Main Chapters:
00:00 Intro - Cymbalta (Duloxetine) for ADHD
00:12 Take home message
01:54 How do Serotonin Norepinephrine Reuptake Inhibitors work? (SNRIs)
08:09 First SNRIs Venlafaxine (Effexor) / Desvenlafaxine (Pristiq)
11:41 Duloxetine (Cymbalta)
15:46 Milnacipran (Savella) / Levomilnacipran (Fetzima)
17:37 Cymbalta for ADHD
28:12 Conclusion
30:32 Questions

Duloxetine (Cymbalta) is a relatively balanced serotonin/norepinephrine reuptake inhibitor (SNRI), approved for depression, fibromyalgia, and a number of chronic pain syndromes. It is used off label for ADHD. Only a few studies support its efficacy in treating ADHD in children and adults.

Other relatively pure norepinephrine reuptake inhibitors (atomoxetine/Strattera), and SNRI (venlafaxine/Effexor, milnacipran/Savella/Fetzima, tricyclic antidepressants) have been shown to reduce both inattentive and hyperactive/impulsive symptoms of ADHD.

I tend to use far more duloxetine for treating ADHD than these other options, because the side effects of duloxetine tend to be more tolerable, predictable, and safer than those with the other SNRI AND NRI. This is a generalization, and there are certainly individuals who do not have good responses to duloxetine or have great responses to these other agents.

Overdoses (which can be fatal) with tricyclics can occur at doses only slightly above the therapeutic range; most individuals have constipation, weight gain, lethargy, and cardiac side effects from this class of drugs. Venlafaxine often creates withdrawal effects with missed doses, and its norepinephrine action is relatively weak. Side effects with atomoxetine tend to be less predictable than those from duloxetine, and most individuals need to titrate upwards for weeks before reaching effective doses. In the US, milnacipran is not available as a generic, making prohibitively expensive for many.

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Free link to my Medium Article on Cymbalta (Duloxetine) for ADHD:
https://medium.com/wise-well/s....top-using-confusing-

Follow https://dockruse.medium.com on Medium for hundreds of full length articles on this subject and more!
Access to other Medium articles requires paid membership.
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References:
Duloxetine May Improve Some Symptoms of Attention-Deficit/Hyperactivity Disorder (2010)
https://www.psychiatrist.com/p....cc/duloxetine-may-im

Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on attention and executive functions in patients with major depressive disorder (2010)
https://pubmed.ncbi.nlm.nih.gov/20385412/

Efficacy and Adverse Effects of Venlafaxine in Children and Adolescents with ADHD: A Systematic Review of Non-controlled and Controlled Trials (2013)
https://www.eurekaselect.com/article/49645

Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison (2014)
https://www.ncbi.nlm.nih.gov/p....mc/articles/PMC40083

Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents (2014)
https://www.cochranelibrary.co....m/cdsr/doi/10.1002/1

Full Chapter list:
00:00 Intro - Cymbalta (Duloxetine) for ADHD
00:12 Take home message
01:54 How do Serotonin Norepinephrine Reuptake Inhibitors work? (SNRIs)
03:39 Comparing Serotonin Reuptake Inhibitors (SSRIs) and SNRIs
04:06 SSRIs and SNRIs Side Effects
06:58 Different Effects between SSRIs and SNRIs
08:09 First SNRIs Venlafaxine (Effexor) / Desvenlafaxine (Pristiq)
11:41 Duloxetine (Cymbalta)
13:02 Cymbalta Effects and Side Effects
15:46 Milnacipran (Savella) / Levomilnacipran (Fetzima)
17:37 Cymbalta for ADHD
18:53 Cymbalta Compared to Strattera (Atomexetine)
20:47 Cymbalta Compared to Tricyclic Antidepressants (TCAs)
26:00 Inhibitory Constant (KI) / Relative Potency / Transporter Binding
28:12 Conclusion
30:32 Questions
30:43 Increasing the Size of the Hippocampus
33:36 Sertraline for ADHD
35:32 Luvox (Fluvoxamine)
37:21 Outro

Streamed live May 15, 2024

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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.

Dr. Kruse has posted talks in both the "live" and the "video" sections of this channel. Thumbnails on ADHD topics have a pink background, and those on more general mental health topics have a purple background. A small collection of ADHD-Trump videos have an orange background.

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#health #mentalhealth #adhd #cymbalta

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