Serotonin Noradrenaline Reuptake Inhibitors ( SNRIs) - Mechanism of Action and Side effects

[@BEyourselfhappy]

I take 'Chlorphenamine' - which has the SSNRI actions - and it just works for my brain! This is the most wonderful video and narrator explaining how it works. Thank you so much!

[@PsychiatrySimplified]

Brian Esdale thank you for your feedback. Here is a summary of common antidepressants if interested in reading more - psychscenehub.com/psychinsights/summary-21-antidepressants-network-metaanalysis/

[@PirateWW]

Thank you do much for explaining how SNRIs work!! There is a lot of info re SSRIs but it is hard to find info which clearly states the action of SNRIs. Very clearly presented and easy to follow and understand!!! Thank you again!!

[@jacklinemmochi6433]

Thank you for the information.

[@PsychiatrySimplified]

Any time!

[@pauline3775]

But i thought that a high level of norepinephrine can cause anxiety and panic disorder ?

[@PsychiatrySimplified]

It's a really good point. Anxiety can be treated through serotonergic means through action on the limbic system ( ‘ blunting effect’) reducing anxiety. It is in this area that NE can worsen panic and anxiety. But when combined with S - the effect may be mitigated. Second way anxiety can be addressed is by ‘strengthening’ the frontal lobe which has an inhibitory effect on limbic pathways. So NA can enhance frontal lobe inhibition of limbic system.

[@kumarkancharlapalli1131]

Plz do videos on psychotropic drugs in pregnancy and lactation, elderly ,children safe druggs ,c/i

[@mikegrass6629]

Thanks for explaining.

[@PsychiatrySimplified]

Glad it was helpful!

[@boris9331]

Cymbalta is the most prescribed, but there is newer ones. Surely newer SNRI's studied what was good with older ones and made them even better (like everything else in technology?), Is this the case or not. That is to say, why would a pharma company take massive risk in millions of dollars if it couldn't better an older SNRI? With this logic shouldn't we go for newer SNRI's than Cymbalta yet Cymbalta is the most prescribed?

[@AndrogenReceptor01]

Doctor Rege, I'm currently on 150 mg of venlafaxine per day and I feel anhedonia and a severe lack of motivation. Anytime I use a medication that inhibits SERT but doesn't inhibit the transmission of serotonin, I run into anhedonia and a dead feeling on the inside--emotional numbness. With patients such as myself, would it be better to approach things from a norepinephrine and dopamine aspect for the motivational drive and hedonic drive. I should preface this by saying that I do not suffer from anxiety just severe melancholic depression. Not asking for medical advice, by the way. Maybe I shall speak to my psych about desvenlafaxine.

[@PsychiatrySimplified]

Without ofcourse providing individual advice yes NA / DA may be a better option or SNRIs with a >NAT blockade than SERT action. Please have a look at the video on melancholic depression as well.

[@camarorules1]

I have anxiety and depression and low motivation I'm on effexor 150 mg I feel better emotionally but have low motivation Do you think going to 225 mg would possibly help with motivation. When the norepinephrine kicks in does it cancel out the serotonin ?

[@zyzzthetics7]

Hey, I take Sibutramine for weight loss but I've been feeling down for the past few days. Could the sibutramine be the reason?

[@PsychiatrySimplified]

It's best to discuss this with your doctor- but there is evidence that sibutramine may be associated with depression.Sibutramine also has evidence of improving depression . "There are also reports showing that sibutramine may induce depression. The FDA drug label for sibutramine contains information concerning increased adverse events of depression in subjects taking sibutramine, compared with subjects taking placebo."

[@nirmanshrestha2038]

Hello doctor how are you .I have a question .I'm taking 150 mg clomipramine and so far it helped my OCD and my mood .yesterday my pscychiatrist want me to add fluvoxamine.why he wants me to take fluvoxamine while I'm on clomipramine.

[@PsychiatrySimplified]

Good question and one for your psychiatrist. It's important that you are aware of any rationale for treatment. Wish you well.

[@RamziShamoun]

Because fluvoxamine affects metabolism of clomipramine metabolite that acts on NE, so Clomipramine becomes more serotonergic..

[@tabeabussmann]

I learnef the receptor is blocked, not the protines. So the the enzyme MAO can‘t dissolve the serotonin…

[@PsychiatrySimplified]

The transporter proteins ( SERT and NART) are inhibited which prevent the breakdown of Serotonin and Noradrenaline and to an extent dopamine. So that more is available in the synaptic cleft. Mao is inhibited by MAOI medications such as phenelzine , tranylcypromine etc

[@tabeabussmann]

@@PsychiatrySimplified ah thx, because with SSNRIs (sertraline, fluoxetine etc.) the channel for the reuptake gets blocked by the antidepressant (not the transpoter proteins themselves) so that serotonin can't go back to the presynapse and be recycled.

[@PsychiatrySimplified]

@@tabeabussmann exactly! 👍🏼

[@transmissionlinetricks9760]

My psychiatrist has advised me to take laxotinal 3mg at bed time and venlafaxine 37.5 mg 1 tab in morning and 2 tabs of venlafaxine 37.5 mg in evening.why he advised me high dose of venlafaxine?

[@PsychiatrySimplified]

The dose of venlafaxine ranges up to 375-425 my at upper end however it's not usually prescribed at night. It's usually prescribed once a day in the long acting form. However the 37.5 mg being short acting may therefore be prescribed at different times during the day. Which country are you in? In terms if dose please ask the doctor re the doses and rationale for current dose; however this dose is at lower end of range. Ps not advice.

[@theacostas0513]

Thanks for sharing!

[@PsychiatrySimplified]

Our pleasure!

[@sushimmukherjee8579]

Very informative sir, but would like to know which one is better in MDD though pathways are different. Would like to know which one works best in MDD based on your clinical practice

[@PsychiatrySimplified]

It's very difficult to pick one as it depends on symptoms. In this article you can find the differences between the various SNRIs - e.g duloxetine is helpful for comorbid pain - Milnacipran and Levomilnacipran again very helpful for pain > Duloxetine. Venlafaxine is 30:1 ratio of Serotonin : NA ; Desvenalfaxine is 10:1. So it depends on clinical picture

[@sushimmukherjee8579]

@@PsychiatrySimplified Thank you!

[@adorawang7785]

Dr are you available for online consultation?

[@evanwilliamson3602]

Do SNRI’s affect levels of GABA and glutamate in the CNS?

[@PsychiatrySimplified]

Yes they do indirectly through action on serotonin receptors. 5-HT differently modifies glutamate- and GABA- mediated effects, acting on distinct 5-HT receptor subtypes.

[@evanwilliamson3602]

@@PsychiatrySimplified I had horrendous side effects coming off Effexor and had horrendous sensory issues and a worsening of Autistic symptoms, and I went down the glutamate route and have followed your videos. Thanks.

[@hiryahussien4035]

1:23 Dat is missing, and why is dat? haha

[@PsychiatrySimplified]

DAT is the dopamine transporter , the protein which is involved in reuptake of dopamine in presynaptic Neuron to be broken down.

[@PsychiatrySimplified]

@@pseudoMIMS think we got that after a while 😁. Late to the party

[@bugglemagnum6213]

I thought the same thing lol

[@franktank2056]

😂🤣😂🤣

[@pritamshil5765]

Sir , can I read other persons mind ? Is it just my common sense? Is it only my perception?

[@PsychiatrySimplified]

Can't answer these questions. If you are concerned about these thoughts and they preoccupied your mind do see a.psychiatrist.

[@pritamshil5765]

@@PsychiatrySimplified ok sir.

[@FhgfRdF]

This video was helpful! Does SNRI always mean serotonin-noradrenaline reuptake inhibitor? I have seen in some papers it is defined as selective-noradrenaline reuptake inhibitors. Eg. Reboxetine is an SNRI but has little affinity for serotonin, so I find this confusing. Thanks

[@PsychiatrySimplified]

Reboxetine is a NARI - Noradrenaline reuptake inhibitor. SNRI Conventionally is serotonin nor adrenaline reuptake inhibitor.

[@FhgfRdF]

@@PsychiatrySimplified Thanks so much for your reply, this is very helpful :)

[@kimfab1973]

Is Duloxetine decreases or increases anxiety?

[@PsychiatrySimplified]

It is evidence based in the treatment of anxiety. However in some individuals, if a comorbid good disorder is present, duloxetine can increase anxiety or agitation e.g in mixed features ( we have a video on this). Your doctor will be able to help. Ps not advice

[@jayton580]

So does SNRI like Effexor work for social anxiety? Or does it make it worse

[@PsychiatrySimplified]

It is an effective treatment for social anxiety

[@franktank2056]

I'm on venlaflaxine effoxors and hand on heart it works massively

[@PsychiatrySimplified]

@@franktank2056 Thank you for sharing your experience. We recently did a video on venlafaxine vs desvenlafaxine kzbin.info/www/bejne/nmO2p3SabdSJbsU

[@jayton580]

@@PsychiatrySimplified i know your not my doctors but if you take 300mg daily how would you take it? Take both 150mg at once or take 1 in morning and 1 at night?

[@jayton580]

@@PsychiatrySimplified Is pristiq good for social anxiety? Your opinion

[@alexwiseman9078]

I hear you saying "what we do know" that implies that there are things that you don't. One of the things that is just as known is of the horrendous side effects that are rarely mentioned or even acknowledged by medicos. Side effects such as the dreadful Akathesia or movement disorders is just irresponsible

[@PsychiatrySimplified]

There are always things we don't know. They are effective medications when used correctly. You are correct about SE. It's led to the development of newer better meds. But these meds continue to remain effective in the right circumstances.

[@sywakit]

THANKS

[@liorlevi7677]

Saffron act like a SNRI

[@albanijajesrbijakosovojesr1242]

I use peruvian coke and pepsi works

[@franktank2056]

🤣😂🤣😂🤣

[@pritamshil5765]

Sir, can I get psychological strength and psychological power by suppressing my sexual urge? Sir please let me know.🙏

[@PsychiatrySimplified]

Sorry it's not possible to answer this question.

[@mehulrajgor6441]

Yes

[@sandbar3000]

Why would any MD give anyone these meds? The Para sympathetic nervous system is what calms us down! If given this it shuts down the para sympathetic nervous system and engages the sympathetic nervous system which makes us more nervous. This is insane. It says all over that increased heart rate can happen. So don't give it to people that are all ready nervous and with anxiety. Jesus is this stupid.

[@PsychiatrySimplified]

You are correct that SNRIs can increase anxiety / activation phenomenon in some patients ; however they are effective in anxiety and depression. Medication prescribing should be individualised and at the same time mixed features should be ruled out as activation phenomenon is more likely to occur in individuals with mixed states . We did a video on mixed features

[@James-yu8nv]

I always wondered this. I took duloxetine for a couple of weeks and it was horrible!

[@tabeabussmann]

It’s not that simple and not stupid. Please inform yourself.

[@bibanu28dumitru24]

Tramadol