Duloxetine (Cymbalta) is licensed for depression as well as Stress Urinary Incontinence
This new antidepressant has not been allowed onto the formulary of Lancashire Care Trust. Also, there are concerns from some of the trial data and more recently from clinical use of a relationship between this drugs use and impulsive suicide attempts
Finally, once again this antidepressant has been shown to be effective in moderate to severe depression, not mild depression. Mild depression is the most commonly seen presentation of depression in Primary Care.
Action: There is no evidence to support the use of any antidepressant as first line in Mild Depression. The additional fact the Cymbalta is not on the local Care Trust formulary and the possible link with suicides means that this drug does not currently have a place in the treatment of depression in Primary Care.