(FDA approved in bold)

• Depression
  
• Generalized anxiety disorder
  
• Panic disorder
  
• Social phobia
  
• Migraine or tension-type headache prophylaxis
  
• Diabetic neuropathy
  
• Other painful peripheral neuropathies
  
• Cancer pain (neuropathic)
  
• Depression secondary to stroke
  
• Stress urinary incontinence
  
• Fibromyalgia
  
• Binge-eating disorder
  
• Insomnia
  
• Post-traumatic stress disorder
  
• ADHD
  
• Perimenopausal/menopausal hot flashes

• Blocks serotonin and norepinephrine reuptake pumps, increasing their levels within hours, but antidepressant effects take weeks. Effect is more likely related to adaptive changes in serotonin and norepinephrine receptor systems over time
  
• Weakly blocks dopamine reuptake pump (dopamine transporter)

• Migraines – effective in as little as 2 weeks, but can take up to 10 weeks on a stable dose to see full effect
  
• Tension-type headache prophylaxis – effective in 4–8 weeks
  
• Neuropathic pain – usually some effect within 4 weeks
  
• Diabetic neuropathy – may have significant improvement with high doses within 6 weeks
  
• Depression – 2 weeks but up to 2 months for full effect

• Migraine/tension-type headache – goal is a 50% or greater reduction in headache 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 symptoms, but usually does not produce remission. Continue to use and monitor for AEs
  
• Diabetic neuropathy – the goal is to reduce pain intensity and reduce use of analgesics, but usually does not produce remission. Continue to use and maintain strict glycemic control and diabetic management
  
• Depression – continue to use and monitor for AEs. May continue for 1 yr following first depression episode or indefinitely if >1 episode of depression

• Increase to highest tolerated dose
  
• Migraine and tension-type 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

• Headache: 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

• Check blood pressure at baseline and when increasing dose