Differences between SSRI and SNRI in depression treatment
DOI:
https://doi.org/10.12775/QS.2025.37.57038Keywords
anxiety disorders, depression, SSRIs, SNRIs, mental health, depression treatment, serotonin, norepinephrineAbstract
Introduction
Depressive disorders represent a significant health problem worldwide. With the development of pharmacotherapy, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have become preferred therapeutic options. SSRIs are the most commonly used first-line medications, but there are controversies regarding their efficacy compared to SNRIs.
Aim of Study
The aim of this study is to analyze the differences between two groups of drugs – SSRIs and SNRIs – in the treatment of depression and to try to identify on this basis a group of drugs that should be used as first-line drugs in the treatment of depression.
Materials and Methods
This review was conducted by searching scientific publications on PubMed and Google Scholar. The analysis took into account a number of studies comparing individual drugs from both groups of drugs, and then concisely summarized their conclusions.
Conclusion
The review of the literature and clinical trial results shows that no single universal group of medications can be identified for depression therapy. The choice should be tailored individually to each patient, taking into account the symptoms of their illness and the side effects of previously used medications. At the same time, the review highlighted the need for further research into the types of treatment for depressive disorders.
References
Ferguson JM. SSRI Antidepressant Medications: Adverse Effects and Tolerability. Prim Care Companion J Clin Psychiatry. 2001;3(1):22-7.
Brigitta B. Pathophysiology of depression and mechanisms of treatment. Dialogues Clin Neurosci. 2002;4(1):7-20.
Montes JM, Ferrando L, Saiz-Ruiz J. Remission in major depression with two antidepressant mechanisms: results from a naturalistic study. J Affect Disord. 2004;79(1-3):229-34.
Thase ME. Are SNRIs more effective than SSRIs? A review of the current state of the controversy. Psychopharmacol Bull. 2008;41(2):58-85.
Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res. 2020;126:134-40.
Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398(10312):1700-12.
Yan M, Chen J, Liu F, Li H, Huang R, Tang Y, et al. Disrupted Regional Homogeneity in Major Depressive Disorder With Gastrointestinal Symptoms at Rest. Front Psychiatry. 2021;12:636820.
Cui L, Li S, Wang S, Wu X, Liu Y, Yu W, et al. Major depressive disorder: hypothesis, mechanism, prevention and treatment. Signal Transduct Target Ther. 2024;9(1):30.
Otte C, Gold SM, Penninx BW, Pariante CM, Etkin A, Fava M, et al. Major depressive disorder. Nat Rev Dis Primers. 2016;2:16065.
Murphy MJ, Peterson MJ. Sleep Disturbances in Depression. Sleep Med Clin. 2015;10(1):17-23.
Tran PV, Bymaster FP, McNamara RK, Potter WZ. Dual monoamine modulation for improved treatment of major depressive disorder. J Clin Psychopharmacol. 2003;23(1):78-86.
Wasielewska M. Comparison of the mechanisms of action of antidepressants and their side effects. Journal of Education, Health and Sport. 2020;10:260.
Dierick M, Ravizza L, Realini R, Martin A. A double-blind comparison of venlafaxine and fluoxetine for treatment of major depression in outpatients. Prog Neuropsychopharmacol Biol Psychiatry. 1996;20(1):57-71.
Silverstone PH, Ravindran A. Once-daily venlafaxine extended release (XR) compared with fluoxetine in outpatients with depression and anxiety. Venlafaxine XR 360 Study Group. J Clin Psychiatry. 1999;60(1):22-8.
Poirier MF, Boyer P. Venlafaxine and paroxetine in treatment-resistant depression. Double-blind, randomised comparison. Br J Psychiatry. 1999;175:12-6.
De Nayer A, Geerts S, Ruelens L, Schittecatte M, De Bleeker E, Van Eeckhoutte I, et al. Venlafaxine compared with fluoxetine in outpatients with depression and concomitant anxiety. Int J Neuropsychopharmacol. 2002;5(2):115-20.
Bagby RM, Kennedy SH, Schuller DR, Dickens SE, Minifie CE, Levitt A, et al. Differential pharmacological treatment response in high angry hostile and low angry hostile depressed patients: a retrospective analysis. J Affect Disord. 1997;45(3):161-6.
Ballús C, Quiros G, De Flores T, de la Torre J, Palao D, Rojo L, et al. The efficacy and tolerability of venlafaxine and paroxetine in outpatients with depressive disorder or dysthymia. Int Clin Psychopharmacol. 2000;15(1):43-8.
Perahia DG, Wang F, Mallinckrodt CH, Walker DJ, Detke MJ. Duloxetine in the treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Psychiatry. 2006;21(6):367-78.
Detke MJ, Wiltse CG, Mallinckrodt CH, McNamara RK, Demitrack MA, Bitter I. Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Neuropsychopharmacol. 2004;14(6):457-70.
Montgomery SA, Huusom AK, Bothmer J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology. 2004;50(1):57-64.
Sir A, D'Souza RF, Uguz S, George T, Vahip S, Hopwood M, et al. Randomized trial of sertraline versus venlafaxine XR in major depression: efficacy and discontinuation symptoms. J Clin Psychiatry. 2005;66(10):1312-20.
Shelton RC, Haman KL, Rapaport MH, Kiev A, Smith WT, Hirschfeld RM, et al. A randomized, double-blind, active-control study of sertraline versus venlafaxine XR in major depressive disorder. J Clin Psychiatry. 2006;67(11):1674-81.
Thase ME, Pritchett YL, Ossanna MJ, Swindle RW, Xu J, Detke MJ. Efficacy of duloxetine and selective serotonin reuptake inhibitors: comparisons as assessed by remission rates in patients with major depressive disorder. J Clin Psychopharmacol. 2007;27(6):672-6.
Khan A, Bose A, Alexopoulos GS, Gommoll C, Li D, Gandhi C. Double-blind comparison of escitalopram and duloxetine in the acute treatment of major depressive disorder. Clin Drug Investig. 2007;27(7):481-92.
Pigott TA, Prakash A, Arnold LM, Aaronson ST, Mallinckrodt CH, Wohlreich MM. Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin. 2007;23(6):1303-18.
Nemeroff CB, Entsuah R, Benattia I, Demitrack M, Sloan DM, Thase ME. Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs. Biol Psychiatry. 2008;63(4):424-34.
Lam RW, Lönn SL, Despiégel N. Escitalopram versus serotonin noradrenaline reuptake inhibitors as second step treatment for patients with major depressive disorder: a pooled analysis. Int Clin Psychopharmacol. 2010;25(4):199-203.
Wang SM, Han C, Bahk WM, Lee SJ, Patkar AA, Masand PS, et al. Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review. Chonnam Med J. 2018;54(2):101-12.
Rao P, Kowey PR. Drug-induced long-QT syndrome and torsade de pointes: an underrated problem? Europace. 16. England2014. p. 4-5.
Mago R, Tripathi N, Andrade C. Cardiovascular adverse effects of newer antidepressants. Expert Rev Neurother. 2014;14(5):539-51.
Cappetta K, Beyer C, Johnson JA, Bloch MH. Meta-analysis: Risk of dry mouth with second generation antidepressants. Prog Neuropsychopharmacol Biol Psychiatry. 2018;84(Pt A):282-93.
Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux L, Van Noord M, et al. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med. 2011;155(11):772-85.
Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3):259-66.
Koenig AM, Thase ME. First-line pharmacotherapies for depression - what is the best choice? Pol Arch Med Wewn. 2009;119(7-8):478-86.
Dionisie V, Filip GA, Manea MC, Manea M, Riga S. The anti-inflammatory role of SSRI and SNRI in the treatment of depression: a review of human and rodent research studies. Inflammopharmacology. 2021;29(1):75-90.
Wohlreich MM, Watkin JG. The Role of Duloxetine in the Treatment of Depression and Associated Painful Physical Symptoms. Prim Care Companion J Clin Psychiatry. 2003;5(6):286-7.
Nordström G, Despiegel N, Marteau F, Danchenko N, Maman K. Cost effectiveness of escitalopram versus SNRIs in second-step treatment of major depressive disorder in Sweden. J Med Econ. 2010;13(3):516-26.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Mateusz Grego, Katarzyna Grego, Łukasz Stojak, Dariusz Popiela, Karina Urbańska, Filip Kwiatkowski, Mateusz Baczewski, Witold Czyż
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 298
Number of citations: 0
