When Depression Hurts
August 31, 2004
Brian Reid, Washington Post

The Next Prozac? Consumers may soon be facing an ad barrage for the antidepressant Cymbalta, approved this month by the Food and Drug Administration. Financial analysts say maker Eli Lilly & Co. is looking for a follow-up to Prozac, which lost patent protection in 2001. A strong sales drive is key to the company's success.

Gain for Pain? Lilly says Cymbalta could be most useful for patients whose depression is accompanied by aches and pains. "The big advertising point is that it's good for pain, which is often part of depression," said Brian Doyle, clinical professor of psychiatry at Georgetown University Medical School. Doyle is on the speakers' board for Lilly as well as rival antidepressant-makers.

A Pill Apart Cymbalta's method of action sets it apart from popular antidepressants Prozac, Zoloft and Paxil. These target serotonin, the brain chemical that helps regulate emotion. Cymbalta boosts both serotonin and norepinephrine, which helps regulate pain sensitivity. But Cymbalta isn't a trailblazer: Effexor XR, which also targets serotonin and norepinephrine, has been on the market for more than a decade. No studies have compared Cymbalta to Effexor on pain relief.

Watch and Wait Clinical trials suggest Cymbalta may act fast and have a low incidence of sexual side effects -- a bugaboo of other antidepressants. Side effects include nausea, dry mouth and constipation. But the drug's real profile won't be known until it's been on the market a year or more, warned David Dunner, director of the Center for Anxiety and Depression at the University of Washington. At a local CVS, a 30-day supply of high-dose, once-daily Cymbalta costs $119, compared to $118 for high-dose Effexor XR and $113 for Paxil CR.