Talk:Duloxetine

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Unclear what sources support this stuff?

Doc James (talk · contribs · email) 01:12, 7 December 2017 (UTC)

"The duloxetine + mirtazapine combination is a particularly effective tool in the antidepressant arsenal. Duloxetine is a very high affinity blocker of both the serotonin and norepinephrine transporters, at 0.8 for the SERT and 7.5 for the NET respectively, resulting in increased serotonergic and noradrenergic neurotransmission, which results in improvements in mood, cognition, desire to work, motivation, greater skill at performing tasks effectively, memory, alertness, and keenness, while also alleviating depression, anxiety, and obsessive-compulsive ideation. Mirtazapine’s antagonism of the α₂ receptors further preserves and enhances serotonergic and noradrenergic neurotransmission and its very high antagonism of the 5-HT₂ receptors also alleviates depression and anxiety. Importantly, duloxetine is a moderate affinity inhibitor of the CYP2D6 enzyme, thereby increasing the plasma concentration of the substrate, mirtazapine, to between 2-5 times the normal levels. After beginning use of this regimen, symptoms such as prolonged headache, fatigue, and even a worsening of psychological symptoms tend to predominate for 3 weeks before going away. Therapeutic effects set in 3-4 weeks after beginning use, even if one has just discontinued a previous antidepressant."

References

Another version

"The duloxetine + mirtazapine combination is a particularly effective tool in the antidepressant arsenal. Duloxetine is a very high affinity blocker of both the serotonin and norepinephrine transporters, at 0.8 for the SERT and 7.5 for the NET respectively, resulting in increased serotonergic and noradrenergic neurotransmission, which results in improvements in mood, cognition, desire to work, motivation, energy, greater skill at performing tasks effectively, memory, alertness, and keenness, while also alleviating depression, anxiety, and obsessive-compulsive ideation. Mirtazapine’s antagonism of the α₂ receptors further preserves and enhances serotonergic and noradrenergic neurotransmission and its very high antagonism of the 5-HT₂ receptors also alleviates depression and anxiety. Importantly, duloxetine is a moderate affinity inhibitor of the CYP2D6 enzyme, thereby increasing the plasma concentration of the substrate, mirtazapine, to between 2-5 times the normal levels. After beginning use of this regimen, symptoms such as prolonged headache, fatigue, and even a periodic worsening of psychological symptoms tend to predominate for 3 weeks before going away. Therapeutic effects set in 3-4 weeks after beginning use, even if one has just discontinued a previous antidepressant.

References

This is strange. This review "Anttila SA, Leinonen EV (2001). "A review of the pharmacological and clinical profile of mirtazapine". CNS Drug Rev. 7 (3): 249–64. PMID 11607047." does not even mention duloxetine?

And neither does this one[1]

Many of the rest do not meet WP:MEDRS. Doc James (talk · contribs · email) 04:49, 16 December 2017 (UTC)

@Doc James: Hi! I'm the one who added that edit. A few of the links I added were done in expedience from, for example, prior information I had gathered from them that applied to this subject, such as the effects of 5-HT receptor antagonism which can be found in the mirtazapine link, or due to the difficulty of finding a scholarly review article for how long it takes for therapeutic effects to set in. However, the brunt of the information, such as the efficacy of the combination, the forms of improvement resulting from increased serotonergic and noradrenergic neurotransmission, and duloxetine's CYP2D6 inhibition, are all supported by the scholarly review articles and university medicine profiles I cited, such as the "Case for LRF, "Importance of norepinephrine in depression", and "Influence of serotonin on mood and cognition" studies. I think it's helpful for some individuals looking for a bottom line profile of efficacy to see information of the nature that I described. Just wondering what your logic was in removing it (maybe because of a few non MEDRS links?) and if you could give me some feedback and see if we could get the edit back in some revised form. Thanks! Reixus (talk) 08:26, 22 December 2017 (UTC)

Oh yeah, looking at the mirtazapine link more closely, I used that one just to describe the effects of mirtazapine's α₂ antagonism. Duloxetine's effects are described elsewhere. Reixus (talk) 08:42, 22 December 2017 (UTC)

Okay it needs to be based on sources per WP:MEDRS. Case reports are not suitable. Best Doc James (talk · contribs · email) 19:24, 22 December 2017 (UTC)