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SNRIs are delivered orally, usually in the form of capsules or tablets. It is recommended to take SNRIs in the morning with breakfast, which does not affect drug levels, but may help with certain side effects. [48] Norepinephrine has activating effects in the body and therefore can cause insomnia in some patients if taken at bedtime. [49]
Some antidepressants, including commonly prescribed ones from the class known as SSRIs (selective serotonin reuptake inhibitors), can cause sexual side effects such as erectile dysfunction ...
For example, cocaine, which non-selectively inhibits the reuptake of serotonin, norepinephrine, and dopamine, is an SRI but not an SSRI. SRIs are used predominantly as antidepressants (e.g., SSRIs, SNRIs, and TCAs), though they are also commonly used in the treatment of other psychological conditions such as anxiety disorders and eating disorders.
This side effect has been particularly associated with serotonergic antidepressants like SSRIs and SNRIs, but may be less with atypical antidepressants like bupropion, agomelatine, and vortioxetine. [ 83 ] [ 85 ] [ 86 ] Higher doses of antidepressants seem to be more likely to produce emotional blunting than lower doses. [ 83 ]
Also, currently available antidepressants all elicit undesirable side-effects, and new agents should be divested of the distressing side-effects of both first and second-generation antidepressants. [6] Another serious drawback of all antidepressants is the requirement for long-term administration prior to maximal therapeutic efficacy.
This side effect has been particularly associated with serotonergic antidepressants like SSRIs and SNRIs but may be less with atypical antidepressants like bupropion, agomelatine, and vortioxetine. [ 167 ] [ 173 ] [ 176 ] [ 177 ] Higher doses of antidepressants seem to be more likely to produce emotional blunting than lower doses. [ 167 ]
The first commercially available selective norepinephrine reuptake inhibitor (sNRI) was reboxetine (Edronax) and was developed as a first-line therapy for major depressive disorder. [29] The selectivity of reboxetine for the norepinephrine transporter (NET) results in benign side effect profile because the drug is well tolerated. [11]
SSRIs have dominated the market for antidepressants [1] and are recommended by the National Institute for Health and Clinical Excellence (NICE) as a first-line treatment of depression, because they tend to have fewer adverse effects than other type of antidepressants with the same effectiveness.