(FDA approved in bold)

• Major depressive disorder (MDD)
  
• Generalized anxiety disorder (GAD)
  
• Obsessive-compulsive disorder
  
• Premenstrual dysphoric disorder
  
• Bulimia nervosa
  
• Panic disorder
  
• Bipolar depression [in combination with olanzapine (Symbyax)]
  
• Migraine prophylaxis
  
• Chronic daily headache (CDH)
  
• Hot flashes
  
• Pain in peripheral neuropathies
  
• Post-traumatic stress disorder
  
• Raynaud phenomenon

• Blocks serotonin reuptake pumps, increasing their levels within hours, but antidepressant effects take weeks. Effect is likely related to adaptive changes in serotonin receptor systems and desensitization of serotonin 1A receptors
  
• Weakly blocks dopamine and norepinephrine reuptake pumps, and has antagonist properties at serotonin 2C receptors which may increase norepinephrine and dopamine neurotransmission

• Migraine/CDH, neuropathic pain – effective in as little as 2 weeks, but can take up to 10 weeks on a stable dose to see full effect

• Migraine/CDH – goal is a 50% or greater reduction in migraine frequency or severity. Consider tapering or stopping if headaches remit for more than 6 months or if considering pregnancy
  
• Neuropathic pain – the goal is to reduce pain intensity and reduce use of analgesics, but usually does not produce remission

• Increase to highest tolerated dose
  
• Headache: address other issues, such as medication-overuse, other coexisting medical disorders, such as anxiety, and consider changing to another agent or adding a second agent
  
• Neuropathic pain: either change to another agent or add a second agent

• Migraine/CDH: For some patients, low-dose polytherapy with 2 or more drugs may be better tolerated and more effective than high-dose monotherapy. May use in combination with AEDs, antihypertensives, natural products, and non-medication treatments, such as biofeedback, to improve headache control
  
• Neuropathic pain: AEDs, such as gabapentin, pregabalin, carbamazepine, and capsaicin, mexiletine are agents used for neuropathic pain. Opioids are appropriate for long-term use in some cases but require careful monitoring

• Not required