Panic Disorder Treatment Taking SNRIs for Treating Panic Disorder By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. Learn about our editorial process Updated on October 20, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Yuichiro Chino/Getty Images Often prescribed to treat mood and anxiety disorders, serotonin and norepinephrine reuptake inhibitors are one of the most common treatment options for panic disorder. What Are Serotonin and Norepinephrine Reuptake Inhibitors? Serotonin and norepinephrine reuptake inhibitors (SNRIs) are one class of antidepressant medications. Some of the most common SNRIs include Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine). These antidepressants are frequently prescribed to treat mood disorders, such as major depressive disorder and depression in bipolar disorder. SNRIs have also been found to safely and successfully treat anxiety disorders, including panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Additionally, SNRIs can also effectively treat persistent pain caused by certain conditions, such as fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The 5 Major Classes of Antidepressants How They Work in Treating Anxiety and Panic Disorders The human brain contains hundreds of naturally occurring chemical messengers called neurotransmitters. These messengers are responsible for directing information throughout the brain. It is believed that if one or more of these neurotransmitters become unbalanced, it can contribute to a person developing a mood or anxiety disorder. The neurotransmitters serotonin and norepinephrine are thought to be particularly linked to the occurrence of panic disorder. Both neurotransmitters play a role in regulating certain functions and emotions that can affect the onset of this condition. Serotonin is connected to the regulation of mood and sleep. Norepinephrine is responsible for how the person reacts to stress and anxiety and is associated with the fight-or-flight response. SNRIs work to influence both serotonin and norepinephrine by preventing a person’s brain cells from rapidly absorbing these neurotransmitters. By stabilizing these neurotransmitters, SNRIs can help improve a person’s mood, reduce feelings of anxiety, and help alleviate panic attacks. SNRIs are sometimes confused with selective serotonin reuptake inhibitors (SSRIs), which are similar antidepressants, but only work to affect serotonin. Press Play for Advice On Dealing With Depression Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast, featuring GRAMMY Award-Winning singer JoJo, shares the benefits of antidepressants and how to manage your mental health. Click below to listen now. Follow Now: Apple Podcasts / Spotify / Google Podcasts Side Effects It is possible to experience side effects when taking SNRIs. Some of the most common side effects of SNRIs include: Nausea or vomitingDry mouthDrowsiness and fatigueHeadachesSexual side-effectsIncreased nervousnessUpset stomach or abdominal painSleep disturbance These side effects should decrease over time. Consult your doctor if side effects don’t improve or worsen. It is possible to experience a serious drug allergy from SNRIs. Contact your pharmacy or doctor immediately if you are experiencing the symptoms of allergic drug interaction, including swelling of the mouth, face, or tongue, inability to take deep breaths, choking sensations, rash, and hives. Precautions Black Box Warning In 2007, the United States Food and Drug Administration (FDA) issued an advisory known as a black box warning. Through this warning, the FDA cautioned that the use of SNRIs and other antidepressant medications may lead to heightened suicidal thoughts and behaviors, particularly in young people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Drug Interactions Certain medications should not be taken or should be used with caution along with SNRIs. Keep your doctor up-to-date with any prescribed and over-the-counter medications you are taking. Alcohol Consumption Consuming alcohol can elevate the toxicity of SNRIs and can impact the effectiveness of these antidepressant medications. Special Populations SNRIs can be passed from mother to child during pregnancy or while nursing. If you are pregnant or nursing, discuss the potential risks of taking SNRIs with your doctor. Older adults are often more susceptible to experiencing the side effects of SNRIs. If you are an older adult taking SNRIs, talk to your doctor about potential side effects. 6 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother. 2018;19(10):1057-1070. doi:10.1080/14656566.2018.1491966 Montoya A, Bruins R, Katzman MA, Blier P. The noradrenergic paradox: implications in the management of depression and anxiety. Neuropsychiatr Dis Treat. 2016;12:541-557. doi:10.2147/NDT.S91311 Santarsieri D, Schwartz TL. Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs Context. 2015;4:212290. doi:10.7573/dic.212290 Pompili M, Serafini G, Innamorati M, et al. Antidepressants and Suicide Risk: A Comprehensive Overview. Pharmaceuticals (Basel). 2010;3(9):2861-2883. doi:10.3390/ph3092861 Dubovicky M, Belovicova K, Csatlosova K, Bogi E. Risks of using SSRI / SNRI antidepressants during pregnancy and lactation. Interdiscip Toxicol. 2017;10(1):30-34. doi:10.1515/intox-2017-0004 Garfield LD, Dixon D, Nowotny P, et al. Common selective serotonin reuptake inhibitor side effects in older adults associated with genetic polymorphisms in the serotonin transporter and receptors: data from a randomized controlled trial. Am J Geriatr Psychiatry. 2014;22(10):971-979. doi:10.1016/j.jagp.2013.07.003 Additional Reading Dell'osso B, Buoli M, Baldwin DS, Altamura AC. Serotonin norepinephrine reuptake inhibitors (SNRIs) in anxiety disorders: a comprehensive review of their clinical efficacy. Hum Psychopharmacol. 2010;25(1):17-29. doi:10.1002/hup.1074 Gorman, J. M., & Kent, J. M. (1999). SSRIs and SNRIs: Broad Spectrum of Efficacy Beyond Major Depression. Assessing Antidepressant Efficacy: A Reexamination., Jan 1998, Phoenix, AZ, US. Physicians Postgraduate Press. Silverman, Harold M. (2010). The Pill Book. 14th ed. New York, NY: Bantam Books. By Katharina Star, PhD Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Panic Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.