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Norepinephrine and dopamine reuptake inhibitors (NDRIs)
By Mayo Clinic staffAlternative medicine (1)
- Treatment-resistant depression: Explore options when depression doesn't get better
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- Support groups: Find information, encouragement and camaraderie
- Depression: Supporting a family member or friend with depression
- Support groups: Share experiences about depression, mental health conditions
- see all in Coping and support
Definition (1)
- Mental health: What's normal, what's not
Lifestyle and home remedies (3)
- Seasonal affective disorder treatment: Choosing a light therapy box
- Meditation: Take a stress-reduction break wherever you are
- Depression and anxiety: Exercise eases symptoms
Risk factors (2)
- Depression in women: Understanding the gender gap
- Stress symptoms: Effects on your body, feelings and behavior
Tests and diagnosis (2)
- Mental health providers: Find one to suit your needs
- Cytochrome P450 (CYP450) genotyping test
Treatments and drugs (21)
- Antidepressants: Are they safe during pregnancy?
- Serotonin syndrome
- Family therapy
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Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Antidepressant NDRIs, like SNRIs, are dual reuptake inhibitors, relieving depression symptoms, such as irritability and sadness. Discover how NDRIs can boost your mood and what side effects they may cause.
By Mayo Clinic staffCertain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-mene). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.
How NDRIs work
Norepinephrine and dopamine reuptake inhibitors (NDRIs) are a type of antidepressant medication that increases the levels of both norepinephrine and dopamine by inhibiting their reabsorption (reuptake) into cells. As with other antidepressants, the precise mechanism of action isn't clear. But it's thought that these increased levels help enhance neurotransmission — the sending of nerve impulses — and thereby improve and elevate mood.
Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate — an organic compound of a nonessential amino acid — in check. This increased support of nerve cells decreases glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to anxiety and depression.
Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.
NDRIs approved to treat depression
Here is the only NDRI that has been approved by the Food and Drug Administration specifically to treat depression, with its generic, or chemical, name followed by available brand names in parentheses:
- Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
Bupropion is available in several forms: an immediate-release form taken three times a day; a slow-release, or sustained-release, (SR) form that requires taking medication twice a day; and an extended-release (XL) form that requires only a once-a-day dose. Zyban, another brand of bupropion, is available as an anti-smoking medication, not as an antidepressant.
In addition to bupropion's use as an anti-smoking therapy and an antidepressant, it may be used to treat other conditions.
Side effects of NDRIs
Side effects of NDRIs include:
- Loss of appetite
- Weight loss
- Headache
- Dry mouth
- Skin rash
- Sweating
- Ringing in the ears
- Shakiness and nervousness
- Stomach pain
- Agitation
- Constipation
- Anxiety
- Dizziness
- Trouble sleeping
- Muscle pain
- Nausea and vomiting
- Fast heartbeat
- Sore throat
- More frequent urination
Safety concerns with NDRIs
Bupropion can increase blood pressure in some people, so regular monitoring is important. The risk of developing high blood pressure may increase if you also use nicotine replacement therapy, such as a nicotine patch, to help you stop smoking.
There's a small chance that taking bupropion can cause a seizure if you've had previous seizures, a head injury or a nervous system tumor, or if you've had an eating disorder, such as bulimia or anorexia. Because of that, don't take this medication if you have a history of seizures or eating disorders or if you're abruptly discontinuing use of alcohol or sedatives. Be sure to tell your doctor about your past medical issues.
Also, because of potentially dangerous medication interactions, be sure your doctor knows about any current or previous use of monoamine oxidase inhibitors (MAOIs). Tell your doctor also if you have severe liver cirrhosis, because Wellbutrin can cause liver problems. In addition, don't take Zyban while you're being treated with any form of Wellbutrin.
Suicidal feelings and NDRIs
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. These symptoms are most likely to occur during the first one to two months of treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.
Talk with your doctor to nix your irritability, sadness or anger and boost your mood with NDRIs. Feel good again.
- Wellbutrin SR (prescribing information). Research Triangle Park, N.C.: GlaxoSmithKline; 2007. http://us.gsk.com/products/assets/us_wellbutrinSR.pdf. Accessed Oct. 9, 2008.
- Wellbutrin XL (prescribing information). Mississauga, Ontario, Canada: Biovail Corp.; 2004. http://us.gsk.com/products/assets/us_wellbutrinXL.pdf. Accessed Oct. 3, 2008.
- Zyban (prescribing information). Research Triangle Park, N.C.: GlaxoSmithKline; 2007. http://us.gsk.com/products/assets/us_zyban.pdf. Accessed Oct. 9, 2008.
- Questions and answers on antidepressant use in children, adolescents, and adults. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/QA20070502.htm. Accessed Sept. 29, 2008.
- FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Accessed Sept. 12, 2008.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 1, 2008.
- Antidepressants: Selecting one that's right for you. MayoClinic.com. http://www.mayoclinic.com/health/antidepressants/HQ01069. Accessed Oct. 16, 2008.
