Duloxetine is a serotonin-norepinephrine reuptake inhibitor. It is effective for major depressive disorder and has been shown to be as effective as venlafaxine for generalized anxiety disorder (GAD).
Duloxetine failed the US approval for stress urinary incontinence amidst concerns over liver toxicity and suicidal events; however, it was approved for this indication in Europe.
Duloxetine alleviates pain associated with diabetic neuropathy and fibromyalgia. Its efficacy relative to established treatments such as anticonvulsants and tricyclic antidepressants has not yet been studied.
The role of duloxetine in the treatment of various conditions has led to divergent opinions. Owing to a large number of side effects and lack of clear advantage over existing medications, some reviews have concluded that duloxetine "should not be used" for stress urinary incontinence and "currently has no place in the treatment of depression or diabetic neuropathy."
At the same time, some professional guidelines recommend duloxetine in chronic neuropathic pain, especially diabetic polyneuropathy for which it is first-line treatment, and as an add-on medication in stress urinary incontinence instead of surgery.