SNRI

Introduction

The so-called serotonin noradrenaline reuptake inhibitors (SNRI) are mainly drugs used in the treatment of depression. The most important active ingredients in this class of drugs are venlafaxine and duloxetine. The name refers to the ability of these drugs to exert their effect on both serotonin and noradrenalin levels in the central nervous system.

This property distinguishes the serotonin noradrenaline reuptake inhibitors from other antidepressants which act exclusively on one of the two substances. “Reuptake” describes the reuptake of messenger substances, in this case noradrenalin or serotonin, into the nerve cells, while the term “inhibitor” is a technical term for an inhibitor. In summary, serotonin noradrenalin reuptake inhibitors are inhibitors of the reuptake of serotonin and noradrenalin into the nerve cells.

The available drugs

The active ingredient venlafaxine is available under the following trade names: Efexor®, Trevilor® retard, venlafaxine generics The active ingredient duloxetine is available under the trade names Ariclaim, Cymbalta®, Duloxalta®, Xeristar®, Yentreve®, generic duloxetine Milnacipran under Milna-neurax®, Ixel, and numerous trade names abroad: Salvella®, Toledomin, Joncia, Tivanyl®, Dalcipran

  • Efexor®, Trevilor® retard, generic venlafaxine
  • Ariclaim, Cymbalta®, Duloxalta®, Xeristar®, Yentreve®, generic duloxetine
  • Milna-neurax®, Ixel, and numerous trade names abroad: Salvella®, Toledomin, Joncia, Tivanyl®, Dalcipran

Indication and application of SNRI

Serotonin-noradrenalin-reuptake inhibitors such as venlafaxine or duloxetine can be used for the treatment of depression, both in acute and long-term therapy. In addition to serotonin noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors and selective noradrenaline reuptake inhibitors exist for the treatment of depression. Which of these drugs is used depends on the form of depression in the affected patient.

For example, a lack of serotonin in certain areas of the brain is primarily blamed for the depressive mood and joylessness of the patients. In contrast, a norepinephrine deficiency is said to cause a lack of drive and lack of concentration. Depending on which of the symptoms predominate in the patient, the choice will therefore be between a serotonin reuptake inhibitor, a norepinephrine reuptake inhibitor or a mixed inhibitor that inhibits the reuptake of both substances.

However, these classifications are to be understood more as basic decision-making aids than as definitive “black and white criteria”. However, the described stimulating effect of selective norepinephrine reuptake inhibitors also has disadvantages. Particularly in severely depressed patients, their use can provoke self-endangering actions, including suicide, by increasing the drive much more than the mood. Because of this risk, selective norepinephrine reuptake inhibitors are now used only very rarely for the treatment of depression, for example in patients with severe drive disorders and unrestricted mood. In addition to their use in the treatment of depression, serotonin norepinephrine reuptake inhibitors are also used in patients with social phobia or those with obsessive-compulsive disorders.