Wednesday, April 25, 2012
Duloxetine, marketed as Cymbalta, was first pitched as a bladder incontinence drug then an anti-depressant, and now a pain killer. It is a serotonin and noradrenalin reuptake inhibitor (SNRI). Dr David Healy, the psychiatrist in the North Wales Department of Psychological Medicine in Bangor who blew the lid on the link between suicides and SSRIs, says this about SNRIs: ‘We can have absolutely no confidence at all that SNRIs will be any better. At this stage Effexor appears, from adverse event reports world wide, to have just the same rates of people becoming suicidal as the SSRI’s.’ In a ‘healthy volunteer’ trial (when a drug is given to people with no illness to check for reactions) of duloxetine (Cymbalta), one volunteer committed suicide. In a study on duloxetine 44 per cent of people reported adverse symptoms on discontinuation, compared to 22 per cent on placebo. In my experience many people get terrible withdrawal symptoms when they try to come off it. There’s a utube spoof ad on the drug which makes its withdrawal effects very clear. A recent study on the drug and it’s effects on knee osteoarthrtitis showed that one in six people who take the drug benefit and one in eight would be harmed, with adverse effects. But this doesn’t take into account the much more serious withdrawal effects that most GPs don’t tell you about. However, just as with the SSRI antidepressant saga, which took ten years of campaigning before risk of suicide was included in the drug’s compulsory information, it will probably take some years before enough evidence accumulates, and probably even longer before the authorities will take action.
Based on two weak trials it’s now being pitched as a joint pain killer, despite not having a licence to treat arthritis. To add insult to injury, in the very same issue of the Daily Mail Professor David Healy writes about how the side-effects of drugs such as these are not mentioned in the press or when GPs prescribe them, in an article entitled Think the drugs your GP gives you are safe? Well, don’t be so sure. It’s well worth a read.
Why don’t these paper carry a headline such as ‘Omega 3 fish oil stops arthritis pain’. A meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 fish oils reported reductions in joint pain intensity (by 26%), minutes of morning stiffness (by 43%), number of painful and/or tender joints (by 29%), and NSAID consumption (by 40%). That’s much stronger evidence of benefit.