Duloxetine Clomipramine

The traditional scheme is complicated by the fact that some antidepressants exhibit characteristics of more than one class. For example, clomipramine, a tricyclic antidepressant (TCA) with side effects and toxicity similar to other TCAs, works more like the selective serotonin reuptake inhibitors (SSRls). Similarly, venlafaxine and duloxetine, which are usually grouped with the atypical antidepressants, have a side effect and safety profile comparable to the SSRls. Although a classihcation system based on mechanism of action offers some advantage (see Table 3.7), even this scheme is limited by the fact that antidepressants that work in the same way may have widely divergent side effect and safety profiles. In the following discussion, the traditional classification system is adopted. Although fraught with problems and inconsistencies. 

In the event that the initial SSRI provides an unsatisfactory treatment response, preferred alternatives include (1) switching to another SSRI, (2) switching to ven-lafaxine or duloxetine, or (3) switching to clomipramine. Despite limited data to date regarding their efficacy, SNRls are included as alternatives prior to considering clomipramine due to their more favorable safety and side effect profiles. 

Norepinephrine-serotonin reuptake inhibitors Amitriptyline (Elavil) Clomipramine (/Vnafranil) Duloxetine (Cymbalta) Imipramine (Tofranil) Venlafaxine (Effexor)... 

ANTIDEPRESSANTS-duloxetine, modobemide, SSRIs - escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, TCAs - amitriptyline, clomipramine, desipramine, doxepin, imipramine... 

If patient Is taking any agent that can Inhibit serotonin reuptake (e.g., SSRIs, sibutramlne, tramadol, mllnacipran, duloxetine, venlafaxine, clomipramine, etc.)... 

The manufacturers note that tricyclics like clomipramine or amitriptyline should be used with caution or avoided with duloxetine, because of the possible risks of the serotonin syndrome , (p.9). 

---