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Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressants that increase serotonin and norepinephrine levels in the brain. Common agents include venlafaxine (Effexor XR), desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and milnacipran (Savella). In addition to treating depression and anxiety disorders, several SNRIs have important pain indications, making them especially useful in patients with neuropathy, fibromyalgia, or chronic musculoskeletal pain. Common adverse effects include nausea, sweating, insomnia, sexual dysfunction, and elevated blood pressure. Clinicians should also remember the significant discontinuation risk associated with shorter half-life agents like venlafaxine and desvenlafaxine.
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