"Peanuts" character Charlie Brown was way ahead of doctors today in understanding that mental and physical pain were connected. "This is my depressed stance," he once said. "When you're depressed, it makes a lot of difference how you stand" [source: Applegate et al.]. Charlie Brown, though just a small boy, understood the mind-body connection. He discerned that mood could affect stance and vice versa.
Physical pain and depression are interlinked because often one causes the other. Approximately 30 percent of those who experience chronic pain eventually suffer from clinical depression, and 75 percent of depression patients seek treatment from a doctor because of a physical symptom such as pain [source: National Pain Foundation].
Scientists believe that mood and pain may be regulated by the same neurochemicals, so obviously, the ideal treatment for a person experiencing both conditions would address both problems. The most well-known drug that serves as both an antidepressant and a pain management tool is Cymbalta. Cymbalta, manufactured by Eli Lilly, is the brand name for the drug duloxetine. Since the U.S. Food and Drug Administration (FDA) approved Cymbalta as a treatment for depression in August 2004, more than 9 million people in the United States have been treated with the drug [source: Cymbalta].
Currently, Cymbalta has four major uses. It's primarily used to treat major depressive disorder, but it may also be prescribed for general anxiety disorder, nerve pain associated with diabetes and pain associated with fibromyalgia. How can one drug do so much? Are there any side effects? Let's take a closer look at Cymbalta.
Cymbalta at Work in Your Body
Let's say you're prescribed Cymbalta, but before you start popping pills, you want to know exactly what the drug will do to your body. Cymbalta is an SNRI, or a serotonin and norepinephrine reuptake inhibitor. That means that Cymbalta, along with other SNRIs, is thought to work by affecting the levels of two key substances in the central nervous system: serotonin and norepinephrine.
Serotonin and norepinephrine are naturally occurring substances in the brain and the spinal cord, and they're tasked with modulating your emotional responses and communicating those responses to other parts of the brain. Additionally, serotonin and norepinephrine help your body to suppress pain. Researchers have linked depression with lowered levels of these neurotransmitters; serotonin and norepinephrine can also affect how much pain you feel.
Cymbalta works by changing the way these neurotransmitters behave. The drug prevents your body's cells from absorbing the serotonin and norepinephrine, which increases the levels of those substances in the brain. That may give your brain more of a fighting chance to ward off pain and depressed moods. It takes approximately one to four weeks for a person taking Cymbalta to notice any major differences in mood or pain levels.
For a more in-depth look at why Cymbalta is prescribed to certain people, go on to the next page.
Cymbalta is used to treat both the emotional and physical symptoms of major depressive disorder. That means that in addition to tackling the sad and gloomy feelings we normally associate with depression, it also helps manage factors such as aches and pains, fatigue, headache and sleep problems. Some forms of depression include problems related to anxiety, which Cymbalta can treat. It's also diagnosed for general anxiety disorder, or GAD.
A person suffering from GAD may complain of constant anxiety and worry. He or she may feel constantly on edge and have difficulty concentrating, which translates to physical symptoms such as fidgeting, muscle tension and sleep disturbance. Cymbalta is designed to treat both the emotional and physical symptoms of this disorder.
In the last two major Cymbalta indications, Cymbalta's work as a means to manage pain is more primary. People with type 1 or type 2 diabetes often experience nerve damage in the extremities, particularly the feet and legs. When the nerves are damaged, they cause painful aching and burning, as well as less painful symptoms including numbness and tingling. When this happens, a person is said to be experiencing diabetic peripheral neuropathic pain; the drug blocks the pain messages sent out by the damaged nerves.
Fibromyalgia (for more common questions and expert answers on Fibromyalgia, visit Sharecare.com) is a condition distinguished by extensive pain with no known cause. While many antidepressants may be prescribed to manage the pain, Cymbalta is the only antidepressant specifically approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia.
In Europe, Cymbalta is sometimes prescribed to treat urinary incontinence, but it's currently not approved for that purpose in the United States. In a 2005 essay for Slate, writer Jeanne Lenzer wrote about a suicide that took place during U.S. clinical trials for using Cymbalta for incontinence; Lenzer speculated that Cymbalta may have caused suicidal tendencies in patients who weren't taking the drug for reasons related to depression [source: Lenzer].
While Lenzer was writing about an isolated incident, using Cymbalta does come with the risk of side effects. On the next page, we'll take a look at the side effects commonly associated with Cymbalta.
Cymbalta Side Effects
The most common side effect of Cymbalta is mild to moderate nausea, which usually abates in one to three weeks. Other common side effects include dry mouth, insomnia, constipation, heartburn, sweating, increased urination or difficulty urinating, drowsiness, decreased appetite and dizziness. Cymbalta may cause sexual dysfunction in men but does so to a lesser extent in women.
As with many antidepressants, Cymbalta can increase thoughts of suicide when it's first taken, particularly in young adults. When first taking Cymbalta, you should alert a health care provider immediately if you have dramatic changes in mood or behavior, including thoughts of suicide.
You should, of course, tell your doctor about any other medications you're taking. If you're on MAOIs or thioridazine, for example, you shouldn't be taking Cymbalta. The drug can also make glaucoma worse, so if you've got the condition, you'll want to try something else instead.
Some of the more severe side effects of Cymbalta are indications that it's having an adverse effect on your liver, including pain in the right upper belly area, darkened urine or yellow skin and eyes.
You may also experience side effects when you stop taking the drug, including nausea, headache and dizziness.
For more information on Cymbalta and other popular prescription drugs, see the stories on the next page.
Related HowStuffWorks Articles
- Applegate, Ashton, William R. Evans, Tripp Evans and Andrew Frothingham. "And I Quote." Macmillan. 2003. (Feb. 9, 2009)http://books.google.com/books?id=H-GfO0jkBLsC&printsec=frontcover
- Boyles, Salynn. "Antidepressants Help Treat Fibromyalgia." WebMD. Jan. 13, 2009. (Feb. 9, 2009)http://www.webmd.com/fibromyalgia/news/20090112/antidepressants-help-treat-fibromyalgia
- Cobb, Carla and Renee Crichlow. "Duloxetine (Cymbalta) for Treatment of Major Depressive Disorder." American Family Physician. Sept. 15, 2005. (Feb. 9, 2009)http://www.aafp.org/afp/20050915/steps.html
- Cymbalta Web site. (Feb. 9, 2009)http://cymbalta.com/index.jsp
- "Duloxetine." MedlinePlus. Sept. 1, 2008. (Feb. 9, 2009)http://www.nlm.nih.gov/medlineplus/druginfo/meds/a604030.html
- Lenzer, Jeanne. "Drug Secrets." Slate. Sept. 27, 2005. (Feb. 9, 2009)http://www.slate.com/id/2126918/
- "The Link Between Pain and Depression." National Pain Foundation. (Feb. 9, 2009)http://www.nationalpainfoundation.org/MyTreatment/News_PainAndDepression.asp