This article is about the other 3 most popular antidepressants. When it became clear that either the serotonin or norepinephrine alone do not solve comprehensively the issue with a depressive state pharmacologists decided: we must make sure that in the gaps between nerves endings accumulated the first and the second. And see what happens. So there were antidepressants with an average biochemical bend. By the power they have surpassed their predecessors with a small biochemical bend. Thus they have much less side effects and tolerability therefore is better. And unlike those that affect only the reuptake of norepinephrine, they are much less likely to cause the development of mania and hypomania. So, here are three examples of this group: Venlafaxine, Duloxetine and Milnacipran.
Venlafaxine was developed in 1993 in the US and since then its generic drugs are produced around the world. It proved to be quite effective in the treatment of depression – both in the lungs, in the neurotic level and severe, psychotic, suicidal thoughts and attempts. At the same time Effexor fairly well tolerated even at high doses. Yes, it can cause nausea and dizziness and dry mouth and just as the SSRI antidepressants cause in men delay of ejaculation (although some women like suddenly stretched sexual intercourse) can give weight gain – but these side effects are less common than in the other groups and tend to be less strong.
Furthermore, Venlafaxine daily activities depend on the dose. In the 75-125 mg bigger making its presence felt the reuptake (and accumulation) of serotonin and the effect is more soothing and anti-anxiety – in addition to the actual antidepressant, of course. In the dose of 225 mg per day begins to accumulate norepinephrine – and appears activating, stimulating effect of Effexor. There is another effect – first discovered by accident but later received the application in medical practice. Venlafaxine just like other antidepressants of this group is capable to act as an analgesic. There were tested and used in practice a combination of Venlafaxine with other antidepressants. Why? – To overcome the severe resistant (barely measurable antidepressant effects) depression. One of these combinations is with Mirtazapine dubbed the Californian rocket fuel. Guess why.
Duloxetine (which is also known as Cymbalta). By its action and a set of adverse events is similar to the Venlafaxine. Accordingly, it is used almost in the same situations. But as I have said many times for antidepressant is desirable to approach to personal patient’s biochemistry of the brain as the key to the lock – so Cymbalta is appointed where for some reason is not suitable Venlafaxine and other antidepressants. In addition, it is used to treat diseases associated with pain – we mean neuropathic pain and fibromyalgia.
Milnacipran (the same as Savella). It has the same principle of action, the same indications for use (including fibromyalgia and neuropathic pain) as in previous drug. At the same time a set of side effects less likely to cause weight gain than the previous two but often makes insomnia, worsening anxiety, tremor (trembling of the body) and palpitation at the beginning of treatment. Furthermore, it may cause urinary retention but less frequently and not as much as the same Amitriptyline. And of course men should be careful with dosages because such drugs sometimes may cause potency problem.