lorazepam, alprazolam, diazepam) are best reserved for short-term use (2-4 weeks) in the early phase of treatment of GAD with an SSRI or SNRI
to provide symptomatic relief.
If the decision is to start pharmacological treatment with an SSRI or SNRI
, the starting dose can be low (sertraline 25-50 mg; paroxetine 10-20 mg; venlafaxine 37.
Initial TX * SSRI,SNRI
* Psychotherapy Step 1 * Switch SSRI or SNRI
* Add psychotherapy Step 2 * Mirtazapine, nefazodone, TCA * Add psychotherapy Step 3 * Switch to alternative in step 2 * TCA or phenelzine * Add psychotherapy
Bicifadine is an SNRI
which is presently being developed for the treatment of
In patients with severe depression, agomelatine also performed significantly better than SSRI and SNRI
A European report of a baby exposed to the SNRI
venlafaxine (Effexor) in late pregnancy, whose symptoms resolved after receiving a small dose of the drug, strengthened the concept that this might be a beneficial approach to treating neonatal withdrawal symptoms.
developed to be the second approved SNRI
for neuropathic pain, offering a
Patients who did not respond to or could not tolerate the SNRI
were given an SSRI (fluoxetine, sertraline, or citalopram).
In response to accumulating evidence of neonatal adverse events associated with gestational SSRI or SNRI
exposure from a variety of sources, including controlled cohort studies, the FDA has recently added a description of these effects to the labeling for this class of drugs.
By 2020, sales of the leading depression drug classes, such as the SSRI and SNRI
antidepressants, are expected to decline.
Savella (minlacipran) is an SNRI
indicated for the treatment of depression, but only in Japan.
It predates the July 2006 Food and Drug Administration warning about the risk of potentially fatal serotonin syndrome resulting from coadministration of a triptan and an SSRI or SNRI
, but the number of at-risk patients today is likely to be even larger--not smaller--than before the FDA warning, she added in an interview.