The main uses of<unk>  are in major depressive disorder, generalized anxiety disorder, neuropathic pain, chronic musculoskeletal pain, and fibromyalgia.<unk>  is recommended as a first-line agent for the treatment of chemotherapy-induced neuropathy by the American Society of Clinical Oncology, as a first-line therapy for fibromyalgia in the presence of mood disorders by the German Interdisciplinary Association for Pain Therapy, as a Grade B recommendation for the treatment of diabetic neuropathy by the American Association for Neurology and as a level A recommendation in certain neuropathic states by the European Federation of Neurological Societies. A 2014 Cochrane review concluded that<unk>  is beneficial in the treatment of diabetic neuropathy and fibromyalgia but that more comparative studies with other medicines are needed. The French medical journal Prescrire concluded that<unk>  is no better than other available agents and has a greater risk of side effects. Major depressive disorder<unk>  was approved for the treatment of major depression in 2004. While<unk>  has demonstrated improvement in depression-related symptoms compared to placebo, comparisons of<unk>  to other antidepressant medications have been less successful. A 2012 Cochrane Review did not find greater efficacy of<unk>  compared to SSRIs and newer antidepressants. Additionally, the review found evidence that<unk>  has increased side effects and reduced tolerability compared to other antidepressants. It thus did not recommend<unk>  as a first line treatment for major depressive disorder, given the (then) high cost of<unk>  compared to inexpensive off-patent antidepressants and lack of increased efficacy.<unk>  appears less tolerable than some other antidepressants. Generic<unk>  became available in 2013. Generalized anxiety disorder<unk>  is more effective than placebo in the treatment of generalized anxiety disorder (GAD). A review from the Annals of Internal Medicine lists<unk>  among the first line drug treatments along with citalopram, escitalopram, sertraline, paroxetine, and venlafaxine. Diabetic neuropathy<unk>  was approved for the pain associated with diabetic peripheral neuropathy (DPN), based on the positive results of two clinical trials. The average daily pain was measured using an 11-point scale, and<unk>  treatment resulted in an additional 1–1.7 points decrease of pain as compared with placebo. At least 50% pain relief was achieved in 40–45% of the<unk>  patients vs. 20–22% of placebo patients. Pain decreased by more than 90%, in 9–14% of<unk>  patients vs. 2–4% of placebo patients. Most of the response was achieved in the first two weeks on the medication.<unk>  slightly increased the fasting serum glucose; this effect was deemed to be of "minimal clinical significance", however. The comparative efficacy of<unk>  and established pain-relief medications for DPN is unclear. A systematic review noted that tricyclic antidepressants (imipramine and amitriptyline), traditional anticonvulsants and opioids have better efficacy than<unk> .<unk> , tricyclic antidepressants and anticonvulsants have similar tolerability while the opioids caused more side effects. Another review in Prescrire International considered the moderate pain relief achieved with<unk>  to be clinically insignificant and the results of the clinical trials unconvincing. The reviewer saw no reason to prescribe<unk>  in practice. The comparative data collected by reviewers in BMC Neurology indicated that amitriptyline, other tricyclic antidepressants and venlafaxine may be more effective. The authors noted that the evidence in favor of<unk>  is much more solid, however. A Cochrane review concluded that the evidence in support of<unk> 's efficacy in treating painful diabetic neuropathy was adequate, and that further trials should focus on comparisons with other medications. Fibromyalgia and chronic pain A review of<unk>  found that it reduced pain and fatigue, and improved physical and mental performance compared to placebo. The U.S. Food and Drug Administration (FDA) approved the drug for the treatment of fibromyalgia in June 2008. It may be useful for chronic pain from osteoarthritis. On 4 November 2010, the U.S. Food and Drug Administration (FDA) approved<unk>  to treat chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain. Stress urinary incontinence<unk>  failed to receive US approval for stress urinary incontinence amid concerns over liver toxicity and suicidal events; it was approved for this use in the UK, however, where it is recommended as an add-on medication in stress urinary incontinence instead of surgery. The safety and utility of<unk>  in the treatment of incontinence has been evaluated in a series of meta analyses and practice guidelines. * A 2017 meta-analysis found that harms are at least as great if not greater than the benefits. * A 2013 meta-analysis concluded that<unk>  decreased incontinence episodes more than placebo with people about 56% more likely than placebo to experience a 50% decrease in episodes. Adverse effects were experienced by 83% of<unk> -treated subjects and by 45% of placebo-treated subjects. * A 2012 review and practice guideline published by the European Association of Urology concluded that the clinical trial data provides Grade 1a evidence that<unk>  improves but does not cure urinary incontinence, and that it causes a high rate of gastrointestinal side effects (mainly nausea and vomiting) leading to a high rate of treatment discontinuation. * The National Institute for Clinical and Health Excellence recommends (as of September 2013) that<unk>  not be routinely offered as first line treatment, and that it only be offered as second line therapy in women wishing to avoid therapy. The guideline further states that women should be counseled regarding the drug's side effects.
Duloxetine
Atomoxetine
Dapoxetine
Fluoxetine
Edivoxetine
Vortioxetine
Guanfacine
Nabilone