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Duloxetine (Cymbalta)

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Definitions
  • Remission: GAD-7 < 5
  • Some Improvement: Any drop in the GAD-7 score
  • No Improvement: No drop in the GAD-7 score
  • Partial Response: A drop of 4 or more points in the GAD-7 score at week 6 compared to week 1
  • Non-Response: A drop of <4 points in GAD-7 score at week 6 compared to week 1

Notes
  • At CDPs 2,3,4,5,6 and 7 consider switching antidepressant  if side effects are intolerable FIBSER.pdf
  • Rather than switch to another medication consider instead switch to Psychotherapy (CBT)
  • If switching to another medication, go to  Increase, Augment or Switch and proceed to the bottom of the page
  • For assistance with switching please go to SwitchRx 
  • Lower doses or less frequent dosage increases may be better for anxious, medically compromised, geriatric patients or those experiencing tolerable side effects
  • For patients who develop treatment-emergent anxiety may need to drop the dose and go more slowly
  • It can help some patients to have some input in determining when to increase the dose
  • In cases of non-response reassess diagnosis, check for non-adherence and assess for impact of extreme psychosocial stressors
  • Check WSAS periodically for change in functioning
  • If treating anxiety with medication only, advise patient to continue to approach situations or experiences that they are avoiding due to anxiety
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