Talk:Serotonin–norepinephrine reuptake inhibitor

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 September 2019 and 13 December 2019. Further details are available on the course page. Student editor(s): Kendallkehr, Jermakiank, Ahmadyarg, Juliemarienguyen. Peer reviewers: KBielaski, Celiahoang, DavidSuSOP.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 09:00, 17 January 2022 (UTC)

Side effects
I have had (an admittedly cursory) look at the sources, and nowhere do I see any mention that SNRIs in general have milder sexual side effects than SSRIs. As for elevated norepinephrine levels causing anxiety, well perhaps but so could elevated serotonin levels. The implication that this is an expected, routine side effect of the NRI effect along with elevated pulse BP etc is at odds with the fact that SNRIs and indeed NRIs are approved for panic disorder and a wide range of other anxiety disorders 2A00:23C5:628C:A000:6D27:589E:A951:D3B4 (talk) 20:39, 7 July 2017 (UTC)

+1, I've added a citation-needed label for the sexual side effects as I also can't find any evidence for this statement. — Preceding unsigned comment added by 86.167.107.107 (talk) 11:55, 28 April 2019 (UTC)

In
In my opinion there is some very questionable information on this page. The issue of which of these drugs is legitimately or meaningfully categorised as an serotonin and noradrenaline reuptake inhibitor (SNRI) is far from clear. Desipramine is the most specific noradrenaline reuptake inhibitor (NRI) of any of the tricyclic antidepressants (TCAs) and almost certainly has no significant serotonergic effects at all. The 'gold standard' serotonin and noradrenaline reuptake inhibitor (SNRI), of the TCAs, is clomipramine, and it has a stronger claim to serotonin and noradrenaline reuptake inhibitor (SNRI) status that venlafaxine see my review: GILLMAN, P.K. (2006). A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action. Biological Psychiatry, 59, 1046-51. Nefazodone has no significant evidence supporting serotonin and noradrenaline reuptake inhibitor (SNRI) effects, indeed is is not a reuptake inhibitor at all, perhaps not even an effective antidepressant. Those wishing for a comprehensive review may find it of some help to consult summaries about these topics available, with references, on my website. If anyone wishes to exerpt, quote or copy material to improve this entry they have my permission. See www.psychotropical.com

Other possible SNRIs?
I have read, although not from any reliable source, that the pain medication Tramadol (Ultram, Ultracet) is also a slight SNRI. If anyone knows more about this medicine it might be useful to add this drug to this page. I've heard of people taking Tramadol with other SSRIs and SNRIs and getting serotonin syndrome, because some doctors don't even know about Tramadol's anti-depressive effect. Icculusioso 00:42, 3 May 2007 (UTC)

I thought Straterra was also a SNRI. 70.69.148.3 (talk) 01:34, 23 January 2008 (UTC)

I'm really pleased with the recent edits to this page and think collectively we've made a far better entry. But I'm not sure about the inclusion of Tramadol on the list. Yes, it has SNRI characteristics that certainly help with its advantage over other opioids on neuropathic pain, but it's still an opioid, with moderate effects on nociceptive pain, something that seems very diminished in the current entry. Wakeham (talk) 23:58, 7 May 2009 (UTC)Wakeham

After reviewing the evidence, I'd say Atomoxetine (Strattera) is not an SNRI. It does inhibit reuptake of NE, but has little effect on 5HT or other neurotransmitters. J Clin Psychiatry. 2006;67 Suppl 8:32-8.Wakeham (talk) 00:11, 8 May 2009 (UTC)

Bupropion (Wellbutrin) has 3-neurotransmmiter action: SNRI, SSRI, and SDRI (dopaminergic). Buccleugh (talk) 19:35, 20 June 2013 (UTC) buccleugh

SERATONIN or SELECTIVE?
...er- although I have not graduated yet and am far from an expert I am well aware of selective norepinephrine re-uptake inhibitor (SNRI) antidepressants, but have never heard of the same abbreviation referring to "Serotonin-norepinephrine re-uptake inhibitor" type antidepressant drugs. I believe this may be a misunderstanding on the part of the author and hope a kind professional/academic might find the time to either authenticate, edit, merge or delete this article accordingly.

SNRI is a valid acronym but if one wants an all-inclusive acronym, go with SSNDRI. It should be used along with a needed discussion of dopaminergic re-uptake inhibitors (SDRIs). Buccleugh (talk) 19:42, 20 June 2013 (UTC) buccleugh Thanks all, and all hail the free encyclopedia!

Toby84.43.122.165 (talk) 23:26, 13 January 2008 (UTC)

OK sorry - think I'm going nuts myself! Have been up far too long writing an unrelated paper & was trying to procrastinate.... Perhaps they are seratonin-norepinephrine RIs...

So long, T 84.43.122.165 (talk) 23:33, 13 January 2008 (UTC)

SNRI is serotonin norepinephrine reuptake inhibitors, and the "specific" is assumed, probably because SSNRI seemed too long. "Specific norepinephrine reuptake inhibitors" is abbreviated "NRI" with the specific assumed again. Psydzl (talk) 18:18, 11 February 2008 (UTC)

Ok I was asked to propose this here on the talk page. I have extensive experience w/ these agents and have spent a considerable amount of my adult years studying and marketing these types of medicines. The correct term to describe a dual acting agent (serontonin/norepinephrine) is referred to as an SSNRI which stands for Selective Serotonin Norepinephrine Reuptake Inhibitor. Now not all SNRI's are considered SSNRI's... which may be part of the confusion. Really the first of the class of SSNRI's was duloxetine, a.k.a. Cymbalta. Even Effexor XR can be considered an SSNRI but those are really the only two that act equally on both receptor sites.

So I propose for the sake of accuracy that we correctly refer to this new class as SSNRI rather than lumping them all into the SNRI classification.

In addition if you do a google search on just the term 'SSNRI' the first result is a wikipedia page with the URL en.wikipedia.org/wiki/SSNRI and a title that says, "SSNRI." So it is in fact misleading to then bring the visitor to a page that uses the term SNRI because that is not what they were looking for.

Thoughts? —Preceding unsigned comment added by Mdphd (talk • contribs) 22:04, 21 May 2008 (UTC)

Mdphd (talk) 22:06, 21 May 2008 (UTC)
 * Per MEDMOS, I'm not certain if that change would be appropriate. A PubMed search for "SSNRI" yields only 4 results, and only 2 of these are in English. (This is compared to 2546 for "SSRI" and 184 for "SNRI".) --Arcadian (talk) 02:46, 22 May 2008 (UTC)

OK, I'm not a clinician, but I teach pharmacology to allied health professionals... and the way I have been teaching it from the textbooks is that SNRI are serotonin noradrenaline reuptake inhibitors, and NARI or NRI are noradrenaline reuptake inhibitors. I think that's standard terminology today, although certainly none of these classes existed at all back when I took pharmacology.

As a medical student currently studying psychiatry I would say that the accepted abbreviation (in the UK at least) is SNRI. If there is confusion the page should be updated to reflect this. Another point id like to raise is the usage of SNRIs, whilst they seem to be popular in America they aren't prescribed much in the UK, at least from my (very limited) experience. 69.137.60.87 (talk) 22:39, 20 April 2011 (UTC)

I think it would be good to combine both under the shorter title. My choice would be SNRI. With tramadol, however, two less-elegant acronyms, SRI and NRI, are needed (imho, of course) to prevent confusion. buccleugh (talk) 18:36, 20 June 2013 (UTC) buccleugh 68.113.85.127 (talk) 18:31, 20 June 2013 (UTC) buccleugh 68.113.85.127 (talk) 18:29, 20 June 2013 (UTC) 18:23, 20 June 2013 (UTC)68.113.85.127 (talk)  —

Nefazadone liver failure
The text currently says that a blood test every six months is sufficient for the prevention of liver failure with nefazadone, but I don't think that's correct. I think the liver failure tends to occur very rapidly. There is extensive damage in the abscence of a prodrome of gradually increasing serum liver enzymes. Psydzl (talk) 18:15, 11 February 2008 (UTC)

According to my psychiatrist, Serzone was unfairly maligned by the popular media... that other drugs in the class have similar liver risks, and that some of the others had higher incidence of liver failure than nefazadone. Also, the current article indicates that nefazadone has been discontinued... it is still available in the generic in the US, so I'm removing that statement. Cstrouss (talk) 06:14, 3 May 2010 (UTC)

When and how used?
It would be nice with a history section, telling when the drug was developed, tested, taken into use, etc. And how widespread it's use is. Is it e.g. taking over the role of SSRI? 84.238.87.77 (talk) 09:32, 15 February 2009 (UTC)

Tramadol information confusing/needs clarification
This is not my area of expertise, but it's confusing to say Tramadol is an SNRI, by including it in the list of SNRIs, and then to say, in Contradindications, that Tramadol is contraindicated with SNRIs. If Tramadol is contraindicated with other SNRIs, it would be more clear to just say that. Hananekosan (talk) 02:01, 13 August 2009 (UTC

Tramadol has other pharmacological issues that need an extended discussion: tramadol's primary metabolite binds to selective opiod receptors in the brain. I recommend mention of tramadol on this page, with link to the separate tramadol page for discussion. There, explain the SRI interaction in more detail. Better, use two acronyms: SRI and NRI on this page to eliminate any confusion. Buccleugh (talk) 19:29, 20 June 2013 (UTC) buccleugh

Merger proposal
I propose merging Discovery and development of dual serotonin and norepinephrine reuptake inhibitors into this article, since it is well written and far more comprehensive than this article. Any objections? SmartSE (talk) 00:02, 12 November 2010 (UTC)


 * Support. The subject matter of both largely overlap, so it would make sense to merge the two articles. In addition, as I have pointed out here, including  "discovery and development" in the article name makes it overly verbose.  The direction of the proposed merger uses the shorter name which is an advantage.  Boghog (talk) 03:56, 12 November 2010 (UTC)


 * Support. The article already covers information outside of the D&D of SNRIs, and as expressed by others, I think the title is too long.  ~rezecib  ( talk ) 16:40, 12 November 2010 (UTC)


 * Oppose. If you check the edit history, it appears this is another in the series of "discovery and development of..." particular drug type articles which are made annually by a medicinal chemistry class at the University of Iceland. See Drug design for other examples, most of which have been retained as stand-alone articles rather than merged with other similar pages. These have been discussed before at Wikipedia_talk:WikiProject_Pharmacology/Archive_2, and I presume there will be another couple of similar pages made by this semester's crop of Icelandic medicinal chemistry students. They have previously been useful, encyclopedic articles of medium to high quality and I would suggest it would be polite to retain them at least until the authors have had a chance to get their assignment marked! Meodipt (talk) 15:03, 18 November 2010 (UTC)


 * Wikipedia is not a place to post assignments… Yes, they are contributing great material, but they can just as easily refer their professor to the previous version of the D&D article before it was merged. All that information is retained in the edit history. I read through the discussion you linked and it seemed the main point against merging is producing undue weight on the D&D of the drug in the merged article, which I think is a valid concern, but I'd still rather see it merged. If nothing else, Discovery and development of dual serotonin and norepinephrine reuptake inhibitors can be moved to Development of serotonin-norepinephrine reuptake inhibitors, given a small blurb in this article with a "for more on this topic" link to the development article.  ~rezecib  ( talk ) 18:15, 18 November 2010 (UTC)


 * Support per the arguments above and per the related discussion at the WikiProject. I think it's great to have student projects, but these projects have to comply with the same policies and guidelines as everything else. --Tryptofish (talk) 22:43, 19 November 2010 (UTC)


 * Support per the arguments above, because it enables the information on discovery and development of SNRIs to be retrieved by the simple term searches "Serotonin Norepineprine Reuptake Inhibitors" or "SNRI" (via a disambiguation page). It simplifies the task for anyone researching SNRIs and doesn't require them to enter additional search terms to get that infoprmation.loupgarous (talk) 02:27, 27 November 2010 (UTC)


 * Support. "Discovery ..." article is analogous to the "history" section of articles on places of interest. Who in their right mind would seek information about a particular place under the heading "history", so large as to be useless as a search term? I say make the "Discovery" article the last section of the SNRI article. Richard Barnett "Dick" Bloom 15:37, 25 March 2011 (UTC)

Second paragraph
Made word, punctuation, and grammar changes to improve clarity and emphasis. Victorsteelballs (talk) 11:44, 25 May 2012 (UTC)

8. Edit
Strattera was listed as an SNRI in the last paragraph with Wellbutrin but it is just an NRI so I took it out. Also, I took out the comma after "studies done" in that same paragraph because I didn't think it was needed (but I could be wrong). Dmitri12 (talk) 07:19, 8 November 2012 (UTC)

Hatnote
The hatnore referring to the SNRI thinktank is a broken link, and I am not sure if I should remove it or change it to a new name if one exists. Rarkenin (talk) 20:26, 3 January 2013 (UTC)

When is the merger going to happen?
It has been almost 9 months since it was agreed to merge this article with the discovery and development article and nothing has been done. When is the merger going to take place?
 * Finally done on 2014-03-05, but an expert will need to review it. -- P 1 9 9 ✉ 14:30, 5 March 2014 (UTC)

CP133 2019 Group 22 proposed edits
Kendallkehr (talk) 22:22, 16 October 2019 (UTC) — Preceding unsigned comment added by Kendallkehr (talk • contribs) 22:20, 16 October 2019 (UTC)
 * Change the header "Types" to something more specific such as "Pharmacotherapies" or "Medications"
 * Combine the drugs listed under "Types" into one table to help with continuity when reading. Right now the beginning portion is paragraph form and the later portion is a table.
 * Update the "Medical Issues" column with additional FDA indications for each medications and consider changing the title "Medical Issues" to "Indications" to make it more specific and clear.
 * Add more information on stigma and public perception of using drugs such as SNRIs

After reviewing group 21's peer review of our article, I linked other Wiki articles under the "Contraindications" heading and I added a citation under the "Medications" heading. Kendallkehr (talk) 19:00, 7 November 2019 (UTC)

Ahmadyarg (talk) 22:42, 16 October 2019 (UTC) Jermakiank (talk) 22:59, 16 October 2019 (UTC) Juliemarienguyen (talk) 03:01, 16 October 2019 (UTC)
 * Add a reference to the lead sentence
 * Expand on side effects portion and include the the most common side effect of SNRIs is nausea which can be alleviated by taking it with food.
 * Expand on the different dosage forms/ formulations and include that extended release formulations available for desvenlafaxine and venlafaxine tablets and venlafaxine and levomilnacipran capsules are intended to be swallowed whole and should not be crushed or chewed. With the exception of venlafaxine extended release capsules which can be opened and the pellets can be sprinkled on food (eg applesauce), which should be swallowed immediately without chewing.
 * Add a table that has the CYP enzyme metabolism
 * Add a section for interactions
 * Add treatment for serotonergic syndrome
 * Add risk for overdose
 * Add onset of efficacy
 * Add linezolid and methylene blue to list of contraindications
 * Add a special populations section (geriatrics, pediatrics, pregnancy)
 * Add use in concomitant pain in lead section
 * Add newer SNRIs to list of approved medications
 * Add medications that may contribute to serotonin syndrome
 * Add signs and symptoms of withdrawal
 * Add recommendation for preventing serotonin syndrome
 * Add citation to use of cyproheptadine as antidote for serotonin syndrome

Group 22 Peer Reviews
Part 1

The group's edit did improve the article. The goal of editing is to 1) provide updated information 2) ensure the article is organized so that specific information can be easily found and understood.

The group did update information which included updating medication indications (addition of social phobia) and the number of FDA approved SNRI’s. They also supplemented information regarding side effects (bleeding and serotonin syndrome) and placed them under helpful subheadings so they were easier to find. Further, they edited the table under "Medications" to include notes originally listed elsewhere in the article. This helped streamline the information.

I believe the group had achieved the goal of editing.

Part 2 There were no signs of obvious plagiarism. No phrases sounded awkward or inconsistent to the authors' manner of writing.

Celiahoang (talk) 05:46, 4 November 2019 (UTC)

Part 1: Yes, the group edits improved the article, especially by expanding information on route of administration and contraindications. The addition of side effects including serotonin syndrome and bleeding is excellent because I think those are crucial for patients to be aware of while taking SNRIs. All edits were made in a neutral point of view, and I saw tidbits of information we learned in class! The links under "See Also" were also intelligent additions as those resources will also be useful for patients to navigate to for more information on adjacent topics. I would encourage the editors to link other Wikipedia articles to the medications listed in "contraindications" so viewers can jump to a more robust reading on those particular medications, if desired.

I believe the group has achieved their goals of improvement.

Part 2: In terms of the sources used to improve the article, I was able to easily access them by clicking on the resource. I noticed this group used a combination of primary sources (NEMJ, PubMed) and secondary/tertiary sources (Poison Center, Mayo Clinic) to back up their statements.

KBielaski (talk) 16:15, 6 November 2019 (UTC)

Part 1: Group 22's edits did improve the article by adding information that was both accurate and understandable. I appreciated that at the very beginning of the article, the approval years for common SNRIs were listed as bullets, which made it easy to see examples of common SNRIs at a glance. Some particularly helpful information was added to the route of administration, contraindications, serotonin syndrome, and bleeding sections. These sections are useful for the general public who may be seeking more information about how to take prescribed SNRIs. The serotonin syndrome and bleeding sections are especially helpful because they highlight more severe side effects that patients should be aware of. Overall, the group's edits add value to the article. Part 2: The draft submission reflects a neutral point of view. Group 22 did not add any biased edits, but instead presented the information simply as facts, without adding their own thoughts or seeking to sway the readers' opinions. This was also evidenced through their added citations, which included many primary and secondary sources. Their edits did include some recommendations (such as in the routes of administration section), but they were appropriately cited and widely considered acceptable practice so I would not qualify them as biased edits.

Azengvoong (talk) 19:41, 6 November 2019 (UTC)

Part 1: Group 22's edits provided additional information on the administration, interactions, and side effects of SNRIs, thus increasing more information available for the public to see. The formatting of the article was appropriate. I liked that they added more crosslinks of related articles so that people can find more information. I say that the group has achieved goals for improvement. Part 2: Reviewing the sources cited, I did not see any sign of plagiarism or copyright violations. However, there were some statements that did not have sources cited. DavidSuSOP (talk) 22:10, 6 November 2019 (UTC)