Serotonin-Norepinephrine Reuptake Inhibitors, or SNRIs, are a common treatment for depression and a variety of other ailments like anxiety disorders and chronic pain. In this video, I discuss how SNRIs work in the brain and how they are proposed to be able to treat the symptoms of depression. TRANSCRIPT: Serotonin-norepinephrine reuptake inhibitors, or SNRIs, first appeared on the market in 1993 with the introduction of venlafaxine. Several others, like duloxetine, would be introduced in the following decades. Most SNRIs were primarily developed for the treatment of depression, but some are now also used to treat a variety of other conditions like anxiety and chronic pain. The development of SNRIs was guided by research that suggests neurotransmitters like serotonin and norepinephrine play a role in depression. Specifically, this research suggests that low levels of these neurotransmitters might contribute to the symptoms of depression. SNRIs work primarily by inhibiting a mechanism called reuptake. In reuptake, a protein called a transporter transports excess neurotransmitter molecules out of the synaptic cleft, typically back into the neuron that released them. SNRIs inhibit the reuptake of serotonin and norepinephrine. When the removal of serotonin and norepinephrine from the synaptic cleft is inhibited, this causes levels of these neurotransmitters in the synaptic cleft to rise. These increases in serotonin and norepinephrine levels have been hypothesized to be the mechanism by which SNRIs can treat the symptoms of depression. It should be noted, however, that research suggests the neurobiological mechanism of depression is more complex than a simple neurotransmitter deficiency. Thus, it may be that increasing serotonin and norepinephrine levels leads to other effects that can alleviate the symptoms of depression, or that the drugs have other mechanisms that contribute to their effectiveness. Studies have found SNRIs to be comparable to other popular antidepressants, like SSRIs, in terms of effectiveness. SNRIS are also generally well-tolerated, with problems like nausea, sweating, and loss of appetite being some of the commonly reported side effects---although different snri drugs have different side effect profiles. REFERENCES: Brunello N, Mendlewicz J, Kasper S, Leonard B, Montgomery S, Nelson J, Paykel E, Versiani M, Racagni G. The role of noradrenaline and selective noradrenaline reuptake inhibition in depression. Eur Neuropsychopharmacol. 2002 Oct;12(5):461-75. doi: 10.1016/s0924-977x(02)00057-3. PMID: 12208564. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018 Apr 7;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7. Epub 2018 Feb 21. PMID: 29477251; PMCID: PMC5889788. Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: from monoamines to glutamate. Exp Clin Psychopharmacol. 2015 Feb;23(1):1-21. doi: 10.1037/a0038550. PMID: 25643025; PMCID: PMC4428540. Lambert O, Bourin M. SNRIs: mechanism of action and clinical features. Expert Rev Neurother. 2002 Nov;2(6):849-58. doi: 10.1586/14737175.2.6.849. PMID: 19810918. Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300.

• published: 03 Nov 2020
• views: 127060