SSRIs, SNRIs, Oh My - All About Medication for Anxiety and Depression
If you’re experiencing depression or an anxiety disorder, your therapist may recommend that you visit a psychiatrist to be evaluated to see if psychiatric medication might be right for you. Psychiatric medications have come a long way since they were first invented in the 1950s, and they are now a popular and safe way to improve mental health outcomes in conjunction with therapy. By far the most popular and commonly used medications are Selective Serotonin Reuptake Inhibitors (SSRIs) and their newer cousins, Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). So, what are these medications and what do you need to know before taking one? In this article, we’ll go over the main types of medications available, as well as talk more generally about important considerations when taking medication for depression and anxiety.
Psychiatric medications are often called “antidepressants,” but this is actually a misnomer. Due to the efficacy of medications that act on the neurotransmitters serotonin and norepinephrine, there’s come to be a general perception that depression is caused by a “chemical imbalance in the brain” and can be treated with medications that “correct” this balance. The truth is, science has yet to discover the ideal “balance” of neurochemicals, and two people can have a completely different neurochemical profile and still experience the same struggles. It is true that some cases of depression have a genetic component, and it’s also true that many people feel better on medications that alter these neurochemicals. However, research simply hasn’t discovered exactly what’s going on in the depressed brain, and depression is caused by many different factors, including biological, environmental, and social.
The most popular medications for depression are Selective Serotonin Reuptake Inhibitors (SSRIs). These medications work by increasing the amount of the neurotransmitter serotonin in the brain. Serotonin is involved in regulating mood, sleep, appetite, learning, and many other functions of being human.
Brand names include: Prozac, Zoloft, Lexapro, Paxil, Celexa, and Trintellix.
Side effects include: sexual problems, nausea, sleep issues, tremor, and nervousness.
Note: Lexapro is (by a small margin) the most effective SSRI, and is likely to be the first medication prescribed in a classic case of anxiety or depression.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are newer versions of the SSRIs that also increase the amount of norepinephrine in the brain. Norepinephrine is involved in attention and focus, mood regulation, stress response, the digestive system, and more.
Brand names include: Cymbalta, Effexor, Pristiq, and Fetzima.
Side effects include: sexual problems, nausea, vomiting, dry mouth, fatigue, drowsiness, and dizziness.
SSRIs and SNRIs are considered “first-line” options due to their strong track record of being safe and effective. Your provider is likely to try prescribing one or more of these medications first. However, there are many more types of medications that can be prescribed for depression and anxiety, such as:
Tricyclic or Tetracyclic antidepressant medications (Asendin, Elavil, and Remeron)
Serotonin modulating medications (Serzone, Desyrel [trazodone])
These medications may have a sedative effect and are sometimes prescribed for people who have trouble sleeping due to depression and/or anxiety.
Wellbutrin (Selective Norepinephrine and Dopamine Reuptake Inhibitor)
This medication is also used for smoking cessation and may come with less severe sexual side effects than SSRIs.
Sprovato (esketamine) is a nasal spray that must be taken in combination with another oral antidepressant medication. This is a new medication and it can be difficult to get a prescription for it, as your provider must prove that you have tried other medications first, and the spray must be administered in a clinical setting.
No matter which psychiatric medication you take, there’s a few important things to know before you start:
Efficacy: even the ‘best’ SSRI (Lexapro) only works for roughly half of people who try it. It’s normal to try a few different prescriptions before finding the one for you. Ask your doctor about newly approved genetic testing that might help you determine which medication will work for you and allow you skip the trial and error. Unfortunately, until we have more research and even better medications, the efficacy of SSRIs is limited.
Time: It takes around 6 weeks for SSRIs to take effect.
Serotonin Syndrome: in rare cases, SSRIs and SSRIs can result in a dangerous condition called serotonin syndrome. If you are new to taking these medications and experience symptoms like restlessness, agitation, confusion, increased heart rate and blood pressure, sweating, and motor tremors, call your doctor right away.
Discontinuation: Psychiatric medications work by changing the chemistry in your brain. If you abruptly stop taking an SSRI or SNRI, you may experience mood swings, restlessness, agitation, insomnia, electric shock sensations “brain zaps,” vivid dreams, and flu-like symptoms. For this reason, it’s best to slowly taper off your medication under the supervision of a qualified provider.
We hope this article helped explain some of the tools psychiatrists have at their disposal to treat anxiety and depression. Mental health conditions should always be diagnosed by a professional, and you should always ask your psychiatric provider any questions you have about your care or prescriptions.
Note: AWC provides empathetic, accessible mental health counseling services, not psychiatry. To make an appointment for counseling or to get a referral to a psychiatrist, please give us a call at (248) 413 - 5865.
References
FDA. (2023). Depression Medicines. FDA. https://www.fda.gov/consumers/womens-health-topics/depression-medicines
