{"id":8132,"date":"2023-01-26T05:16:53","date_gmt":"2023-01-26T13:16:53","guid":{"rendered":"https:\/\/cms.helloklarity.com\/?p=8132"},"modified":"2023-12-20T11:52:55","modified_gmt":"2023-12-20T19:52:55","slug":"snris-vs-tricyclics","status":"publish","type":"post","link":"https:\/\/cms.helloklarity.com\/post\/snris-vs-tricyclics\/","title":{"rendered":"SNRIs vs. Tricyclics: What Is the Difference and Which One Should I Take?<\/strong>"},"content":{"rendered":"\n

Antidepressants are not one-size-fits-all.<\/em><\/p>\n\n\n\n

Whether you\u2019re new to antidepressant treatment or feel your current medication is ineffective, learning about all the antidepressants available can be overwhelming.<\/p>\n\n\n\n

You may be worried about negative side effects, high drug costs, feeling worse on a new medication, or you may have treatment-resistant depression and need to switch medications. Regardless of the reason, deciding on a new treatment takes some trial and error, a bit of patience, and trusted medical advice from a healthcare provider.<\/p>\n\n\n\n

If you\u2019re ready to talk with a licensed provider about the anxiety<\/a> or depression treatment<\/a>, Klarity is here to help. In less than 48 hours, you can speak to a board-certified medical provider to learn if one or more of these medications is right for you. Schedule an appointment<\/a> today.<\/p>\n\n\n\n

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.<\/em><\/p>\n\n\n\n\n\n\n\t\n\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t
<\/th>Tricyclics<\/th>SNRIs<\/th>\n<\/tr>\n<\/thead>\n
Drug Class<\/strong><\/td>Tricyclic antidepressants (TCAs)<\/td>Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)<\/td>\n<\/tr>\n
Brand \/ Generic Status<\/strong><\/td>Brand-names and generics available
\r\n
\r\nMost common TCAs:
\r\n\u2022 Tofranil (imipramine hydrochloride)
\r\n\u2022 Pamelor (nortriptyline)
\r\n\u2022 Asendin (amoxapine)
\r\n\u2022 Elavil (amitriptyline)
\r\n\u2022 Surmontil (trimipramine)
\r\n\u2022 Vivactil (protriptyline)
\r\n\u2022 Silenor (doxepin)
\r\n\u2022 Zonalong or Prudoxin (doxepin)
\r\n\u2022 Norpramin (desipramine)
\r\n
\r\n<\/td>		Brand names and generics available
\r\n
\r\nMost common SNRIs:
\r\n\u2022 Effexor (venlafaxine)
\r\n\u2022 Cymbalta (duloxetine)
\r\n\u2022 Irenka (duloxetine)
\r\n\u2022 Pristiq (desvenlafaxine)
\r\n\u2022 Khedezla (desvenlafaxine)
\r\n\u2022 Fetzima (levomilnacipran)
\r\n\u2022 Savella (milnacipran)
\r\n
\r\n<\/td>\n<\/tr>\n
Form(s) of the Drug<\/strong><\/td>Common forms of TCAs include:
\r\n\u2022 Capsules
\r\n\u2022 Tablets
\r\n\u2022 Flavored liquid suspensions
\r\n
\r\n<\/td>		Common forms of SNRIs include:
\r\n\u2022 Color-coded* capsules
\r\n\u2022 Color-coded* tablets
\r\n\u2022 Flavored liquid suspensions
\r\n
\r\n*Color-coding often indicates dosage amount<\/td>\n<\/tr>\n
Standard Dosage<\/strong><\/td>Varies, depending on TCA and condition being treated<\/td>Varies, depending on SNRI and condition being treated<\/td>\n<\/tr>\n
Conditions Treated<\/strong><\/td>Conditions most often treated:
\r\n\u2022 Depression
\r\n\u2022 Migraine headaches
\r\n
\r\nOther conditions treated:
\r\n\u2022 Obsessive-compulsive disorder (OCD)
\r\n\u2022 Anxiety disorders
\r\n\u2022 Insomnia
\r\n\u2022 Chronic pain
\r\n\u2022 Neuropathic pain
\r\n\u2022 Nerve pain
\r\n\u2022 Itching and eczema
\r\n
\r\nDifferent TCAs are FDA-approved for different uses
\r\n
\r\nMany TCAs are prescribed off-label to treat certain conditions
\r\n<\/td>		Conditions most often treated:
\r\n\u2022 Depression
\r\n\u2022 Anxiety disorders
\r\n
\r\nOther conditions treated:
\r\n\u2022 Attention deficit
\r\nhyperactivity disorder (ADHD)
\r\n
\r\n
\r\nDifferent SNRIs are FDA-approved for different uses
\r\n
\r\nMany SNRIs are prescribed off-label to treat certain conditions
\r\n<\/td>\n<\/tr>\n
Cost<\/strong><\/td>Average cost of a 30-day supply:
\r\n\u2022 $20 for a 30-day supply of:
\r\n \u2022 Amitriptyline
\r\n \u2022 Pamelor
\r\n \u2022 Silenor
\r\n \u2022 Norpramin
\r\n \u2022 Tofranil
\r\n\u2022 $120 or more for most other tricyclics*
\r\n
\r\n*Most TCAs are covered under insurance<\/td>		Average cost of a 30-day supply:
\r\n\u2022 $29 for generic formulas*
\r\n\u2022 $539 for brand-name formulas**
\r\n
\r\n*Some SNRIs don\u2019t have a generic formula available for Rx.
\r\n
\r\n**Cost of brand-name SNRIs may be offset by coupons and insurance
\r\n
\r\n<\/td>\n<\/tr>\n
Side-Effects<\/strong><\/td>Common side effects:
\n\u2022 Drowsiness
\n\u2022 Constipation
\n\u2022 Dry mouth
\n\u2022 Blurred vision
\n\u2022 Orthostatic hypotension
\n\u2022 Urine retention
\n\u2022 Increased sweating
\n\u2022 Tremors
\n\u2022 Increased or decreased appetite
\n\u2022 Sexual dysfunction
\n<\/td>		Common side effects:
\r\n\u2022 Increased blood pressure
\r\n\u2022 Increased heart rate
\r\n\u2022 Headache
\r\n\u2022 Difficulty urinating
\r\n\u2022 Nausea
\r\n\u2022 Eating too much or too little
\r\n\u2022 Dry mouth
\r\n\u2022 Excessive sweating
\r\n\u2022 Constipation
\r\n\u2022 Muscle weakness
\r\n\u2022 Tremors
\r\n\u2022 Irritability
\r\n\u2022 Heart palpitations
\r\n\u2022 Dizziness
\r\n\u2022 Insomnia
\r\n\u2022 Drowsiness
\r\n\u2022 Fluid retention, especially in older adults
\r\n\u2022 Inability to maintain an erection or have an orgasm
\r\n<\/td>\n<\/tr>\n
Warnings For Use<\/strong><\/td>\u2022 Combination with other medications may cause serotonin syndrome <\/b>
\n\u2022 Symptoms of serotonin syndrome <\/b>include:
\n \u2022 Anxiety or agitation
\n \u2022 Fever, sweating
\n \u2022 Tremors
\n \u2022 Restlessness
\n \u2022 Confusion
\n \u2022 Lack of coordination
\n \u2022 Blood pressure and heart rate changes
\n
\n\u2022 May cause seizures or falls in those prone to them
\n\u2022 Do not mix with alcohol<\/b>
\n\u2022 Rarely, TCAs cause suicidal thoughts or behaviors
\n \u2022 Contact your doctor immediately if this occurs<\/td>		\u2022 Combination with other medications may cause serotonin syndrome
\r\n\u2022 Symptoms of serotonin syndrome include:
\r\n \u2022 Anxiety or agitation
\r\n \u2022 Fever, sweating
\r\n \u2022 Tremors
\r\n \u2022 Restlessness
\r\n \u2022 Confusion
\r\n \u2022 Lack of coordination
\r\n \u2022 Blood pressure and heart rate changes
\r\n
\r\n\u2022 Contraindicated conditions include:
\r\n \u2022 Pregnancy
\r\n \u2022 Breastfeeding
\r\n \u2022 Liver problems
\r\n \u2022 Heart conditions
\r\n
\r\n\u2022 Discuss other medications with your doctor, as adverse reactions may occur
\r\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n

When SSRIs Aren\u2019t The Right Choice<\/strong><\/h2>\n\n\n\n

Selective serotonin reuptake inhibitors (SSRIs) are currently the standard treatment for most mood and anxiety disorders.<\/p>\n\n\n\n

However, SSRIs may not achieve the desired results or could have unfavorable side effects. In these cases, second-line agents such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs) may prove helpful.<\/p>\n\n\n\n

In this post, we\u2019re going to explore two alternatives to SSRIs\u2014SNRIs and Tricyclic antidepressants.<\/p>\n\n\n\n

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)<\/strong><\/h2>\n\n\n\n

How Do SNRIs Work?<\/strong><\/h3>\n\n\n\n

Your brain has several chemicals (neurotransmitters) influencing mood, energy, sleep patterns, appetite, and focus. If neurotransmitter levels are too low, you can experience symptoms of depression and anxiety. SNRIs target two chemical messengers, serotonin and norepinephrine, to alleviate symptoms.<\/p>\n\n\n\n

Serotonin is responsible for feelings of well-being, calmness, and restful sleep. Norepinephrine contributes to increased focus, concentration, and energy levels. Despite what you may think, SNRIs do not increase the levels of these neurotransmitters in the body. <\/p>\n\n\n\n

These antidepressant drugs work by increasing the availability of the serotonin and norepinephrine your brain already produces. When you release these neurotransmitters, SNRIs keep your brain from reabsorbing the chemicals too quickly (reuptake inhibition).<\/p>\n\n\n\n

What Do SNRIs Treat?<\/strong><\/h3>\n\n\n\n

Depression<\/strong><\/h4>\n\n\n\n

When a patient is new to antidepressants, a medical provider will usually start by prescribing selective serotonin reuptake inhibitors as a first-line treatment. Many people benefit from this class of medication. Still, sometimes it is only partially effective (in the case of treatment-resistant depression) or has undesirable side effects. <\/p>\n\n\n\n

After one or more trials of different selective serotonin reuptake inhibitors, prescribers then start an SNRI. While SSRIs and SNRIs both regulate serotonin, SNRIs also work on norepinephrine. Because this neurotransmitter is responsible for your energy levels, attention span, and alertness, SNRIs fill in some of the gaps in depression treatment that an SSRI may not. <\/p>\n\n\n\n

Patients with mood disorders typically notice greater motivation, a boost in energy, and better quality sleep when taking an SNRI.<\/p>\n\n\n\n

Anxiety<\/strong><\/h4>\n\n\n\n

If you are diagnosed with Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive Compulsive Disorder (OCD), or Post Traumatic Stress Disorder (PTSD), you could also benefit from the effects of SNRIs. <\/p>\n\n\n\n

Anxiety disorders are marked by an exaggerated fight-or-flight response, with large quantities of norepinephrine released into the bloodstream. By regulating norepinephrine and serotonin, SNRIs reduce both physical sensations of anxiety and racing, uncontrollable thoughts.<\/p>\n\n\n\n

Unlike SSRIs, SNRIs are also approved to treat certain types of pain, including diabetic nerve pain, fibromyalgia, and chronic musculoskeletal pain. These medications are an excellent solution if you suffer from both mood and pain disorders.<\/p>\n\n\n\n

What Are the Most Commonly Prescribed SNRIs?<\/strong><\/h3>\n\n\n\n

Here are the four most common SNRIs prescribed in the US:<\/p>\n\n\n\n

    \n
  • Venlafaxine (Effexor)<\/strong><\/li>\n\n\n\n
  • Duloxetine (Cymbalta)<\/strong><\/li>\n\n\n\n
  • Desvenlafaxine (Pristiq)<\/strong><\/li>\n\n\n\n
  • Levomilnacipran (Fetzima)<\/strong><\/li>\n<\/ul>\n\n\n\n

    Among all SNRIs, Cymbalta and Effexor are prescribed more often due to lower costs and because they have the largest number of FDA-approved uses.<\/p>\n\n\n\n

    Costs<\/strong><\/h3>\n\n\n\n

    SNRIs tend to be more expensive than SSRIs. Despite being available in brand and generic forms, SNRIs are newer but also considered a first-line choice. As a result, drug companies charge a higher rate, and insurance companies cover less cost. On average, the out-of-pocket cost for a one-month supply of generic SNRIs is roughly $13 more than SSRIs.<\/p>\n\n\n\n

    The cost for generic forms of Cymbalta and Effexor is $10 – $50 monthly with insurance, depending on the dose. Fetzima, on the other hand, does not yet have a generic equivalent. This medication can cost over $400 for a 30-day supply.<\/p>\n\n\n\n

    Common Side Effects<\/strong><\/h3>\n\n\n\n

    Side effects of SNRIs will vary from one individual to another based on dose, metabolism, and even genetics. What may be an issue for one person is hardly recognizable for another. Side effects are typically more noticeable when starting a new medication, although they may persist throughout treatment.<\/p>\n\n\n\n

    The most common side effects include:<\/p>\n\n\n\n

      \n
    • Nausea\/vomiting<\/li>\n\n\n\n
    • Diarrhea or constipation<\/li>\n\n\n\n
    • Headache<\/li>\n\n\n\n
    • Sexual dysfunction (trouble becoming aroused or achieving orgasm)<\/li>\n\n\n\n
    • Dizziness\/lightheadedness<\/li>\n\n\n\n
    • weight gain or weight loss<\/li>\n\n\n\n
    • Dry mouth<\/li>\n<\/ul>\n\n\n\n

      In addition, the norepinephrine component of SNRIs may trigger the following:<\/p>\n\n\n\n

        \n
      • Sweating<\/li>\n\n\n\n
      • Racing heart<\/li>\n\n\n\n
      • Anxiety\/panic attacks<\/li>\n\n\n\n
      • Insomnia<\/li>\n<\/ul>\n\n\n\n

        SNRIs have short half-lives, meaning your body quickly removes the medication from your system. For this reason, it is essential to take your medication at the same time every day to avoid discontinuation effects. When discontinuation occurs rapidly or without physician supervision, you may experience many of the side effects listed above.<\/p>\n\n\n\n

        Warnings for Use<\/strong><\/h3>\n\n\n\n

        Like all medications, SNRIs are not without risk. You should use them cautiously if you have a history of heart, liver, or kidney problems or high blood pressure. Taking more than the prescribed dose can lead to a potentially life-threatening condition known as serotonin syndrome.<\/p>\n\n\n\n

        Watch for symptoms such as:<\/p>\n\n\n\n

          \n
        • Agitation<\/li>\n\n\n\n
        • Excessive sweating<\/li>\n\n\n\n
        • Muscle tremors or rigidity<\/li>\n\n\n\n
        • Prolonged elevated heart rate or abnormal heart rhythm<\/li>\n\n\n\n
        • High blood pressure<\/li>\n\n\n\n
        • Headache<\/li>\n\n\n\n
        • Diarrhea<\/li>\n\n\n\n
        • Insomnia<\/li>\n\n\n\n
        • Confusion<\/li>\n\n\n\n
        • Dilated pupils<\/li>\n<\/ul>\n\n\n\n

          SNRIs also carry the risk of worsening depression\/anxiety and increased risk of suicide in the first few weeks of taking the medication. If you notice these symptoms in you or a loved one, stop the medication immediately, contact your doctor, and go to the nearest emergency room or crisis center for assessment.<\/p>\n\n\n\n

          Potential Drug Interactions With SNRIs<\/strong><\/h3>\n\n\n\n

          SNRIs, like other medications, can have interactions with various substances, which may result in heightened side effects or diminished efficacy. To prevent such interactions, it is crucial to inform your healthcare professional about other antidepressants, medications, supplements, and over-the-counter products you are using. Frequent interactions with SNRIs involve:<\/p>\n\n\n\n

            \n
          • Monoamine oxidase inhibitors (MAOIs): Mixing SNRIs and MAOIs, another antidepressant category, might cause serotonin syndrome, a potentially fatal condition with symptoms like agitation, confusion, rapid heart rate, and elevated blood pressure.<\/li>\n\n\n\n
          • Selective serotonin reuptake inhibitors (SSRIs): Since SSRIs and SNRIs operate similarly, taking them concurrently can heighten the likelihood of serotonin toxicity.<\/li>\n\n\n\n
          • Tricyclic antidepressants (TCAs): Using SNRIs alongside TCAs can result in elevated TCA levels in the bloodstream, possibly leading to intensified side effects or toxicity.<\/li>\n\n\n\n
          • Central nervous system (CNS) depressants: Combining SNRIs with other CNS depressants, such as benzodiazepines, opioids, or alcohol, can augment drowsiness and the danger of sedation or respiratory depression.<\/li>\n\n\n\n
          • Serotonergic drugs: Taking SNRIs with other serotonergic medications, like triptans (employed for migraines), tramadol, or St. John’s wort, can heighten the risk of serotonin syndrome.<\/li>\n\n\n\n
          • Anticoagulants or antiplatelet drugs: SNRIs can elevate bleeding risk when used with blood thinners like warfarin or antiplatelet medications such as aspirin and clopidogrel.<\/li>\n\n\n\n
          • Nonsteroidal anti-inflammatory drugs (NSAIDs): Using SNRIs with NSAIDs, like ibuprofen or naproxen, can heighten the possibility of gastrointestinal bleeding.<\/li>\n\n\n\n
          • Antifungal medications: Certain antifungal medications, including ketoconazole or fluconazole, can influence the metabolism of some SNRIs, possibly resulting in intensified side effects or toxicity.<\/li>\n<\/ul>\n\n\n\t\t
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