Switching From SSRIs To SNRIs: What You Need To Know

Living with depression or anxiety is not easy. Those who live with it would know that the most common medication prescribed are serotonin reuptake inhibitor or SSRI. However, at times when their depression and anxiety cannot be treated with those, it may be the time to switch to serotonin-norepinephrine reuptake inhibitor (SNRI). This is a common strategy that follows the medical treatment of prolonged mental health illness, but under doctor's supervision, of course.

While both takes care of mood management, the kinds may be different, especially in terms of how it approaches. What is more helpful is to be aware of these variation, so it can be a seamless transition.

About two-thirds of people with major depression, according to research, do not react well to their initial antidepressant and frequently need to switch within a few weeks without seeing any noticeable improvement. The doctor you are see may suggest you to switch from SSRI to SNRI.

While SNRIs enhance both serotonin and norepinephrine levels, as the name also suggests, SSRIs, only primarily raise serotonin. What is norepinephrine, if one asks? They regulate energy levels, stress responses and alertness. This dual action can result in additional benefits like increased energy, reduced chronic pain, and many more. There are studies that also suggests that because SNRIs influence dopamine, they could be a faster solution to depression.

Incomplete Symptom Relief: If an SSRI has not been effective in lowering symptoms of anxiety or depression, an SNRI may have a more balanced impact by concentrating on both the serotonin and norepinephrine channels.

Coexisting Symptoms: An SNRI may be more helpful if you're also dealing with chronic pain, fatigue, or low energy because it tackles mood in addition to these other problems.

Side Effects: Weight gain and sexual dysfunction are two adverse effects of SSRIs that some people find difficult to manage. Without these issues, SNRIs may have similar mood-enhancing effects.

When switching antidepressants, careful preparation is required to lower the risk of drug interactions and withdrawal symptoms. The main techniques for switching are as follows:

Conservative Approach: Weaning off the SSRI gradually and allowing the medication to leave the body over time—typically five half-lives—is the conservative approach. It may take longer and necessitate a time of no treatment, even though it is the safest approach.

Moderate Approach: By reducing the washout time to about two days, this strategy finds a balance between safety and convenience.

Direct Switch: In some circumstances, the SNRI is started the next day after the SSRI is terminated. This method is quicker, but there is a higher risk of withdrawal symptoms and drug interactions.

Cross-Tapering: This tactic entails introducing the SNRI at a low dose while progressively lowering the SSRI dosage. After the SSRI is reduced, the SNRI dosage is gradually raised. This approach facilitates a more seamless transition and lessens withdrawal symptoms.

When switching from an SSRI to an SNRI, it's important to take into account the potential risks and side effects:

SSRI Withdrawal: If SSRIs are tapered off too soon, side effects might include flu-like symptoms, nausea, irritability, and disorientation. These side effects may worsen if the medication was taken for an extended period of time.

SNRI Onset: Starting an SNRI too soon may cause headaches, nausea, and dizziness. It is often necessary to raise the dosage gradually to help the body acclimatize.

Serotonin Syndrome: When using SSRIs and SNRIs combined during a medication switch, serotonin syndrome may occur since both medications increase serotonin levels. Symptoms that require immediate medical attention include fever, agitation, a rapid heartbeat, high blood pressure, and confusion.

Mood Shifts: During the shift, some people may experience mood swings, increased anxiety, or worsening depression, however this isn't always the case.

Increased Blood Pressure: When taken in larger doses, SNRIs, notably venlafaxine, have the potential to raise blood pressure. This may worry people who already have high blood pressure or are at risk.

Drug Interactions: SNRIs and SSRIs may interact with one another to increase their negative effects or decrease their effectiveness. It is important to consider any other medications you may be taking, especially ones that affect serotonin or blood pressure. Some SNRIs, such desvenlafaxine, have less interactions due to their simpler metabolic profiles.