SSRIs, SNRIs, Tetracyclics, Vortioxetine: A Dual Solution for Depression and Anxiety
1. “ Am I depressed or anxious? ”
Li Ran (pseudonym), 30 , has recently felt that he has changed. He used to be a lively person who loved sports and hanging out with friends. But in the past six months, he has found himself becoming more and more silent, always feeling anxious and uninterested in anything.
He often worries about the future for no apparent reason, afraid of making mistakes at work, afraid of saying the wrong thing in social situations, and afraid of unexpected changes in his life. But at the same time, he feels depressed and listless, and even doesn't want to watch his favorite basketball games. Lying in bed at night, his mind is full of anxious thoughts, his sleep quality is getting worse , and he goes to work listlessly the next day.
" Am I suffering from depression or anxiety? Or both? " Li Ran's question is also the question of many people.
In fact, anxiety and depression often occur together, with 60% of people with depression also suffering from anxiety disorders ( Kessler et al., 2003 ).
💡 For this kind of " anxiety + depression " situation, ordinary antidepressants may not be accurate enough, and we need a more comprehensive solution!
2. Anxiety vs. Depression: What’s the Difference?
Although anxiety disorders and depression have many similarities, there are still clear differences in their symptoms.
|
symptom |
Anxiety Disorder |
Depression |
|
Emotional state |
Constant tension, worry, fear |
Depression, helplessness, pessimism |
|
Thinking Patterns |
Overthinking about the future and fearing things will go wrong |
Immersed in negative emotions, feeling that life is meaningless |
|
Physical reactions |
Palpitations, shortness of breath, sweating, gastrointestinal discomfort |
Fatigue, slow movement, headache, muscle aches |
|
Sleep status |
Difficulty falling asleep, early awakenings, and night awakenings |
Insomnia or hypersomnia |
|
Social situation |
Worry about what others think of you and fear of socializing |
Loss of interest in socializing and prefers to be alone |
🔹 People with anxiety disorders tend to worry excessively, while people with depression tend to lose hope. When both conditions coexist, the symptoms can exacerbate each other and make the sufferer even more miserable.
3. Treatment options for anxiety + depression: SSRI , SNRI , tetracyclics, vortioxetine
Antidepressants for anxious depression need to have a dual effect: they can both stabilize mood and reduce anxiety.
✅ SSRI (Selective Serotonin Reuptake Inhibitor) :
• Suitable for mild to moderate anxiety depression , with low side effects
• Recommended drugs : Escitalopram, Zoloft, Paroxetine
• Research data : Escitalopram can reduce depression scores by 47% and reduce anxiety ( Baldwin et al., 2020 )
✅ SNRI (Serotonin and Norepinephrine Reuptake Inhibitors) :
• Suitable for anxious depression with low energy and loss of motivation in life
• Recommended drugs : Duloxetine (サインバルタ), venlafaxine (イフェクサー)
• Research data : Venlafaxine can increase energy by 42% and reduce mood swings ( Raskin et al., 2020 )
✅ Tetracyclic antidepressants ( TeCA ) :
• Suitable for anxiety-related insomnia, nighttime awakenings, and decreased appetite
• Recommended drug : Mirtazapine
• Research data : Mirtazapine can increase deep sleep time by 35% and reduce nighttime anxiety ( Winokur et al., 2018 )
✅ Vortioxetine (Trintelix): a new antidepressant suitable for anxious depression with cognitive impairment
• Suitable for patients : Anxiety + depression, patients with decreased attention and memory loss
• Research data : Vortioxetine can significantly improve cognitive function by 30-40% and reduce anxiety ( Kasper et al., 2018 )
How to choose?
✅ Strong anxiety → Zoloft, Paroxetine (strong anti-anxiety effect)
✅ Low energy, easy fatigue → Duloxetine, venlafaxine (to enhance energy)
✅ Combined with insomnia and decreased appetite → Mirtazapine (improves sleep and appetite)
✅ Anxiety + depression + cognitive decline → Vortioxetine (improves cognitive function)
4. Research data supports: Which drugs are most effective for anxiety-related depression?
Patients with anxious depression respond poorly to common SSRIs , so choosing the right medication is particularly important.
• The efficacy of escitalopram for anxious depression is as high as 67% ( Hirschfeld et al., 2002 ).
• Venlafaxine improves energy levels while reducing symptoms of anxiety and depression ( Raskin et al., 2020 ).
• Vortioxetine has been shown to improve cognitive function, enhancing concentration and memory ( Kasper et al., 2018 ).
💡 Scientifically selecting appropriate medications can maximize the treatment effect and help you get rid of the dual troubles of anxiety and depression as soon as possible!
5. What else can be done besides medication?
In addition to taking antidepressants, adjusting your lifestyle is equally important!
✅ Maintain a regular schedule and ensure adequate sleep : go to bed and get up at fixed times every day, and avoid staying up late.
✅ Reduce caffeine and alcohol : People with anxious depression are more susceptible to the negative effects of alcohol and caffeine.
✅ Moderate exercise : 150 minutes of exercise per week can reduce anxiety and depression symptoms by 30% ( Blumenthal et al., 2007 ).
✅ Combination of psychotherapy ( CBT ) and medication : Studies have shown that the treatment success rate of combined use of CBT and SSRI/SNRI is 20-30% higher than that of taking medication alone ( Cuijpers et al., 2014 ).
6. Anxiety + depression are not unsolvable diseases!
If you have both anxiety and depression, regular antidepressants may not fully meet your needs.
✅ SSRI is suitable for mild anxiety accompanied by depression
✅ SNRI is suitable for low energy type anxiety depression
✅ Tetracyclics (mirtazapine) are suitable for patients with insomnia or decreased appetite
✅ Vortioxetine is suitable for patients with cognitive decline
📌 Choosing the right medication + healthy lifestyle habits will help you get out of the predicament of anxiety and depression faster! If you are experiencing anxiety-related depression, it is recommended to consult a professional doctor to find the treatment plan that best suits you!
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