SNRIs: Uses, most common brand names, and safety information
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Selective serotonin reuptake inhibitors (SSRIs) have been the most commonly prescribed medications for depression since the late 1980s. In the early 1990s researchers were looking for pharmacological alternatives to improve SSRIs’ effectiveness and tolerability. The U.S. Food and Drug Administration (FDA) approved the first and still the most commonly prescribed serotonin-norepinephrine reuptake inhibitor (SNRI), Effexor (venlafaxine), in 1993. Effexor is typically dosed twice a day and its reuptake effects are dose-dependent. It was followed in 1997 with a micro-encapsulated extended-release (Effexor XR) formulation, which is dosed once per day.
The list below includes the best SNRI treatment options approved by the FDA and their pricing:
List of SNRIs
Effexor is indicated to treat major depressive disorder, panic disorder, GAD, and SAD.
Effexor XR (venlafaxine)
Effexor XR is indicated to treat major depressive disorder, panic disorder, GAD, and SAD.
Cymbalta is indicated to treat major depressive disorder, diabetic peripheral neuropathy, GAD, and chronic musculoskeletal pain.
Pristiq is indicated to treat major depressive disorder.
Fetzima is indicated to treat major depressive disorder.
Savella is indicated to treat fibromyalgia.
What are SNRIs?
SNRIs are a class of antidepressants that inhibit the reabsorption of both serotonin and norepinephrine. They are typically used to treat symptoms of SNRIs are used for the treatment of numerous mental health disorders, including major depression and anxiety disorders.
While they work differently from SSRIs, SNRIs have been shown to be just as effective as SSRIs in the treatment of major depressive disorder in adults. Like other antidepressants, SNRIs need time to work. While you may see some improvements in sleep or energy within 1 to 2 weeks, it can take 6 to 8 weeks for your mood to improve.
How do SNRIs work?
Depression is thought to be caused by low levels of neurotransmitters such as serotonin, dopamine, and norepinephrine in your brain. Serotonin is thought to be a key hormone that stabilizes your mood, while norepinephrine helps manage your emotions, energy, and focus.
SNRIs act primarily upon serotonergic and noradrenergic receptors. They relieve symptoms of depression by the reuptake inhibition of serotonin and norepinephrine in your brain. Increasing the levels of serotonin in your brain makes you feel happier, calmer, and more focused.
SNRIs help to relieve chronic pain symptoms through noradrenergic effects similar to tricyclic antidepressants (TCAs). By blocking norepinephrine receptors in the spinal cord, SNRIs can directly inhibit neuropathic pain.
What conditions are SNRIs used to treat?
SNRIs are a class of medications used in the treatment of depression and other conditions such as:
- Major depressive disorder
- Generalized anxiety disorder (GAD)
- Panic disorder
- Social anxiety disorder (SAD)
- Diabetic peripheral neuropathy (nerve pain associated with diabetes)
- Obsessive-compulsive disorder (OCD)
- Chronic pain
- Attention deficit hyperactivity disorder (ADHD)
- Migraine prevention
Are SNRIs safe?
The use of SNRIs is relatively safe and effective when taken as prescribed. Your prescribing physician should be aware of your health conditions, including:
- Heart disease including hypertension (high blood pressure)
- Bleeding disorder
- Low sodium levels (hyponatremia)
- High blood sugar (hyperglycemia)
- Have manic episodes of bipolar disorder
- Kidney or liver impairment
- Hypersensitivity to an SNRI or its inactive ingredients
- Are pregnant or plan on becoming pregnant as they may cause fetal harm and/or death
You should also make sure they are aware of all the medications you take, including prescription drugs, over-the-counter medications, and supplements, as they may cause drug interactions:
- Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Lexapro (escitalopram)
- Monoamine oxidase inhibitors (MAOI) such as Emsam (selegiline)
- Tricyclic antidepressants (TCAs) such as Elavil (amitriptyline) and Pamelor (nortriptyline)
- St. John’s wort, antipsychotics, and any other types of antidepressant medications that increase serotonin
- Blood thinners or any medication that affects coagulation such as aspirin and Coumadin (warfarin)
Can you take SNRIs while you are pregnant or breastfeeding?
Withdrawal symptoms (poor feeding, low blood sugar, hypothermia, irritability) have been reported in infants whose mothers were taking an SNRI, especially during their third trimester. Untreated depression may also have a negative effect on the infant.
Most SNRIs are passed into the breast milk. If you are pregnant or breastfeeding, you should only take an SNRI if the benefits of taking them outweigh the risk to you or your baby. You should always discuss the risks and benefits of any medication you need with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.
What are the common side effects of SNRIs?
The most common possible adverse effects of SNRIs include:
- Dry mouth
- Sexual dysfunction including erectile dysfunction
- Weight gain
- Weight loss
- Blurred vision
- Increased heart rate
SNRIs can rarely cause serious side effects, including:
- Serotonin syndrome, which can be life-threatening
- Increased risk of suicidal thoughts or behavior, especially in adolescents and young adults under the age of 25
- Increased risk of cardiovascular events such as heart attack and stroke
- Increased risk of seizures
- Mixed/manic episodes in patients with bipolar disorder
- Hyponatremia (low sodium levels)
- Angle-closure glaucoma
- Discontinuation syndrome if treatment is stopped suddenly
This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.
How much do SNRIs cost?
SNRIs are very expensive with an average cost of around $1,000-2,000 per year.
You can purchase SNRIs for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.
Related resources for SNRIs