Venlafaxine vs sertraline (A review)

In this guide, we will analyze which of these two antidepressants, venlafaxine vs sertraline, are better for treating diverse disorders like depression and anxiety.

Venlafaxine vs sertraline

Various methods have been used to treat different mental disorders. Disorders such as anxiety, depression, bipolar and phobias have been treated with methods ranging from cognitive behavioural therapies to medication.

Depending on the severity of the symptoms that a person suffers due to the disorder, in some cases, it is not necessary to use psychopharmaceutical treatment. When the health professional looks at the result that the patient has with psychological therapy, it decides if it is necessary to use another type of therapy. There are cases where it is necessary to use treatment with psychoactive drugs because the levels of the disorder are very marked in the person and the therapy alone does not take effect, even if the results that it gives are scientifically proven.

When starting treatment with psychoactive drugs, the health professional evaluates the symptoms that a person presents and tries to prescribe the most appropriate. Many are the antidepressants that have gone on the market, as an immediate and effective cure for mental disorders such as depression, but according to clinical trials, some work better in the body of the human being.

Two medications are part of the most prescribed for disorders such as depression, and these are venlafaxine and sertraline. Both medications have positive effects in the treatment of depressive and other disorders, but apart from this, there are other aspects that the doctor takes into account when prescribing. So, venlafaxine vs sertraline, which one is better?

At the time of the health professional to prescribe a medication, apart from the effectiveness that it may have on the disease, the doctor seeks to take care of other aspects of the person’s health, one of these aspects are the side effects that it can cause. Among venlafaxine vs sertraline, which has major side effects? To know the effects of both medications, it is important to know what they are and how they act in the body of the person.

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Venlafaxine 

Venlafaxine is an antidepressant of the Serotonin-norepinephrine reuptake inhibitors (SNRIs) class. This medicine is used for the treatment of Major Depressive Disorder, as a treatment for Generalized Anxiety Disorder and indications of comorbidity in certain Anxiety Disorders with depression. It is also used for the treatment of Social Phobia, Panic Disorder and vasomotor symptoms.

Venlafaxine works by blocking the retraining proteins of key neurotransmitters that affect mood, leaving more active neurotransmitters at the synapse. The neurotransmitters affected are serotonin and norepinephrine. Serotonin is the fundamental neuromodulator of the human nervous system. Behavioural and neuropsychological processes modulated by serotonin include mood, perception, reward, anger, aggression, appetite, memory, sexuality and attention. Its metabolism is associated in several psychiatric disorders and its concentration is reduced by stress. Norepinephrine is a stress hormone, affecting parts of the brain such as the cerebral tonsil, where attention and responses are controlled. As can be seen, when these neurotransmitters are altered, they negatively affect human functioning and here the function of antidepressants such as venlafaxine has the function of normalizing these neurotransmitters.

Venlafaxine also weakly inhibits dopamine retraining. Evidence has been shown that the norepinephrine transporter also transports some dopamine since dopamine is inactivated by the reception of norepinephrine in the frontal cortex. The frontal cortex is largely lacking dopamine transporters, therefore, venlafaxine can increase the neurotransmission of dopamine in this part of the brain. Dopamine is important in all nervous responses that are related to the expression of emotions.

Adverse effects of venlafaxine

Some of the strongest adverse effects that a person can experience taking venlafaxine are:

  • Headache
  • Insomnia
  • Nausea
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Sweat
  • Memory loss

An important aspect to consider when prescribing venlafaxine, are studies conducted between this medication and a possible risk of suicide. Recent research cites that people taking venlafaxine have a higher risk of suicide. Some studies also revealed that venlafaxine can cause dependence.

Sertraline

Sertraline is an antidepressant belonging to the group of selective serotonin reuptake inhibitors (SSRIs). Sertraline is used for the treatment of depression, obsessive-compulsive disorder, panic disorder, social phobia and premenstrual dysphoric disorder. Studies have found that sertraline may work better than fluoxetine in some types of depression. The difference between this medication and others in terms of side effects has also been highlighted, where sertraline has fewer side effects.

The use of sertraline in the treatment of panic disorders helps reduce panic attacks, contributing to a better quality of life. In the case of obsessive-compulsive disorder, it has been proven that sertraline is not as effective as cognitive behavioural therapy. Better results have been given when combining cognitive behavioural therapy and an SSRI. Sertraline is also effective in treating PTSD and Social Phobia.

Sertraline potentiates serotonin in the central nervous system. Sertraline increases extracellular levels of serotonin and, therefore, increases serotonergic neurotransmission in the brain. It is believed that this action is responsible for the antidepressant, anxiolytic and anti-obsessive effects of sertraline. Sertraline has no significant affinity for the norepinephrine transporter or serotonin, dopamine, adrenergic, histamine or acetylcholine receptors. But it does show an affinity for the dopamine transporter.

Adverse effects of sertraline

Compared to other SSRIs, sertraline tends to be associated with a higher rate of psychiatric side effects and diarrhoea. It tends to be more activating (that is, associated with a higher rate of anxiety, agitation, insomnia) than other SSRIs. In the sexual field, sertraline is associated with sexual side effects, including sexual arousal disorder and difficulty reaching sexual release.

Venlafaxine vs sertraline – Which is better?

Both medications are frequently prescribed by health professionals for the treatment of depressive and other disorders. Although each one is indeed prescribed according to the symptoms that each person presents, the professional of the area takes into account other aspects so that it does not interfere with the functioning of the organism and has the least amount of side effects. Thus, venlafaxine vs sertraline, which one to choose?

While it is true that venlafaxine is one of the most used medications, being the sixth most prescribed antidepressant in the retail market in the United States, it is advisable not to prescribe it in the first line due to certain side effects it has. In the case of children and adolescents, according to the National Institute for Health and Care Excellence (NICE), venlafaxine should not be prescribed in the first place due to side effects such as a possible suicide risk. Studies suggest that this medication should be used as a last resort when other treatments have failed.

In the case of sertraline, so far the scientific evidence has not found sufficient evidence that it causes people to be at greater risk of suicide. According to a clinical analysis carried out by the FDA, the use of sertraline decreases the chances of suicidal behaviour. But, in an analysis by the Medicine and Healthcare products Regulatory Agency (MHRA) of the United Kingdom, it found a 50% increase in the probability of suicide-related events, without reaching statistical significance, in patients treated with sertraline compared with those treated with placebo.

In the area of ​​side effects where the patient is at greater risk of suicide, if venlafaxine vs sertraline is measured, it could be said that the effects of sertraline on the risk of suicide are minor, but this does not mean that it does not cause them, the evidence Scientific continues in research in this area.

Now, venlafaxine vs sertraline, which causes greater dependence? Several tests conducted suggest that venlafaxine may cause a dose-dependence. Studies suggested a dose dependence for several adverse events including chills, hypertension, anorexia, nausea, agitation, dizziness, drowsiness, tremor, yawning, sweating, and abnormal sexual release. In the case of sertraline, there is no evidence of dependency cases created by sertraline. Based on this, if venlafaxine vs sertraline is used, sertraline may be better due to the little evidence of cause dependence, this does not assure that it does not cause since, like any drug, in high doses, it may cause some dependence or similar effects.

So, venlafaxine vs sertraline, which is better? Both medications are widely used in the treatment of depressive disorders, anxiety and others, but proper precautions must be taken. Venlafaxine, while proven to be more potent than other antidepressants, has greater side effects. Regarding sertraline, studies express that sertraline has greater efficacy and acceptability and that it is a more suitable antidepressant to start treatment in case of moderate to severe major depression.

Although sertraline has lower side effects and studies point to its greater effectiveness, as every medication should have its precautions. Each treatment is indicated according to the needs and symptoms that a person presents.

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FAQs about venlafaxine vs sertraline

In the case of venlafaxine, there are few well-controlled studies on its use in pregnant women. A study by the Canadian Medical Association Journal suggests that the use of venlafaxine doubles the risk of abortion. Venlafaxine should only be used in pregnancy if strictly necessary. In the case of sertraline, its use is contraindicated during pregnancy. In conclusion, both can cause side effects in pregnancy.

Both medications do not seek to be substituted for cognitive behavioural therapy, but these can be used together to provide better patient outcomes.

In 2007, venlafaxine was the sixth most prescribed antidepressant in the US retail market, with 17.2 million prescriptions, while sertraline in 2016 was the most prescribed psychiatric medication in the United States, with more than 37 million of recipes Studies express that sertraline use has increased due to the smaller amount of side effects it produces.

Venlafaxine was first introduced in 1993, while sertraline was introduced to the market in 1991.

It is not recommended that a person decide to take antidepressants such as venlafaxine or sertraline on their own. Both medications, due to side effects and their contraindications, must be prescribed by a healthcare professional. There are aspects that the person can ignore when taking them, so it is better to consult a GP.


Conclusion

If we put it on the table, venlafaxine vs sertraline, which is better? We could say that each use is prescribed according to the symptoms and to what the doctor understands that it is better for the well-being of the person. The use of sertraline has surpassed venlafaxine in recent years because it causes fewer side effects as a dependency and studies conducted so far do not indicate strong evidence that sertraline leads to higher suicide risks, while in the venlafaxine is. The greater acceptance of a drug in many cases does not mean that it should be the most recommended, but the scientific evidence helps to choose the most appropriate one.

Recommended links

  1. The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence and “Addiction
  2. Coming off Antidepressants: Successful Use and Safe Withdrawal 
  3. Psychiatric Drugs Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families

What we recommend for depression

Professional counselling

If you are suffering from depression then ongoing professional counselling may be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.

References

1. Wikipedia contributors. (2019, December 16). Venlafaxine. In Wikipedia, The Free Encyclopedia. Retrieved 17:14, December 21, 2019, from https://en.wikipedia.org/w/index.php?title=Venlafaxine&oldid=931088832

2. Wikipedia contributors. (2019, December 16). Sertraline. In Wikipedia, The Free Encyclopedia. Retrieved 17:15, December 21, 2019, from https://en.wikipedia.org/w/index.php?title=Sertraline&oldid=931083390

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