Serotonin and norepinephrine are neurotransmitters that affect mood and mental illness. Rapid reuptake can lead to conditions like depression and anxiety. Drugs that prevent reuptake can help, but may have side effects. SNRIs may be better for some conditions, but treatment varies by individual.
Serotonin and norepinephrine are two neurotransmitters identified as having a strong effect on mood and many forms of mental or other illness, together or separately. If these chemicals exist in adequate amounts and aren’t used up too quickly by receptors in the brain, this often corresponds to a more even mood. When they are used (reuptake) too quickly, mood can be difficult to control and conditions such as depression or anxiety can occur. To a greater or lesser extent, they also appear to impact conditions such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder or diseases that cause chronic pain, such as fibromyalgia. Depending on your condition, you may need a drug that prevents the rapid reuptake of one or both of these neurotransmitters.
Although serotonin and norepinephrine have similar roles, they are not identical. Most serotonin resides in the gastrointestinal (GI) system and contributes to the function of the gastrointestinal tract. Drugs that increase levels of this neurotransmitter (selective serotonin reuptake inhibitors or SSRIs) can sometimes cause stomach problems. The major location of most serotonin also offers an explanation for why food consumption and mood are sometimes related. Only about 20% of the serotonin in the body circulates through the central nervous system.
Conversely, norepinephrine is produced in the sympathetic nervous system and can be released in high amounts by the adrenal glands during fight-or-flight responses. In addition to influencing mood stability, norepinephrine also appears to help increase cognitive focus. The “antidepressant” drugs used to treat ADHD are often ineffective if they do not inhibit the reuptake of norepinephrine.
Drug research has resulted in numerous drugs that specifically target serotonin levels. With the advent of tricyclic drugs, some drugs began to act as both serotonin and norepinephrine reuptake inhibitors. This meant they prevented the receptors for these chemicals from starting a reuptake process too quickly, giving the brain greater access to available serotonin and norepinephrine. Tricyclics had a heavy load of side effects and were replaced by drugs that acted only on serotonin: SSRIs.
It became apparent that many people with depression or anxiety were not fully helped by SSRIs, and drug researchers developed a new set of drugs that again addressed norepinephrine and serotonin reuptake. These are called serotonin norepinephrine reuptake inhibitors, or SNRIs. Common SNRIs currently available include venlafaxine (Effexor®), desvenlafaxine (Pristiq®), and duloxetine (Cymbalta®). Some of the tricyclics are being rebranded as SNRIs, and it’s not clear that the side effect profiles of tricyclics and SNRIs are really that different.
Research also suggests that some conditions will respond better to SNRIs. Phobias, ADHD, generalized anxiety disorder, and major depressive disorder might all be best treated with a serotonin norepinephrine reuptake inhibitor. However, this isn’t always the case, so treatment varies by individual. There are drawbacks to drugs that act on both neurotransmitters simultaneously, including a tendency to create a withdrawal syndrome, which is similar to withdrawal. Furthermore, inappropriate use of SNRIs in people with undiagnosed bipolar disorder can easily create mania or hypomania.
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