# Serotonin reuptake inhibitors **URL:** \ **Category:** General\ **Created:** [January 17, 2014, 4:23pm UTC](https://forum.livingwitherythromelalgia.org/t/serotonin-reuptake-inhibitors/562 "2014-01-17T16:23:32Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![mads](https://yyz1.discourse-cdn.com/flex027/user_avatar/forum.livingwitherythromelalgia.org/mads/32/1568_2.png) [@mads](https://forum.livingwitherythromelalgia.org/u/mads)\ **Post date:** [January 17, 2014, 4:23pm UTC](https://forum.livingwitherythromelalgia.org/t/serotonin-reuptake-inhibitors/562/1 "2014-01-17T16:23:32Z")
Hi everyone, Has anyone has any success with the serotonin reuptake treatment option?. As you know i am trialing sodium channel blockers and seeing subtle changes especially in cramps. As the 2 are compatible I have decided to also start SNRI therapy taking Venlafaxine(Effexor) at 75 mg day increasing up to 375 mg day. Be interesting to hear your experiences or views. Lets keep sharing and moving forward God bless mads **Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)** SNRIs increase serotonin and norepinephrine in the nervous system and provide substantial benefit for some EM patients. Effexor (venlafaxine) has been reported many times in medical journals to help EM, but it fails sometimes too. Cymbalta (duloxetine) has also provided benefit for many. **Serotonin Reuptake Inhibitors (SSRIs)** This group increases serotonin in the nervous system. There are a handful of case reports of benefit with sertraline (Zoloft), fluoxetine (Prozac), or paroxetine (Paxil). For Tramadol (Ultram), which increases serotonin by the different mechanism, there is one report of benefit. [http://medicationsense.com/articles/2012/emtreatment.html](http://medicationsense.com/articles/2012/emtreatment.html) Article from Dermatology Times.USA. May 15, 2002 By: Cheryl Guttman Venlafaxine improves primary erythromelalgia New Orleans - Results from an open pilot study indicate venlafaxine (Effexor), a combined norepinephrine and serotonin reuptake inhibitor, may be a safe and effective treatment for primary erythromelalgia, Ali Moiin, M.D., and Sharam S. Yashar, M.D., said at the annual meeting of the American Academy of Dermatology. They presented their experience using venlafaxine 37.5 mg BID to treat 10 subjects. A diagnosis of primary erythromelalgia was established after investigations to rule out other causes for the patients' signs and symptoms, and all existing medications being used for their condition were withdrawn. At one week after starting treatment with venlafaxine, marked improvement, in the range of 30 percent to 40 percent, was noted by the investigators in the severity and extent of skin warmth and erythema, and the patients reported reduction of symptoms of pain and burning as well. Further benefit was gained with continued treatment, and by two months, some patients were rated as improved 80 percent from baseline. These favorable responses occurred with minimal side effects. Two patients developed nausea and one patient discontinued treatment due to drowsiness. Currently, six patients are being followed on chronic treatment that ranges from six months to four years in duration and they are continuing to derive benefit and are very satisfied as well, said Dr. Moiin, clinical assistant professor of dermatology, Wayne State University, Detroit, and president, Comprehensive Dermatology Center, Detroit. "A variety of medications can be used to treat primary erythromelalgia, including aspirin, gabapentin, opiates, benzodiazepines, and amitriptyline. The response to those agents is variable and importantly, they are associated with significant side effects. Venlafaxine appears to perform well relative to those options in terms of efficacy, but it has the advantage of offering a more favorable safety profile with long-term use,"said Dr. Moiin. "No conclusions can be drawn from this small, open-label trial, and we cannot rule out the possibility of a placebo effect. However, based on venlafaxine's promising potential for efficacy and safety, we plan to conduct a randomized, double-blind, placebo-controlled study with more objective measurements to document clinical improvement. The limiting factor in conducting that trial will be our ability to recruit patients with this relatively rare disorder." Venlafaxine is approved for the treatment of depression, and has been used as well for the management of obsessive-compulsive disorder and anxiety. The 75 mg/day dose that has been effective in the patients with erythromelalgia represents the recommended starting dose for antidepressant treatment with venlafaxine. Its maximum recommended dose is 375 mg/day. Dr. Moiin noted he was prompted to try venlafaxine to manage erythromelalgia based on a published report describing success in two patients. Previously, he had prescribed serotoninergic antidepressants, including paroxetine (Paxil) and fluoxetine (Prozac), for some patients with erythromelalgia, but found those agents were ineffective. Based on that experience, Dr. Moiin and Dr. Yashar postulate the noradrenergic activity of venlafaxine is important in its efficacy. "The pathogenesis of primary erythromelalgia is not known for certain, but histologic studies of affected skin show evidence of decreased sympathetic innervation and deficient sympathetic regulation. By inhibiting norepinephrine reuptake, venlafaxine may address those defects," said Dr. Yashar, dermatology resident at Henry Ford Hospital, Detroit. Via its serotoninergic effects, venlafaxine could alter platelet function and reduce platelet plug formation that might contribute to symptoms of erythromelalgia. Anticoagulant effects pull trigger "There is thought that erythromelalgia-associated pain might arise from clumping and coagulation of platelets in the small vessels of the extremities. In fact, it is believed that the benefit associated with aspirin treatment is due at least in part to its anticoagulant effects. Studies with venlafaxine and selective serotonin reuptake inhibitors show they can affect platelets, and perhaps the activity of venlafaxine is mediated at that level as well," Dr. Yashar said. Dr. Moiin proposed that the mechanism of venlafaxine's efficacy might also be secondary to some effects at the level of the central nervous system and not due wholly to peripheral activity. "Recent studies report a role of venlafaxine in treating hot flashes in postmenopausal women and in men receiving hormonal ablation therapy for prostate cancer. Those findings would suggest venlafaxine can affect the peripheral vasculature through a central mechanism," Dr. Moiin said. Effexor is a product of Wyeth-Ayerst. Neither Dr. Moiin nor Dr. Yashar has any financial interest in the product. DT