Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor, this helps to increase the natural substance in the brain and is helpful in maintaining the mental stress in balance and stopping the signals. Serotonin is a neurotransmitter which is a good feel hormone. The nerve synapse continues with more serotonin and norepinephrine, which means the information is transmitted efficiently. It is also used in the state of depression, depression is a mental state of low mood which is affecting the person’s behavior, feelings and motivations. When the Serotonin-norepinephrine reuptake inhibitor gets increased in the brain it blocks and delays the reuptake of nerves. It is an imbalance of two natural chemicals in the brain and the body. This drug belongs to a group of antidepressants. In this article, we are going to discuss its uses, side effects and its ayurvedic correlation in detail.
Cymbalta (Duloxetine) is useful in treating depression and anxiety, it is a group of medications which comes under serotonin and norepinephrine reuptake inhibitors. Cymbalta has a molecular weight of 333.88 and it usually contains coated pellets of Duloxetine hydrochloride. This class of drugs contains Milnacipran (Savella), Venlafaxine (Effexor) and many more. This usually affects the neurotransmitter which has chemicals in the nerves which get released and communicate with each other. Cymbalta prevents the reuptake of these hormones, this drug is usually used in conditions such as Major depressive disorder (MDD), Fibromyalgia, chronic musculoskeletal pain and diabetic neuropathic pain. The chemical formula of Cymbalta is C18H19NOS.
- Cymbalta increases the serotonin and norepinephrine concentration in the ventral horn of the sacral spinal cord, which intensifies the glutamatergic of the pudendal motor nerve which usually supplies the external urethral sphincter. Increased contraction of the sphincter produces urinary incontinence. Duloxetine helps to improve incontinence.
- Cymbalta is helpful in strengthening the serotonergic adrenergic pathway which is seen in the descending part and there is inhibition of pain, which provides the threshold activation of the pain to the stimuli of the brain.
MECHANISM OF ACTION
- Duloxetine inhibits the secretion of serotonin and norepinephrine, combining these two drugs it is used in anxiety and depression.
- Duloxetine enhances the dopamine levels in the cortex level. When there is an increase in dopamine level it involves the inhibition of norepinephrine transporters.
- These inhibitory receptors on neurons serve directly to suppress the transmission of painful stimuli.
- These both hormones are responsible for emotional modulation such as the limbic system which affects mood disorders.
- When its effect hypertensive effect increases the norepinephrine which leads to the activation of androgen receptors in the vascular epithelium. Then the Gq-coupled receptor helps to mediate the calcium release from the sarcoplasmic reticulum which allows easy contraction of smooth muscle.
- It is primarily metabolized by CYP192 and CYP2D6 and it is a greater contributor.
- It is hydroxylated at the 4,5 and 6 positions which proceed directly to the glucuronide conjugate which proceeds through a catechol and undergoes sulfate conjugation.
- It can be excreted through the feces.
ROUTE OF ELIMINATION
- It is excreted in the urine as conjugated metabolites.
- Biliary excretion plays an important role in fecal excretion.
USES OF CYMBALTA
- This is mainly used to treat depression and anxiety and is helpful in relieving nerve pain or in peripheral neuropathy along with diabetes.
- Musculoskeletal conditions such as arthritis, fibromyalgia and chronic back pain.
- Improves sleep, mood and appetite
- Decreases nervousness.
- It can be recommended as a first-line agent for chemotherapy and induced neuropathy.
- Stress urinary incontinence
Long use of Cymbalta, may cause various side effect
- Dry mouth
- Seizures and various sexual dysfunctions
- Increased risk of suicidal thinking and behaviour
- Panic attack
- Extreme increase in activity and talking
- Muscle cramps, difficulty in urination and liver problems
- Blurred vision, redness and widened pupils.
- Unexplained fever
- Overdose- When a high dose of Cymbalta is taken by the patient it involves Somnolence, Coma and syncope and sometimes hypertension and tachycardia, hypertension.
- Carcinogenicity and mutagenicity– There is an increased incidence of hepatocellular adenomas and carcinomas.
Cymbalta is an antidepressant medication which is used and in ayurveda, it can be correlated with medhya rasayan. Medhya Rasayan is a nootropic group of herb which is helpful in all types of neural anomalies, improves the power of remembrance and retention and is an essential nutrient for the brain. Medhya rasayan is derived from two words- medhya means to intellect and rasayan means to rejuvenate. There are many herbs which have many curative properties. Mano avasada is used for depression and in ayurveda it is equivalent to medhya which can be treated with ayurvedic herbs and other panchkarma procedures which is helpful in curing the disease.
- Nidana parivarjan– it is the avoidance of etiological factors
- Shodhana Chikitsa- it is the bio-cleansing therapy which is followed by samana chikitsa (palliative therapy) which includes- Snehapana (internal oleation), Virechana (purgation), Nasya Karma, Shiro Vasti, Shirodhara and Shiro Abhyanga.
- Medhya Herbs- Medhya herbs supply the micronutrients which are helpful in delaying brain aging and are used in the regeneration of neural tissue. It plays an important role in mental well-being and provides strength and cognitive power. There are the following herbs-
Mandukaparni (Gotu Kola) is an ancient herb in ayurveda which is a small perennial plant with fan-shaped green leaves commonly found in marshy places in the tropical and subtropical regions. This herb contains various proteins and is rich in dietary fiber. It is helpful in calming and has sedation properties which induce sleep and calm the mind. Due to its tikta rasa, it enhances the digestive fire, is rich in antioxidants and increases blood circulation to various parts of the body. Has rejuvenating properties so it is categorized in medhya rasayan and has wound-healing properties.
Shankhpushpi (Convolvulus pluricaulis) is a plant which is usually growing in the rainy season and its leaves are elliptical in shape. This is helpful in reducing stress and helps to keep the brain relaxed. This herb has rejuvenating properties and is promoting good sleep. It has analgesic properties and is helpful in regulating the metabolism of the body and reducing gastric ulcers. Helpful in balancing the Kapha and pitta doshas in the body. It Enhances mood relieves anxiety and is useful in treating sexual disorders. Excellent brain tonic and is acting as a rejuvenator.
Licorice (Glycyrrhiza glabra) is a perennial shrub whose roots are long, wrinkled and brown in color. It is commonly known as mulethi. It is analgesic and has antibacterial and anti-asthmatic properties. It is helpful in pacifying the pitta dosha and Vata doshas, so helpful in inflammation. It is good to maintain the digestive system and is useful in managing indigestion and heartburn. Increases the secretion of thyroid hormones and prevents the conversion of testosterone. Boosts the immune system and is helpful in fighting viral and bacterial infections. It has soothing, expectorant properties so useful in asthma and bronchitis.
Guduchi (Tinospora cordifolia) is a herbaceous shrub which has the highest medicinal properties and immune modulator properties. It is helpful in reducing the ama (toxins) and has anti-inflammatory properties. Guduchi is helpful in balancing tridoshas of the body, boosts up the immune system and is very beneficial in gout and in uric acid. It has rejuvenative properties and is helpful in relieving intestinal worms and is useful in skin disorders.
Jatamansi (Nardosyachys jatamansi) is a well known neuropsychiatric herb which has a bitter taste so useful in blood purifying. Helpful in depression and in psychiatric conditions. It is light and sharp and alleviates tridoshas. It has a soothing and sedative action on the nervous system. Used as a memory booster and has anticonvulsant properties. It helps to calm and relax the mind. Balances the tridoshas and helps in improving the skin complexion. Provides vitality and provides good strength to the nervous system. It also has anti-fungal properties so protects from various infections.
Brahmi (Bacopa monnieri) is a non-aromatic and creeping herb which comes under medhya rasayan. It is helpful in balancing Vata and Kapha doshas. This herb is useful for improving strength and immunity. It is used for skin diseases, anemia and inflammation. It is the best brain tonic which helps in promoting the regeneration of cells in the brain, helpful in removing toxins and promoting liver functions. Rich in antioxidants, improves memory and rejuvenates the mind. Improves neuron degeneration and pacifies the Vata and Kapha doshas.
Ashwagandha (Withania somnifera) is a short woody herb which is used as an ayurvedic healing system. It is helpful in strengthening the immune system and is helpful in balancing the Kapha and Vata doshas. Rich in antioxidants and helpful in pacifying the nervous system so helpful in anxiety and depression. Has anti-inflammatory properties and supports good heart health. Supports strengthening the respiratory system and improves thyroid health. Maintains healthy blood pressure and keeps good cholesterol on the level in the body. Promotes healthy joints and provides relief from pain and swelling, reducing the level of sugar in the body.
Kushmana (Benincasa hispida) is commonly known as wax gourd and fuzzy gourd. This plant has creeping which crawls over the ground. This herb has various properties such as it works as a brain tonic, diuretic and as anthelmintic. It is helpful in managing the Vata and Pitta doshas, helpful in providing strength and works as an aphrodisiac. It is helpful in managing the nervous system and in epilepsy and has the property of laxatives and diuresis.
Yogic Practices– follow these yogic practices which are beneficial in depression-
- Padmasana, savasana, surya namaskar
- Deep relaxation technique
Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor, this helps to increase the natural substance in the brain and is helpful in maintaining the mental stress in balance and stopping the signals. Cymbalta (Duloxetine) is useful in treating depression and anxiety, it is a group of medications which comes under serotonin and norepinephrine reuptake inhibitors. There are many herbs which are equivalent to Cymbalta which are very helpful in depression and its related disorders.