Selective serotonin (5-HT) and norepinephrine (NE) reuptake inhibitors (SNRIs) like duloxetine have the efficacy of tricyclic antidepressants (TCAs) with a more tolerable side-effect profile. Bipolar disorder is often undetected, with the most common misdiagnosis being unipolar depression. Studies have suggested that treatment of bipolar and unipolar depression with heterocyclic TCAs may increase the risk of switch rate to mania. Studies of antidepressants in unipolar major depression show a small risk of mania or hypomania, presumably because some bipolar depressives were mistakenly studied. This study investigated the rate of hypomania, mania, and hypomanic-like symptoms observed during treatment with duloxetine in patients with major depression. One case of mania occurred in the placebo group (0.1%), and two cases of hypomania were observed in the duloxetine-treated group (0.2%). Among hypomanic-like symptoms, only insomnia was significantly higher in the duloxetine group than in the placebo group (Duloxetine was associated with a low incidence of treatment-emergent hypomania, mania, or hypomanic-like symptoms in patients with major depressive disorder (MDD). The use of traditional antidepressants to treat bipolar depression is considered experimental. This is because these medicines have not been proven effective for treating bipolar depression and, therefore, none are FDA approved for that indication. There is no research to show that they have any greater benefit than taking a mood stabilizer (such as lithium or Depakote) alone. Many of the existing studies of their efficacy have focused mainly on people with unipolar rather than bipolar disorder. Using antidepressant medication alone to treat a depressive episode is not recommended in people with bipolar I disorder. The drugs may flip a person, particularly a person with bipolar I disorder, into a manic or hypomanic episode. Using antidepressants alone also may lead to or worsen rapid cycling in some bipolar patients. In rapid cycling, a person has 4 or more distinct episodes of mania/hypomania or depression over a 1-year period.
Treatment for bipolar disorder, formerly called manic-depression, generally involves medications and forms of psychotherapy — whether you have bipolar I or bipolar II. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment with substantial consequences. You may need to try different medications or combinations of medications to determine what works best. So it's important to regularly meet with your psychiatric care provider to see how well your treatment is working. If necessary, your provider may make periodic adjustments to your medication to keep symptoms and side effects under control. Duloxetine (Cymbalta) is a serotonin and norepinephrine reuptake inhibitor in the same class as venlafaxine (Effexor). In Europe it is marketed for the treatment of stress urinary incontinence; it is not approved for that indication in the United States. In one open-label study1 there were seven suicide attempts among 1,279 patients in one year (one suicide attempt per 115 patient-years of drug exposure) and no cases of fatal acute overdose. Food and Drug Administration (FDA) for use in the treatment of major depressive disorder and of diabetic peripheral neuropathic pain. Duloxetine should not be used in patients taking a monoamine oxidase inhibitor (MAOI), including a period of five days before initiation of the MAOI and 14 days after its discontinuation.2 Duloxetine is metabolized extensively by cytochrome P450 enzymes 1A2 and 2D6. Duloxetine plasma concentrations may be increased significantly by some antidepressants, quinidine, and quinolone antibiotics. Duloxetine may increase the plasma concentrations of other antidepressants, antipsychotics, and type 1C antiarrhythmics such as propafenone (Rythmol) and flecainide (Tambocor). Serum alanine transaminase levels increased to more than three times the upper limit of normal in about 1 percent of patients taking duloxetine in placebo-controlled trials2; alcohol may increase this risk. However, there have been no reports of hepatic failure.
Read about Duloxetine and the other conditions it treats. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression. Possibly, but troubl If you have bipolar disorder and are prescribed Cymbalta for anxiety, pain, panic, or depression, it could help temporarily, but there is a definite risk that the cymbalta, duloxetine or any antidepressant, could precipitate a manic or hypomanic episode. This could be very devastating and painful.