Depression is one of the most common mental health struggles around — across the globe, approximately one in 10 people will become depressed at some point during their lives. Even the most severe depression can be treated successfully, and this is usually done with talk therapy, antidepressant medications, or a combination of the two.
Antidepressants have always been quite effective, but they also used to induce side effects that many people found extremely difficult to deal with. With advances in modern medicine, antidepressants have become more tolerable, meaning they treat the symptoms depression with fewer side effects.
What are SNRIs? How do they work?
Serotonin and norepinephrine are two important neurotransmitters (sometimes explain as chemical "messengers" in the brain) that help manage a person's overall mood. "Reuptake" essentially means absorption, and inhibitor, obviously, means something that stops something else. SNRIs ultimately work by blocking the absorption of serotonin and norepinephrine, so you have more of these neurotransmitters available in your brain. This is meant to restore balance to your brain and help you relieve the symptoms of depression (as well as some other illnesses, such as anxiety and disorders that cause chronic pain).
SNRIs are quite similar to another class of antidepressants called Selective serotonin reuptake inhibitors (SSRIs). They were created with the hope that they'd be more effective while causing fewer side effects, but in practice, some depressed people do better on SSRIs while others find that SNRIs are the superior treatment for them. Research has shown that SNRIs appear to be superior to SSRIs in treating severe, as opposed to moderate and milder, depression. Both SNRIs and SSRIs are now very often first choice medications for depression.
If you are prescribed an SNRI antidepressant, you can expect to take it for a minimum six and nine months. You'll continue to take your antidepressant for a while after you start feeling better in order to prevent relapse. Some people take SNRIs for much longer, however. Your doctor will always prescribe you the lowest possible dose that is also effective.
What SNRIs are available?
The SSRIs your doctor may prescribe for depression (brand names in brackets) are:
- Venlafaxine (Effexor) was the first SNRI to be approved by the FDA in 1993
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristique)
- Milnacipran (Savella)
- Levomilnacipran (Fetzima)
- Tramadol (Ultram)
- Atomoxetine (Strattera)
What side effects can you expect if you use an SNRI antidepressant?
While side effects will vary from person to person as well as from one specific SNRI to another, the general spectrum of possibilities is similar. While this list may look scary if you have never used an antidepressant (or, really, any other prescription medication over a longer period of time) before, you should know that older antidepressants — specifically tricyclic antidepressants and monoamine oxidase inhibitors — have a larger spectrum of possible side effects.
Side effects that are possible if you take an SNRI include:
- A dry mouth
- Weakness in the muscles
- Appetite changes
- Heart palpitations
- Fluid retention
- Sexual dysfunction
- Profuse sweating
- Increased blood pressure
People who do get certain side effects while taking SSRI antidepressants at first may find that they subside after a while.
SNRIs raise the blood pressure, which can be problematic for people who already suffer from hypertension. Taking certain other meds alongside SNRIs can induce serotonin syndrome, which leads to fever, muscle tremors, and seizures. The medications that have this interaction can include tricyclic antidepressants, beta blockers, codeine, and warfarin — but this is not an exhaustive lis. SNRIs cannot be taken together with monoamine-oxidase inhibitors.
If you're pregnant, breastfeeding, or trying to conceive, let your doctor know about this as well. It's not necessarily a reason for them not to prescribe you an SNRI, but it's a factor to be taken into account. The safety of SNRIs during pregnancy hasn't been established, but that fact has to be weighed against the possible dangers of depression that is left untreated.
When you are ready to stop taking your SNRI, don't do so without your doctor's guidance. Though SNRIs aren't addictive, coming off them does produce some withdrawal symptoms like agitation and symptoms similar to the flu if you abruptly stop taking them. This is why your doctor will gradually want to reduce your dose instead.
Serotonin–norepinephrine reuptake inhibitors are a popular and effective class of antidepressants that have a very good chance of relieving your depression. As with all medications, there are possible side effects, but this newer-generation class of antidepressants is much more tolerable for most people than the older options.