Duloxetine (Cymbalta) versus...

Duloxetine (Cymbalta) vs. Escitalopram (Lexapro)

Major depressive disorder

Escitalopram may be superior to duloxetine in the treatment of major depression and at least as effective and better tolerated in long-term treatment of major depressive disorder1. Withdrawal due to the side effects occurs more frequently with duloxetine3.

Results of comparative study of escitalopram versus duloxetine in major depressive disorder1 Duloxetine Escitalopram
Regimen 60 mg/day for 24 weeks 20 mg/day for 24 weeks
Mean change from baseline in total MADRS score at week 8
Proportion of responders at week 8
Mean change from baseline in total MADRS score at week 24
Withdrawal rates due to adverse events
Adverse events:
- insomnia
- constipation



Results of randomized, double-blind, placebo-controlled trial in patients with major depressive disorder2 Duloxetine Escitalopram
Regimen 120 mg/day for 8 months 20 mg/day for 8 months
Probability of remission at 8 months
Sleep improvement   escitalopram had a statistically significant advantage over duloxetine in improving sleep.
Rates of discontinuation due to adverse events
Adverse events tended to emerge early in treatment (e.g., nausea, dry mouth) tended to emerge later in treatment (e.g., diarrhea, weight increase)
Mean changes from baseline to study endpoint for:

+3.05 beats per minute

-0.89 beats per minute
systolic blood pressure +3.73 mmHg +0.31 mmHg
diastolic blood pressure +0.81 -0.24
Change in weight +0.61 kg +1.83 kg


Duloxetine (Cymbalta) vs. Paroxetine (Paxil)

Major depressive disorder

In clinical study duloxetine treated patients (80 and 120 mg/day) showed significantly greater improvement in the HAMD(17) total score at week 8 compared with placebo. Paroxetine was not significantly different from placebo on mean change on the HAMD(17). Duloxetine 120 mg/day also showed significant improvement on most secondary efficacy measures (six of nine) compared with placebo while duloxetine 80 mg/day (three of nine) and paroxetine (three of nine) were significantly superior to placebo on fewer secondary measures. Both duloxetine doses were non-inferior to paroxetine 4.

Premature ejaculation

Results of randomized trial in patients diagnosed with lifelong premature ejaculation 7 Duloxetine Paroxetine
Regimen 40 mg once a day for a month 20 mg once a day for a month
Increase of intravaginal ejaculatory latency time from baseline to treatment 117% 126%
International index of erectile function questionnaire at baseline to treatment scores no statistically significant difference between two treatment groups

Side effects

Nausea occurs more frequently with duloxetine. The incidence of sexual dysfunction is significantly higher with paroxetine 5. Insomnia occurs significantly more frequently with duloxetine than with paroxetine (19.8% vs. 8.0% respectively) 6.

Further reading
  • 1. Wade A, Gembert K, Florea I. A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder. Curr Med Res Opin. 2007 Jul;23(7):1605-14. PubMed
  • 2. Pigott TA, Prakash A, Arnold LM, Aaronson ST, Mallinckrodt CH, Wohlreich MM. Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin. 2007 Apr 27. PubMed
  • 3. Khan A, Bose A, Alexopoulos GS, Gommoll C, Li D, Gandhi C. Double-blind comparison of escitalopram and duloxetine in the acute treatment of major depressive disorder.Clin Drug Investig. 2007;27(7):481-92. PubMed
  • 4. Perahia DG, Wang F, Mallinckrodt CH, Walker DJ, Detke MJ. Duloxetine in the treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Psychiatry. 2006 Sep;21(6):367-78. PubMed
  • 5. Delgado PL, Brannan SK, Mallinckrodt CH, Tran PV, McNamara RK, Wang F, Watkin JG, Detke MJ. Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder. J Clin Psychiatry. 2005 Jun;66(6):686-92. PubMed
  • 6. Goldstein DJ, Lu Y, Detke MJ, Wiltse C, Mallinckrodt C, Demitrack MA. Duloxetine in the treatment of depression: a double-blind placebo-controlled comparison with paroxetine. J Clin Psychopharmacol. 2004 Aug;24(4):389-99. PubMed
  • 7. Ozcan L, Polat EC, Otunctemur A, Ozbek E. Duloxetine, dual serotonin and norepinephrine reuptake inhibitor, versus paroxetine, selective serotonin reuptake inhibitor, in the treatment for premature ejaculation. Int Urol Nephrol. 2015 Feb;47(2):283-7. PubMed

Published: March 31, 2008
Last updated: February 19, 2017


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