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, known as SNRIs (serotonin-norepinephrine reuptake inhibitors), work similarly to duloxetine by increasing both serotonin and norepinephrine levels. Some key points to consider when choosing an alternative medication include:

• The specific pain condition being treated
• Comorbidities, such as cardiac disease or renal insufficiency
• Potential drug interactions
• Individual response to treatment 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 on the pharmacological management of neuropathic pain 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 of treatments for fibromyalgia 1. These medications work by modulating neurotransmitters that influence both pain perception and mood regulation pathways in the brain. Treatment should typically start at lower doses and gradually increase based on response and tolerability, with side effects varying by medication class but may include dizziness, drowsiness, dry mouth, and gastrointestinal issues, as reported in a study on the use of antidepressants for irritable bowel syndrome 1. Overall, the choice between these options depends on the individual patient's needs and circumstances, and should be made in consultation with a healthcare provider.

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-norepinephrine reuptake inhibitor (SNRI) that has been shown to be effective in managing fibromyalgia symptoms, including pain and fatigue, as well as improving mood 3, 4, 5.
• Mirtazapine: an antidepressant that has been found to have a moderate effect on mood, although its effectiveness for pain relief is less clear 6.
• Desvenlafaxine: an SNRI that has been studied for its effectiveness in treating fibromyalgia, although the evidence is limited and of low quality 7.

Key Findings

• Milnacipran has been found to be effective in reducing pain and improving mood in patients with fibromyalgia, with a moderate effect on pain intensity and a small effect on mood 3, 4, 6.
• Duloxetine, another SNRI, has been found to be moderately efficacious in reducing pain and improving mood, although its effectiveness may be limited to certain patient populations 6, 7.
• The evidence for other antidepressants, including mirtazapine and desvenlafaxine, is limited and of low quality, making it difficult to draw conclusions about their effectiveness for improving mood and pain 6, 7.

Considerations

• When considering medications for improving mood and pain, it is essential to weigh the potential benefits against the potential harms, as some medications may have significant side effects or interact with other medications 6, 7.
• A multidisciplinary treatment approach, including medication, therapy, and lifestyle changes, may be the most effective way to manage chronic pain and improve mood 3, 4.