What is the Difference Between Venlafaxine and Sertraline

The key difference between Venlafaxine and Sertraline is that Venlafaxine inhibits the reuptake of both serotonin and norepinephrine from the presynaptic membrane to increase their presence in the synapsis, while sertraline selectively inhibits the reuptake of serotonin from the presynaptic membrane to increase its presence in the synapsis.

Venlafaxine and sertraline are widely prescribed antidepressants for various anxiety and depressive disorders. Venlafaxine is a serotonin and norepinephrine reuptake inhibitor that increases the levels of serotonin and norepinephrine levels in synapsis of the brain. Sertraline is a selective serotonin reuptake inhibitor (SSRI) that only increases the serotonin levels in the synapsis of the brain. Both serotonin and norepinephrine affect mood, energy, motivation, and sleep. Both Venlafaxine and Sertraline are generally safe and well-tolerated. However, they can cause side effects such as nausea, diarrhea, dry mouth, dizziness, drowsiness, and headache. Both these drugs are associated with withdrawal symptoms if stopped suddenly. Therefore, it is important to talk to a doctor to decide which medication is best for individual situations.

CONTENTS

1. Overview and Key Difference
2. What is Venlafaxine
3. What is Sertraline
4. Similarities – Venlafaxine and Sertraline
5. Venlafaxine vs. Sertraline in Tabular Form
6. Summary – Venlafaxine vs. Sertraline

What is Venlafaxine?

Venlafaxine is a selective serotonin and norepinephrine reuptake inhibitor used for the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder. Furthermore, it is also used as a second-line treatment for obsessive-compulsive disorder. Off-label uses of Venlafaxine include managing migraines, reducing vasomotor symptoms associated with menopause, and treating neuropathic pain. Desvenlafaxine, the active metabolite of Venlafaxine, blocks the reuptake of both serotonin and norepinephrine to increase their presence in synapsis. Both these hormones are essential for mood regulation. Low doses of Venlafaxine inhibit serotonin reuptake, while higher doses inhibit norepinephrine and serotonin.

Twice-daily oral administration of Venlafaxine results in an absolute bioavailability of 45% due to its good absorption from the gastrointestinal tract. Upon absorption, 27% of the Venlafaxine is bound with plasma proteins and is distributed through the body. It is metabolized in the liver and excreted in the urine with an elimination half-life of 3-7 hours. Overdose symptoms of Venlafaxine include numbness, dizziness, altered consciousness, nausea, vomiting, hot/cold flashes, convulsions, tachycardia, rhabdomyolysis, vertigo, liver necrosis, ECG changes, serotonin syndrome, and death. Moreover, it is recommended to avoid consuming alcohol while undergoing treatment with Venlafaxine. Venlafaxine is sold under the brand name Effexor.

What is Sertraline?

Sertraline is a selective serotonin reuptake inhibitor used to treat major depressive disorder, social anxiety disorder, and panic disorder. In addition, it is also used to treat post-traumatic stress disorder and premenstrual dysphoric disorder. The off-label uses of sertraline include prevention of post-stroke depression, anxiety, fibromyalgia, premature ejaculation, migraines, and diabetic neuropathy. Sertraline selectively inhibits serotonin reuptake in the presynaptic membrane, resulting in increased serotonin levels in the synapsis, leading to functional changes associated with serotonin-related neurotransmission. The onset of action and beneficial effects are believed to be noticed 4-6 weeks after starting the treatment.

Once-daily administration of 50-200 mg of sertraline after the meal for one-week results in steady-state concentration. Upon absorption, 99% of the sertraline binds with the plasma proteins and is widely distributed throughout the body. It is heavily metabolized in the liver, mainly to norsertraline, and both metabolites and non-metabolized forms are included in both urine and feces to excrete with an elimination half-life of 26 hours. Sertraline overdose can cause somnolence, vomiting, tachycardia, nausea, dizziness, agitation, tremors, and serious health problems, including serotonin syndrome, hypertension, syncope, stupor, coma, and pancreatitis. Fatal overdose is rare but can occur when combined with other drugs. Zoloft is one of the most common brand names sold under sertraline.

What are the Similarities Between Venlafaxine and Sertraline?

• Venlafaxine and sertraline are antidepressants that work by increasing the levels of serotonin in the brain.
• They are approved to treat depression, social anxiety, and panic disorders.
• Both these drugs cause similar side effects, such as nausea, diarrhea, dry mouth, dizziness, drowsiness, and headache.
• They both can cause withdrawal symptoms if stopped suddenly.

What is the Difference Between Venlafaxine and Sertraline?

Venlafaxine and sertraline are medications used to treat depression and other mood disorders, but they belong to different classes of antidepressants. There is a distinct difference between Venlafaxine and Sertraline in terms of their mechanisms of action and side effects. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor. It works by increasing the levels of both serotonin and norepinephrine in the brain. In contrast, sertraline is a selective serotonin reuptake inhibitor, primarily increasing serotonin levels in the brain. The dual mechanism of action Venlafaxine has a more pronounced effect in some cases of depression, particularly when norepinephrine is believed to play a significant role. Venlafaxine was approved in 1993 and is sold under Effexor and Effexor XR, while sertraline was approved in 1991 and is sold under the brand name Zoloft.

Below is a summary of the difference between Venlafaxine and Sertraline in tabular form for side-by-side comparison.

Summary – Venlafaxine vs. Sertraline

Venlafaxine and sertraline are commonly prescribed to treat depression and anxiety disorders. The key difference between Venlafaxine and Sertraline lies in their drug classes and mechanisms of action. Venlafaxine is a serotonin and norepinephrine reuptake inhibitor (SNRI) affecting both serotonin and norepinephrine levels, while sertraline is a selective serotonin reuptake inhibitor (SSRI), primarily targeting serotonin levels. Both are used to treat various mood disorders but may have different side effects and withdrawal profiles. Venlafaxine is associated with a higher risk of discontinuation symptoms, while sertraline is considered to have a milder withdrawal profile. Both drugs should be prescribed based on individual needs and under medical supervision.

Reference:

1. Sir, Aytekin, et al. “Randomized trial of sertraline versus Venlafaxine XR in major depression.” The Journal of Clinical Psychiatry, vol. 66, no. 10, 2005, pp. 1312–1320.
2. DeVane, C. Lindsay, et al. “Clinical pharmacokinetics of sertraline.” Clinical Pharmacokinetics, vol. 41, no. 15, 2002, pp. 1247–1266.

Image Courtesy:

1. “Venlafaxine structure” By Vaccinationist – Own work (Public Domain) via Commons Wikimedia
2. “Sertraline” By Vaccinationist – Own work using: PubChem (Public Domain) via Commons Wikimedia