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SNRIs, Serotonin Antagonists and SSRIs – Antidepressants

by Pravin Shukle, MD
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    In terms of the new class of drugs called the serotonin/ norepinephrine reuptake inhibitors. Take a look here. So now these drugs are getting more and more specific to act on either norepinephrine or serotonin, and this group of drug acts on both relatively equally. So in terms of the profile, they are similar to the tricyclic antidepressants but because they are more specific, we have fewer side effects peripherally. Now SNRI's do not have a blocking effect on the peripheral tissues and in particular they don't have blocking effects on the post-synaptic neuron like the other drugs. The classic SNRI is Cymbalta. It's a very widespread drug used almost everywhere in the world. It's used in major depressive disorders. It's also interestingly used in neuropathic pain. So many of my patients who are diabetic who have neuropathic pain are on this drug. The most popular antidepressant in Canada is venlafaxine or Effexor or Effexor XR. It is a heavily prescribed drug because it has relatively few side effects and it has less affinity for norepinephrine than duloxetine. The side effects, it do include a decrease in blood pressure which sometimes is a benefit because a lot of our patients have high blood pressure. The side effect profile is similar to the newest class of drugs which is called the SSRI's which we will talk about later. There are some withdrawal symptoms. So if a patient misses even one dose you can see withdrawal symptoms develop. So the drug company developed Effexor XR which is the extended release version of this drug which somewhat mitigates that disadvantage but it's still there. So it's important that this drug be used in those patients who are very compliant or very adherent to medication regimens. Let's talk about the serotonin antagonists. The acronym...

    About the Lecture

    The lecture SNRIs, Serotonin Antagonists and SSRIs – Antidepressants by Pravin Shukle, MD is from the course CNS - Pharmacology. It contains the following chapters:

    • Serotonin/Norepinephrine Reuptake Inhibitors
    • Selective Serotonin Reuptake Inhibitors

    Included Quiz Questions

    1. Duloxetine: withdrawal symptoms
    2. Venlafaxine: withdrawal symtoms
    3. Duloxetine: neuropathic pain treatment
    4. Duloxetine: diabetic neuropathy
    5. Venlafaxine: decreased blood pressure
    1. Improved sleep quality
    2. Lowers blood pressure
    3. Improves erectile dysfunction
    4. Assists with smoking cessation
    5. Lowers the seizure threshold
    1. Sedation and dry mouth
    2. Headache and nausea
    3. "The Jitters"
    4. Akathisia and dyskinesia
    5. Anxiety and agitation
    1. 34 year old with depression, currently being treated with a Monoamine Oxidase Inhibitor (MAOI).
    2. 25 year old with depression and is interested in smoking cessation.
    3. 75 year old with depression, currently being treated with a TCA.
    4. 42 year old with depression who enjoys aged cheese and red wine.
    5. 31 year old with depression who failed a trial of SSRI's in the past.

    Author of lecture SNRIs, Serotonin Antagonists and SSRIs – Antidepressants

     Pravin Shukle, MD

    Pravin Shukle, MD


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    By Tinashe M. on 09. June 2017 for SNRIs, Serotonin Antagonists and SSRIs – Antidepressants

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