SNRIs — Serotonin-Norepinephrine Reuptake Inhibitors
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) are another class of antidepressants used for anxiety and depression. In addition to serotonin, they also block the reuptake of norepinephrine — which can offer additional benefit for some patients and is also helpful for chronic pain (often comorbid with anxiety and depression). Examples: venlafaxine (Effexor), duloxetine (Cymbalta).
They are often used when SSRIs haven't been sufficiently effective, or when there is comorbid chronic pain. Duloxetine has a specific approved indication for fibromyalgia and diabetic neuropathy, in addition to anxiety and depression.
Side effects include increased blood pressure (especially at higher doses), and discontinuation syndrome can be more intense than with SSRIs.
💡 Practical example
A patient with GAD and fibromyalgia may benefit particularly from duloxetine — which addresses both the anxiety and the chronic pain — rather than an SSRI, which would only act on the emotional dimension.
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