SNRI antidepressants in general practice: current state of knowledge
This article provides a brief update of the state of knowledge of the selective serotonin and noradrenaline reuptake inhibitors (SNRIs), namely venlafaxine, duloxetine, extended-release venlafaxine and desvenlafaxine. Their mechanism of action and their related adverse effects are discussed. Their FDA-approved, clinical indications are outlined. The psychiatric indications include major depressive disorder (MDD), generalised anxiety disorder (GAD), panic disorder and social phobia. Their use in several neurological conditions is presented; these include: cognitive symptoms associated with MDD, fibromyalgia and three other pain syndromes, namely diabetic peripheral neuropathy, musculoskeletal pain and osteoarthritis. Their gynaecological indications are the vasomotor symptoms experienced during perimenopause. Two of their potential risks, serotonin syndrome and discontinuation syndrome, are mentioned. Potential ways to minimise these syndromes are also outlined. Finally, benefits and potential problems associated with the use of SNRIs in pregnancy and lactation follow. In conclusion, the SNRIs represent a class of antidepressants with a specific list of indications and side-effect profile. They can be extremely useful in the treatment of depression, some anxiety and pain disorders.