Selective serotonin reuptake inhibitors (SSRIs) and serotonin & noradrenaline reuptake inhibitors (SNRIs): use and safety
1. Overview
1.1 Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are widely used in the treatment of depression, anxiety disorders and some personality disorders. They act by inhibiting the reuptake of serotonin into the presynaptic cell, increasing the levels of serotonin available for binding to postsynaptic receptors and/or prolonging the effects of serotonin.
The SSRIs prescribed in the UK are:
- fluoxetine (brand names Prozac, Oxactin)
- paroxetine (Seroxat)
- citalopram (Cipramil)
- escitalopram (Cipralex)
- sertraline (Lustral)
- fluvoxamine (Faverin)
1.2 Selective serotonin and noradrenaline reuptake inhibitors (SNRIs)
Dual action serotonin and noradrenaline reuptake inhibitors (SNRIs) are a class of antidepressant drug used to treat major depression and other disorders. They are a newer class of drug than selective serotonin reuptake inhibitors (SSRIs), but act in a similar way, altering neurotransmitter levels in the brain, or prolonging their effects. SNRIs act particularly on serotonin and noradrenaline.
The SNRIs prescribed in the UK are:
- venlafaxine – brand names:
- Bonilux
- Depefex
- Foraven
- Politid
- Venlalic
- Winfex
- Efexor
- duloxetine – brand names
- Cymbalta
- Yentreve
Venlafaxine was the first SNRI to be marketed (in 1994) and is the most commonly used medicine in this class. It is used to prevent recurrence of major depressive episodes and to treat:
- major depressive disorders
- generalised anxiety disorder
- social anxiety disorder and panic disorder
For the treatment of major depressive disorder, generalised anxiety disorder and diabetic peripheral neuropathic pain, duloxetine is marketed as Cymbalta. For the treatment of stress urinary incontinence, duloxetine is marketed as Yentreve. Cymbalta and Yentreve should be prescribed for their correct intended use, and should not be used together.
