Inhibitor of serotonin and noradrenaline reuptake – Wikipedia

THE Reupport (or recovering) inhibitors of serotonin-noradrenaline ( Irsna, Irsn or Snri in English for Serotonin-norepinephrine reuptake inhibitor ) are psychotropic drugs that selectively inhibit noradrenaline and serotonin reuptake. This inhibition leads to an increase in the synaptic concentration of these neuromediators. Within a few weeks, we ^{[Who ?]} Think that an adaptive decrease (“down regulation”) of postsynaptic receptors 5HT2A to serotonin and postsynaptic β with noradrenaline, receptors that would be in too large number in subjects with depression. ^{[ Ref. desired]} , occurs.

This hypothesis is however questioned by the fact that a study highlights an elevation of the 5HT2A receptors and that, in studies where a decrease in these receptors is observed, there is no correlation between the therapeutic response and The decrease in 5HT2A receptors: the decrease was observed both in patients who replied that those who did not respond to antidepressant ^{[ first ]} . Antidepressants are based on the monoaminergic hypothesis (hypothesis of a chemical imbalance in the brain).

In development :

• Treatment of major depressive episodes in adults
• Venlafaxine can be used in the prevention of depressive recurrences in the unipolar patient
• Duloxetine is indicated in the United States for fibromyalgia treatments, urinary incontinence for effort and diabetic neuropathy
• Milnacipran is indicated in the United States for the treatment of fibromyalgia

Some doctors also prescribe venlafaxine to treat certain symptoms of menopause such as heat puffs, in prophylactic treatment of migraines or in treatment of chronic painful conditions such as diabetic neuropathy and fibromyalgia.

• Venlafaxine is used to overcome the cataplexies of certain narcoleptics.

In the event that there are sexual dysfunctions (hypoactive sexual desire, anorgasmia, excitement disorder, etc. ) Before the appearance of a depressed state, use of an IRSNA will be not recommended because it could have a counterproductive effect ^{[ 2 ] , [ 3 ]} .

This family of antidepressants will be better tolerated than that of tricyclics, but will be less effective. The main side effects are identical to those of selective serotonin reuptake inhibitors (ISRS)

• Anticholinergic effects: oral drought and urinary retention.
• Peripheral noradrenergic effects: increased blood pressure
• Peripheral serotonergic effects: nausea and vomiting, sexual disorders.
• Central anti -H1 (histamine) effect: especially with venlafaxine, important sedative effect.
• We also observe with the Milnacipran a lifting of suicidal inhibition.

These molecules are against indicated in case:

It will be necessary to halve the dosage ^{[ Ref. desired]} in the event of renal or liver insufficiency.

• Absolute contraindication with non-specific MAIOs (iproniazide) and with triptans.
• Associations not recommended with selective MAOs A, adrenaline and noradrenaline …
• Perhaps combined with precautions to an ISRS or another Irsna ^{[ 4 ]}

Discontinuation syndrome associated with antidepressants [ modifier | Modifier and code ]

The marked stop or reduction in the dose of IRSNA treatment can cause discontinuation syndrome associated with antidepressants.