Duloxetine: a review.

A developing concept is that antidepressant strategies which combine multiple mechanisms of action may have advantages over agents with single mechanisms. Duloxetine is a novel potent dual reuptake inhibitor of noradrenaline and serotonin. The antidepressant efficacy of duloxetine is reviewed in three trials. Results that emerge confirm the acute efficacy of the agent in major depressive disorder. In particular, remission rates in the comparative trials are higher with duloxetine than with either paroxetine or fluoxetine. Duloxetine appears to have specific efficacy in patients with somatic symptoms and there is some clinical evidence of analgesic properties. Modest weight loss was consistently described in the three acute trials and modest weight gain was seen in an open label follow-up study. Duloxetine was well-tolerated in all three trials with similar patterns of adverse events. No significant safety issues emerged from these trials.