When should SNRI not be given?

SNRIs must not be used if an intolerance and allergic reaction to the active substance has occurred. The use of so-called MAOIs, the irreversible monoamine oxidase inhibitors, is also considered a strict contraindication.These are drugs used to treat depression or Parkinson’s disease. If taken at the same time or if taken less than two weeks ago, life-threatening side effects may occur.

The group of MAOIs includes drugs such as tranylcypromine or Selegelin. Special caution is required when taking other substances that affect the serotoninergic system in addition to SNRI. This can lead to the so-called serotonin syndrome, which is sometimes life-threatening.

Patients suffering from increased intraocular pressure, high blood pressure or heart problems are also advised to take SNRIs with increased caution. Furthermore, blood clotting disorders, elevated cholesterol levels and diabetes are considered relative contraindications. Patients suffering from the above-mentioned diseases or taking medication should inform their physician in detail about them. The doctor will carefully weigh up the benefits and risks and, if necessary, adjust the prescription.

What is the difference to SSRIs?

In addition to SNRIs, SSRIs are the most commonly used in the treatment of depression today. SSRIs stand for “Selective Serotonin Reuptake Inhibitors. Representatives of this group are, for example, the drugs fluoxetine, fluvoxamine, paroctein, setralin, citalopram or escitalopram.

SSRIs act on the serotoninergic system, inhibiting the reuptake of serotonin and thereby enhancing its effect. SNRI also act on serotonin transporters, but also on the reuptake of norepinephrine. There is no clear evidence that SNRIs are more effective than SSRIs; the choice of drug determines the indication and tolerability.

In general, SNRIs are more likely to be used in patients in whom an increase in drive is desired, as noradrenaline appears to have a positive effect on energy levels and attention. Patients with suicidal thoughts are more likely to be advised against SNRIs, as the risk of suicidal behaviour may be increased by the drugs. How patients react to the respective antidepressants is very individual and depends on various factors.

Some patients show intolerance to a certain group, and a change may be advisable. Patients should discuss with their doctor an effective and well-tolerated medication. Alcohol is an important topic in the context of depression.

Many alcoholics are depressed and many people who suffer from depression take to the bottle. The mechanism behind this vicious circle becomes clear when we look at the processes of our nervous system: alcohol counteracts the serotonin deficiency underlying depression in the short term by increasing serotonin levels in the central nervous system. In this way, the mood of the patients is improved and sociability is promoted – this is precisely what depressive patients find very pleasant, since social contacts often suffer from depression as well.

All in all, regular alcohol consumption causes an additional long-term reduction in serotonin levels. In order to combat this increased depression, the patient starts drinking again, and so on – the vicious circle is in full swing. It is precisely this mechanism that makes alcohol consumption a sensitive issue for depressed people.

In fact, as with all psychotropic drugs in general, the consumption of alcohol should be strictly avoided when treated with serotonin-noradrenalin-reuptake inhibitors. Otherwise, in the long run, the effects of alcohol and SNRIs on the central nervous system can add up and lead to serious interactions. This can lead to seizures and in extreme cases even death. For this reason, depressed patients with alcohol dependency should not only undergo depression therapy but also alcohol withdrawal and therapy.