QUESTION: I have a 42yo female patient with anxiety/depression and lots of COMT/MAO SNPs. She recently was put on Cymbalta and it is working really well. This surprised me because I would expect a norepinephrine re-uptake inhibitor to potentially exacerbate her anxiety if she has more trouble metabolizing catecholamines. Can you shed any light on this?
ANSWER: It is an SSNRI so the “S” effect is winning. Often in the SSNRI the “S” is the bigger effector anyway