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Vol 19, No 2 (2022)
Review paper
Published online: 2022-11-22
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SNRI antidepressant medication: evidence-based and experience-based medicine

Agata Szulc
Psychiatria 2022;19(2):128-143.

Abstract

Serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants are drugs registered for the treatment of depression and anxiety disorders. These drugs affect the reuptake of both serotonin and noradrenaline. There are two such drugs available in Poland: venlafaxine and duloxetine. The mechanism of venlafaxine’s antidepressant effect in humans is believed to be related to increased neurotransmitter activity in the central nervous system (CNS). Preclinical studies have shown that venlafaxine and its major metabolite (O-demethylenlafaxine, ODV) are serotonin and norepinephrine reuptake inhibitors. Venlafaxine is also a weak dopamine reuptake inhibitor. Venlafaxine acts by blocking neurotransmitter transport and reuptake proteins and acts through postsynaptic terminals, ultimately enhancing postsynaptic stimulation. Duloxetine is an inhibitor of serotonin (5-HT) and norepinephrine (NA) reuptake. It weakly inhibits dopamine reuptake (e.g. in frontal regions), and has no significant affinity for histamine, dopaminergic, cholinergic and adrenergic receptors. Duloxetine dose-dependently increases extracellular serotonin and norepinephrine concentrations in different brain areas in animals. In this paper we will discuss the most important literature data concerning the above mentioned drugs, as well as define a patient profile that could most benefit from individually selected treatment.

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