What other medications are available that improve both mood and pain besides duloxetine (Cymbalta)?

From the Guidelines

Several medications besides duloxetine can help improve both mood and pain, with venlafaxine (Effexor) at doses of 150-225mg daily and milnacipran (Savella, typically 50mg twice daily) being effective alternatives, as shown in a recent study 1. These medications work by increasing both serotonin and norepinephrine levels, similar to duloxetine. Some key points to consider when choosing an alternative medication include:

• The specific pain condition being treated
• Other medical issues that may be present
• Medication tolerances and potential side effects Some tricyclic antidepressants (TCAs) such as amitriptyline (10-75mg at bedtime) and nortriptyline (10-75mg daily) are also effective for both conditions, though they often cause more side effects than newer medications, as noted in a study from 1. Certain anticonvulsants like pregabalin (Lyrica, 150-600mg daily divided into 2-3 doses) and gabapentin (300-3600mg daily divided into 3 doses) can address both neuropathic pain and anxiety symptoms, as discussed in a review from 1. These medications work through different mechanisms - SNRIs and TCAs affect neurotransmitters that regulate both mood and pain perception, while anticonvulsants modulate calcium channels and GABA activity to reduce pain signals and provide calming effects. Treatment should start at lower doses and gradually increase to minimize side effects, with regular monitoring for effectiveness and tolerability, as recommended in a guideline from 1. It's also important to consider the potential risks and benefits of each medication, as well as any potential interactions with other medications or medical conditions, as noted in a study from 1.

From the FDA Drug Label

Milnacipran hydrochloride tablets are prescription medicine used to manage fibromyalgia Duloxetine delayed-release capsules are a prescription medicine used to treat a certain type of depression called Major Depressive Disorder (MDD) Duloxetine delayed-release capsules are also used to treat or manage: Generalized Anxiety Disorder (GAD) Diabetic Peripheral Neuropathic Pain (DPNP) Fibromyalgia (FM) Chronic Musculoskeletal Pain

Other medications that improve both mood and pain besides duloxetine (Cymbalta) include:

• Milnacipran (Savella) for managing fibromyalgia 2 Note that the FDA label does not provide a comprehensive list of all available medications for improving mood and pain. The information provided is limited to the specific drug labels included.

From the Research

Medications for Improving Mood and Pain

Besides duloxetine (Cymbalta), there are other medications available that can improve both mood and pain. These include:

• Milnacipran: a serotonin-noradrenaline reuptake inhibitor (SNRI) that has been approved for the treatment of fibromyalgia and has been found to be effective in reducing pain and improving mood 3, 4
• Mirtazapine: an antidepressant that has been found to have a moderate effect on mood, although the evidence is limited to a single study 5
• Desvenlafaxine: an SNRI that has been found to have no clinically relevant benefit over placebo in the treatment of fibromyalgia, although the evidence is limited to a single small trial 6

Efficacy of Medications

The efficacy of these medications in improving mood and pain varies:

• Duloxetine: has been found to be consistently effective in reducing pain and improving mood, with moderate- to high-certainty evidence 5, 7
• Milnacipran: has been found to be effective in reducing pain and improving mood, although the certainty of evidence is lower than that of duloxetine 3, 5, 4
• Mirtazapine: has been found to have a moderate effect on mood, although the evidence is limited to a single study 5
• Desvenlafaxine: has been found to have no clinically relevant benefit over placebo in the treatment of fibromyalgia, although the evidence is limited to a single small trial 6

Safety and Tolerability

The safety and tolerability of these medications also vary:

• Duloxetine: has been found to be generally well-tolerated, although it may be associated with a higher discontinuation rate due to adverse events 5, 7
• Milnacipran: has been found to be well-tolerated, although it may be associated with a higher risk of adverse events such as nausea and insomnia 3, 4
• Mirtazapine: has been found to be generally well-tolerated, although the evidence is limited to a single study 5
• Desvenlafaxine: has been found to have a similar safety and tolerability profile to duloxetine and milnacipran, although the evidence is limited to a single small trial 6