Cymbalta vs. Remeron
See how Cymbalta and Remeron compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Cymbalta (duloxetine) is an SNRI approved for depression, anxiety, and several chronic pain conditions, while Remeron (mirtazapine) is FDA-approved only for major depressive disorder.
Remeron causes more sedation and appetite increase than Cymbalta, while Cymbalta more often causes nausea and requires caution with liver or kidney disease.
Both carry a boxed warning for suicidal thoughts in children and young adults, but doctors choose between them based on symptoms like pain, anxiety, sleep problems, or appetite loss.
Cymbalta vs. Remeron Drug Summary
Cymbalta
Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor (SNRI) approved for major depressive disorder, generalized anxiety disorder, and chronic pain conditions like diabetic neuropathy and fibromyalgia. It comes as a delayed-release capsule taken once or twice daily, with the dose increased over the first two weeks of treatment.
Remeron
Remeron (mirtazapine) is a tetracyclic antidepressant approved for major depressive disorder in adults. It is taken as a tablet or dissolvable tablet, usually once daily at bedtime, with the dose raised gradually over several weeks based on response.
Cymbalta vs. Remeron Side Effects
Cymbalta
Remeron
Cymbalta vs. Remeron Dosage
Cymbalta
Remeron
| STAGE | DOSE | WHEN |
| Starting dose | 30 mg once daily | Week 1 |
| Maximum dose | 60 mg twice daily | If needed |
| Dose changes | 2 increases | Every week |
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | Week 1 |
| Maximum dose | 45 mg once daily | If needed |
| Dose changes | 2 increases | Every week |
Cymbalta
| STAGE | DOSE | WHEN |
| Starting dose | 30 mg once daily | Week 1 |
| Maximum dose | 60 mg twice daily | If needed |
| Dose changes | 2 increases | Every week |
Remeron
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | Week 1 |
| Maximum dose | 45 mg once daily | If needed |
| Dose changes | 2 increases | Every week |
Cymbalta vs. Remeron Indications
Cymbalta
Cymbalta is FDA-approved for major depressive disorder and generalized anxiety disorder, as well as chronic pain conditions including diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain such as osteoarthritis and low back pain. This makes it one of the few antidepressants also approved to treat ongoing physical pain.
Major depressive disorder
Generalized anxiety disorder
Diabetic peripheral neuropathic pain
Fibromyalgia
Chronic musculoskeletal pain (including osteoarthritis and low back pain)
Remeron
Remeron is FDA-approved only for major depressive disorder in adults. Doctors sometimes prescribe it off-label for insomnia, anxiety disorders, or to stimulate appetite in people who are underweight, though these uses are not FDA-approved.
Major depressive disorder (FDA-approved)
Insomnia (off-label)
Anxiety disorders (off-label)
Appetite or weight stimulation (off-label)
Nausea in pregnancy (off-label)
Cymbalta vs. Remeron Pros and Cons
Cymbalta
Cymbalta's SNRI mechanism gives it FDA approval for both psychiatric symptoms and chronic pain, making it a common choice for people with depression alongside conditions like fibromyalgia or nerve pain. It requires caution in people with liver disease or significant kidney impairment and tends to cost more than generic mirtazapine.
Pros
FDA-approved for chronic pain conditions like diabetic neuropathy and fibromyalgia, not just depression
Also approved to treat generalized anxiety disorder
Less likely to cause weight gain or heavy sedation than Remeron
Once- or twice-daily dosing without a strict bedtime requirement
Cons
Requires caution and monitoring in people with liver disease
Not recommended for people with severe kidney impairment
Nausea is common, especially during the first few weeks
Typically costs more than generic mirtazapine, roughly $130 to $500 per month before savings programs, versus $10 to $40 for generic Remeron
Remeron
Remeron's sedating profile makes it useful at bedtime and appealing for people who also struggle with insomnia or poor appetite, though it is approved only for depression itself. Generic mirtazapine is widely available and inexpensive, but it carries a higher likelihood of weight gain and sedation than Cymbalta.
Pros
Generic mirtazapine is inexpensive, typically $10 to $40 per month, compared to $130 to $500 for Cymbalta
Sedating effect can help with sleep, often used off-label for insomnia
Available as an orally disintegrating tablet for people with swallowing difficulty
Simple three-step dosing schedule with fewer maintenance adjustments
Cons
Only FDA-approved for depression; other uses are off-label
Significant sedation and appetite increase often lead to weight gain
Rare but serious risk of neutropenia requiring blood monitoring
Not indicated for anxiety or chronic pain conditions, unlike Cymbalta
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