In a double-blind, randomized, double-blind clinical trial, patients with refractory symptoms that have not received treatment before, referral to Rasool Akram Hospital in year 96, will be included. The criteria for entering the study included people over 18 years of age with typical symptoms of reflux or endoscopic diagnosis of reflux referring to Rasul Akram Hospital, 1995. Exit criteria include recent and previous use of non-steroidal anti-depressant drugs and anxiety or anti-inflammatory drugs, Previous use of proton pump inhibitors, history of allergy to any of the used drugs, etiology of reflux symptoms, previous or recent history of anxiety or severe depression, history of opium and alcohol consumption, history of systemic diseases (heart disease, pulmonary disease, Kidney failure, cancer, myopathy, scleroderma, etc.), previous history of AS Malignant Gastrointestinal Surgery, Previous history of gastric ulcer or duodenum in endoscopy, obese, pregnant. For patients after GERD final diagnosis, two scoring bell questionnaires are used to assess anxiety and depression and in the absence of severe anxiety and depression, the questionnaire of reflux symptoms is filled up. Then, using a randomized table, the numbers are divided into two groups, so that a group Lansoprazole (30 mg / day) plus placebo and the second group of lansoprazole (30 mg / day) with duloxetine (30 mg / day) for up to four weeks. After the end of the treatment period, the symptoms are again based on each questionnaire Previous treatments are evaluated and compared between the two groups. It should be noted that the placebo is prepared by the pharmaceutical company