SNRIs - The Antidepressants People Love to Hate.
The data are contradictory regarding how effective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are compared with SSRIs. When it comes to treating neuropathic pain SNRIs generally work a lot better, especially the ones that have more of an effect on norepinephrine (NE). Savella (milnacipran) has much greater effect on norepinephrine than serotonin (5HT)1, while Effexor is essentially an SSRI until you’re taking 187.5–225 mg a day, give or take 37.5 mg. Depression and anxiety are something else. On one hand SSRIs are easier to deal with, on the other SNRIs are far less likely to poop out (tachyphylaxis).
- Cymbalta / Xeristar ( duloxetine )
- Effexor / Efexor / Alventa / Efectin / Venlax / Venlift ( venlafaxine )
- Pristiq ( desvenlafaxine )
- Savella / Ixel / Dalcipran ( milnacipran ) - in the US Savella is approved only to treat fibromyalgia. Outside of the US Ixel/Dalcipran is an antidepressant.
- Fetzima ( levomilnacipran ) - Basically an extended-release version of Savella that’s approved as an antidepressant in the US.