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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.
References:
Duloxetine May Improve Some Symptoms of Attention-Deficit/Hyperactivity Disorder (2010)
www.psychiatri...
Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on attention and executive functions in patients with major depressive disorder (2010)
pubmed.ncbi.nl...
Efficacy and Adverse Effects of Venlafaxine in Children and Adolescents with ADHD: A Systematic Review of Non-controlled and Controlled Trials (2013)
www.eurekasele...
Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison (2014)
www.ncbi.nlm.n...
Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents (2014)
www.cochraneli...
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