Qualitative Review of SNRIs in Anxiety

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Anxiety disorders pose a problem for a significant number of individuals, with a 1-year prevalence rate estimated at 13.1% to 17.1%. Many pharmacologic agents have been used to treat anxiety disorders, and among those in current use are newer benzodiazepines (alprazolam), azapirones (buspirone), selective serotonin reuptake inhibitors (paroxetine and sertraline), and venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI). The likely role of abnormal serotonergic neurotransmission in anxiety is widely supported, while the role of norepinephrine is less clear. Still, many lines of evidence support the hypothesis that a perturbation in norepinephrine neurotransmission contributes to the symptoms of anxiety. Therefore, it is conceivable that modulation of both serotonin and norepinephrine systems by dual-reuptake inhibitors may be an advantage in the treatment of anxiety disorders. Given this, the current review examines evidence on the possible role of venlafaxine in the treatment of anxiety disorders. From this review it is clear that venlafaxine is as efficacious as selective serotonin reuptake inhibitors in treating anxiety, with comparable tolerability. Future research will be valuable in determining if antidepressants that combine pharmacologic actions on serotonergic and noradrenergic systems have advantages over more selective agents in treating anxiety disorders.

J Clin Psychiatry 2004;65(suppl 17):19-28