidepressant that primarily inhibits the reuptake of serotonin and norepinephrine, while Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor.
Elavil tends to be considered an alternative option when first-line SSRI/SNRI treatments have not yielded satisfactory results or if there's need for pain management alongside depression treatment. On the other hand, Cymbalta might be prescribed as initial therapy or coupled with another medication due to its effectiveness in treating both depressive symptoms and nerve-related pain.
Generic forms exist for both medications which can lead to significant cost savings particularly for patients paying out-of-pocket. The onset period varies between individuals meaning beneficial effects may not appear immediately after starting either drug.
While side effects vary by individual tolerance levels, common issues include weight gain, sexual dysfunction, dry mouth or dizziness among others. In comparison with Elavil though, Cymbalta has been found less likely to cause weight gain or contribute significantly towards sexual dysfunction although it might increase blood pressure slightly more than Elavil does. Patients on either drug should monitor any mood changes closely especially during initiation periods; immediate medical help must be sought if worsening depression or suicidal thoughts arise.
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Refrences
- McClure, E. W., & Daniels, R. N. (2021, January 13). Classics in Chemical Neuroscience: Amitriptyline. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/acschemneuro.0c00467
- Trivedi, M. H., Desaiah, D., Ossanna, M. J., Pritchett, Y. L., Brannan, S. K., & Detke, M. J. (2008, May). Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/yic.0b013e3282f41d7e
- ARNOLD, L. M., CLAUW, D., WANG, F., AHL, J., GAYNOR, P. J., & WOHLREICH, M. M. (2010, September 15). Flexible Dosed Duloxetine in the Treatment of Fibromyalgia: A Randomized, Double-blind, Placebo-controlled Trial. The Journal of Rheumatology. The Journal of Rheumatology.http://doi.org/10.3899/jrheum.100365
- Frampton, J. E., & Plosker, G. L. (2007). Duloxetine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200721070-00004