Serotonin and Norepinephrine Reuptake Inhibitor
How it works:
Boosts the effects of two neurotransmitters found in the brain called serotonin and norepinephrine.
What makes it unique:
Dosing impacts what neurotransmitters are affected. At low doses, it mainly increases serotonin, as the dosing increases, in increases norepinephrine’s effect and at high doses, it even increases dopamine’s effect by a bit.
Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Blood pressure can be increased with this medication, especially as the dose increases. Venlafaxine may also cause nervousness, insomnia, and sedation.
Rare side effects include hyponatremia, seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.
How effective is it:
(1) A British analysis of 32 trials compared Venlafaxine to other antidepressants. 5,562 patients were compared. The analysis showed that Venlafaxine had greater efficacy than SSRIs.
(2) An older analysis from 1999 compared Venlafaxine with other antidepressants in the SSRI and TCA drug classes. 44 trials were reviewed. Successful treatment was defined as a 50% or more decrease in HAM-D or MADRS depression scales. Venlafaxine (XR) had a 73.7% success rate compared to 61.1% in the SSRI group and 57.9% in the TCA group.
This is commonly seen as only a few SNRI medication are available. This is usually tried after a patient has not responded to an SSRI or two, but it can be used right off the bat as well. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.
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1. Smith D, Dempster C, Glanville J. Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: a meta-analysis. Br J Psychiatry. 2002 May;180:396-404.
2. Einarson TR1, Arikian SR, Casciano J, et al. Comparison of extended-release venlafaxine, selective serotonin reuptake inhibitors, and tricyclic antidepressants in the treatment of depression: a meta-analysis of randomized controlled trials. Clin Ther. 1999 Feb;21(2):296-308.