Use of Cymbalta to Treat Bipolar Disorder in Teenagers

Cymbalta is the brand name for a medication called duloxetine. It is an antidepressant that is approved for treating major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, and fibromyalgia. It is also being used to treat episodes of depression in bipolar disorder. Cymbalta has not been approved for use in teenagers, but it is being prescribed as an off-label medication to treat their symptoms of depression.

Definition

• Cymbalta is in a class of medications called selective serotonin-norepinephrine reuptake inhibitors (SSNRIs). When the nerve cells in the brain communicate, they release chemicals called neurotransmitters, which travel through a small space to bind with nearby nerves. The chemicals that remain in the space are reabsorbed. SSNRIs prevent this reabsorption, making more of the neurotransmitters available longer for the brain to use. Increasing the amount of serotonin and norepinephrine helps improve the symptoms of depression.

Antidepressants and Bipolar Disorder

• Teens diagnosed with bipolar disorder need to take medications to stabilize the manic and depressive mood swings. Most mood stabilizers target the manic episodes, either by alleviating acute symptoms or by preventing future swings toward mania. Antidepressants may be considered for teenagers with bipolar disorder, but they must be monitored very closely. Bipolar mood episodes cycle more frequently in teenagers than they do in adults, creating more of a chronic mood disruption than a distinct swing from mania to depression. Also, when teens take antidepressants, there is a higher chance that the medication will trigger an abrupt manic episode. Because of these differences, antidepressant use by teenagers is riskier.

Precautions

• Even though Cymbalta is prescribed for teenagers, its effectiveness and safety for this age group have not been confirmed through major studies, and it is not approved for their use. One limited study of two teenagers with major depressive disorder found that Cymbalta provided rapid improvement of mood symptoms and the chronic pain associated with depression. Two clinical trials to study the use of Cymbalta by teenagers began recruiting participants in February 2009. The trials are expected to be completed in March 2012.

  Antidepressants should be started at a low dose and slowly increased over a number of weeks so that the physician can monitor for side effects and see how the teen responds. Teenage metabolism breaks down the medication more quickly than an adult. Where a once daily dose will suffice for adults, teenagers should take lower doses twice a day.

Side Effects

• One critical side effect for teenagers taking antidepressants is the risk of increased suicidal thoughts or behaviors. Additionally, Cymbalta should never be stopped abruptly or without consulting a physician, as this can result in withdrawal symptoms. Cymbalta is processed in the liver and may cause liver toxicity. Teenagers who suddenly bruise more easily while taking Cymbalta should be evaluated by their physician. Except for the serious concern over suicidal ideation, Cymbalta has the same potential side effects as other antidepressants, whether they are prescribed for teens or adults. The most serious side effects are an increased risk of mania, anxiety, agitation, and worsening depression. Some of the less serious side effects that typically go away after the body adapts to the medication include high blood pressure, abdominal pain, sleepiness or insomnia, headache, dizziness, and weight loss or gain.

Considerations

• Even though many medications are prescribed for off-label use, a January 2009 review published in the journal "Pharmacotherapy" included Cymbalta in a list of top-priority drugs needing research to determine the effectiveness and safety of their off-label uses. That includes using Cymbalta for teenagers with bipolar disorder. Cymbalta may be a good choice to treat depressive cycles, but there are many variables to be considered. Cymbalta is not the only medication in its class, and others will have a different chemical structure, which means they may be better or worse for any given teenager. It is important to remember that every teenager will respond to each medication differently, depending on his own genetics, body chemistry, and the severity and frequency of his bipolar episodes.