Does Cymbalta contain an MAOI? (3+ differences)

In this article, we will answer the question ” Does Cymbalta contain an MAOI?”. We will discuss key differences between Cymbalta and MAOIs (monoamine oxidase inhibitors), including the mode of action, therapeutic uses and side effects. We will also discuss how to choose between Cymbalta or MAOIs.

Does Cymbalta contain an MAOI?

No, Cymbalta does not contain a monoamine oxidase inhibitor (MAOI). Cymbalta contains a medication called duloxetine which belongs to the class of serotonin and norepinephrine reuptake inhibitors (SNRIs). Cymbalta is approved by the FDA to treat conditions like major depressive disorder (MDD), generalised anxiety disorder (GAD), fibromyalgia, musculoskeletal pain and diabetic peripheral neuropathic pain (DPNP) (1).

Monoamine oxidase inhibitors or MAOIs are a class of antidepressants used to treat various depressive illnesses like social phobia or panic disorder. This class contains medications like phenelzine, selegiline, isocarboxazid and tranylcypromine (2).

MAOIs are one of the first antidepressants but are not used as the first-line treatment medication for any depressive disorders due to their extensive side effect profile. Whereas, Cymbalta is a comparatively safer and more well-tolerated option.

How is Cymbalta different from MAOIs?

Cymbalta is very different from MAOIs in terms of its pharmacological profile and therapeutic uses. Some key differences between Cymbalta and MAOIs are as follows:

Mode of action

Cymbalta (Duloxetine) is an SNRI that works by inhibiting the reuptake of serotonin and norepinephrine in the brain. It also affects dopamine levels causing them to increase. High levels of these neurotransmitters in the brain result in the reduction of anxiety and depression, and also an overall improvement in mood. Duloxetine can also help manage chronic pain in some situations. This is due to the effect of Duloxetine on the serotonergic neurons in the spinal pathway.

MAOIs on the other hand are antidepressants which work by blocking the enzyme monoamine oxidase. This enzyme is responsible for the breakdown of neurotransmitters like dopamine, serotonin and norepinephrine. This mechanism of monoamine oxidase inhibition is responsible for an increased level of these neurotransmitters in the brain. Hence, the increased level improves mood and helps with depression in individuals taking therapy.

Therapeutic uses

As both Cymbalta and MAOIs are antidepressants and are used to treat depressive illnesses their therapeutic uses can be common. However, which agent will be used for any specific individual depends on patient characteristics and tolerability.

Some conditions which can be treated or managed by Cymbalta are as follows:

• Generalised anxiety disorder (GAD)
• Major depressive disorder (MDD)
• Fibromyalgia
• Diabetic peripheral neuropathic pain (DPNP)
• Chronic musculoskeletal pain

Whereas MAOIs are used to treat the following conditions:

• Depression (with or without atypical features)
• Social phobia
• Panic disorder (PD)
• Parkinson’s disease
• Multiple system atrophy

Treatment duration

The treatment duration with both medications depends upon various factors such as the physiology of the individual receiving therapy, the condition being treated, and the response and tolerability of the patient.

Normally Cymbalta takes almost 2-4 weeks to improve the condition of individuals who show a positive response to the medication. The MAOIs also have a similar duration for showing improvement in patient symptoms. However, the onset and any visible changes in the conditions of individuals taking either medication depend solely on the patient-specific characteristics and the underlying medical condition being treated.

Both medications may decrease the symptoms of the condition being treated but are continued well after the symptoms have resolved to prevent relapse.

Efficacy rate

A systematic review published on the safety and efficacy of Duloxetine has shown this medication to be effective in more than 80% of the cases under observation. This suggests that Cymbalta (or Duloxetine) is very effective in treating various depressive disorders and chronic pain conditions (3).

MAOIs have also been reported as an effective class of antidepressants. A research study assessing the efficacy of phenelzine for the treatment of depression in the elderly population found the medication to be effective in almost 60% of individuals (4).

Side effects

Some side effects of Cymbalta include the following (1):

• Nausea
• Dry mouth
• Fatigue
• Decreased appetite
• Hyperhidrosis
• Constipation
• Somnolence
• Diarrhoea
• Weight loss or gain

Sometimes rare side effects like hair loss, suicidal ideation, serotonin syndrome, hyponatremia, seizures, activation of manis and hepatotoxicity can also occur.

Medications belonging to the class of MAOIs can produce the following side effects (2,5):

• Dry mouth
• Diarrhoea
• Drowsiness
• Insomnia
• Constipation
• Nausea
• Dizziness
• Lightheadedness
• Sedation
• Hypotension or Hypertension
• Weight gain/oedema
• Sexual dysfunction
• Hypomania
• Involuntary muscle jerks

Withdrawal symptoms

Cymbalta has been shown to cause withdrawal symptoms if it is abruptly discontinued. Therefore it is always advised to gradually taper off the medication to avoid withdrawal effects. Some symptoms experienced by individuals are as follows:

• Dizziness
• Nausea
• Headache
• Fatigue
• Irritability
• Vomiting
• Paresthesias
• Insomnia
• Anxiety
• Hyperhidrosis
• Diarrhoea
• Agitation
• Tinnitus

MAOIs can also cause withdrawal symptoms in some patients taking therapy. Some of these symptoms include (6):

• Anxiety
• Agitation
• Drowsiness
• Hallucinations
• Delirium
• Pressured speech
• Sleeplessness
• Paranoid psychosis

Both Cymbalta and MAOIs exhibit severe side effects if discontinued abruptly. If your healthcare provider discontinues these medications he will construct a plan to gradually taper off the medication to reduce the occurrence of withdrawal symptoms.

Can you take Cymbalta and MAOIs together?

Cymbalta and MAOIs cannot be taken together. The combination of these medications is contraindicated. Both medications should have a gap of two weeks between each other. If used simultaneously these can result in increased levels of serotonin and lead to serotonin syndrome.

Serotonin syndrome can present with many different symptoms, some of which are agitation, hallucinations, tachycardia, nausea, vomiting, diarrhoea, dilated pupils, confusion, hyperthermia, hyperreflexia, seizures and coma.

If you have to change your medication to an alternative agent, it is advised to gradually taper off the dose and keep a gap of a few weeks, especially when transitioning from Cymbalta to MAOIs or selective serotonin reuptake inhibitors (SSRIs). 

How to choose between Cymbalta and an MAOI?

The choice of whether a patient is going to receive Cymbalta or MAOIs for the condition under treatment depends on various factors. These factors include:

• Individual tolerability and response to either agent
• Suitability of the medication for your condition
• The severity of the depressive illness
• Patient symptoms and medical history
• History of antidepressant use
• Underlying comorbidities

Your healthcare provider will assess your situation, consider all these factors and assess the risks and benefits of all available medication options before prescribing any medication for you.

Conclusion

In this article, we discussed the key differences between Cymbalta and MAOIs. We also discussed the kind of side effects that can arise due to the concomitant use of Cymbalta and MAOIs. In conclusion, to the best of my knowledge and according to published research Cymbalta is an SNRI and does not contain an MAOI. Both these classes are very different in their mode of action on neurotransmitters, therapeutic uses and side effect profiles.

References