In recent years, clinicians have scaled down the dosages of these antidepressants to well below established ranges to treat insomnia symptoms.
Pharmacologically, the TCAs noted for their sleep-enhancing effects are more potent in blocking the serotonin transporter than the norepinephrine transporter, in addition to exerting prominent blockade of histamine HDoxepin has been studied at very low dosages in patients with primary insomnia.
The studies demonstrate the efficacy of low-dosage doxepin therapy (3 and 6 mg qhs) for alleviating symptoms of insomnia.
Some TCAs are more activating and have been used to treat a subset of depressed patients who experience hypersomnolence and daytime lethargy.
SNRIs can be contrasted with the more widely used selective serotonin reuptake inhibitors (SSRIs), which act upon serotonin alone.
The human serotonin transporter (SERT) and norepinephrine transporter (NET) are membrane proteins that are responsible for the reuptake of serotonin and norepinephrine.
One lament of many in the mental health profession (psychiatrists and pharmascolds alike) is that we really don’t know enough about how our drugs work.
Sure, we have hypothetical mechanisms, like serotonin reuptake inhibition or NMDA receptor antagonism, which we can observe in a cell culture dish or (sometimes) in a PET study, but how these mechanisms translate into therapeutic effect remains essentially unknown.
SNRIs, along with selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (NRIs), are second-generation antidepressants.
SNRIs are potent inhibitors of the reuptake of serotonin and norepinephrine.
These neurotransmitters are known to play an important role in mood.
To be sure, many people experience side effects of Abilify, but as far as I can tell, it’s an acceptable drug to most people who take it. Like other atypical antipsychotics, it binds to several different neurotransmitter receptors; this “signature” theoretically accounts for its therapeutic efficacy and side effect profile.
But unlike others in its class, it doesn’t signaling where they’re in excess.