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- Title
Serotonin norepinephrine reuptake inhibitors: a brief review of the class.
- Authors
Thase ME
- Abstract
Major depressive disorder (MDD) is one of the leading causes of disability worldwide and, although many treatment options are avail-able, the percentage of patients brought to remission remains low Newer antidepressants, including serotonin norepinephrine reuptake inhibitors (SNRIs), have been developed to address this unmet need. Extrapolating from studies of older 'dual reuptake inhibitors' such as the tricyclic antidepressant (TCA) clomipramine, it was hoped that therapy with SNRIs would result in high rates of response and remission and relieve a broad array of associated symptoms, yet have a more favorable safety profile than the TCAs. The SNRI class now includes four medications: venlafaxine, duloxetine, milnacipran, and desvenlafaxine. Among these medications, milnacipran is not United States Food and Drug Administration-approved for the treatment of MDD and desvenlafaxine, which is the succinate salt of O-desmethylvenlafaxine (ie, 0DV, the principal active metabolite of venlafaxine), was introduced in early 2008. All four SNRIs have established efficacy in MDD, and several members of the class also have been shown to reduce symptoms commonly associated with MDD, including anxiety and pain. When the first SNRI, venlafaxine, was introduced in 1994, it was widely considered a second-line treatment option (ie, used after selective serotonin reuptake inhibitor failure); this ranking was mainly based on dosing and tolerability issues. Introduction of the extended-release formulation of venlafaxine and duloxetine (in 1997 and 2004, respectively, in the US) have addressed some, but not all, of these concerns. Although the four drugs are grouped together as a class, there are important differences among the SNRIs in terms of pharmacologic and pharmacokinetic characteristics. Thus, SNRIs are not interchangeable and vary in their safety and tolerability profiles and, in all likelihood, utility for particular patients.
- Publication
Primary Psychiatry, 2009, Vol 16, Issue 5, p1
- ISSN
1082-6319
- Publication type
Journal Article