The Definitive Guide to SNRIs for Vulvodynia

If you have never come across antidepressants while looking for effective solutions for your vulvar pain then this might be an option worth exploring.

Antidepressants remains a mainstay of treatment for vulvodynia in the medical community. Along with tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs) have been used to treat vulvodynia, even though their effectiveness has not been proven in large controlled studies.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a type of antidepressant. They were first introduced in the mid-1990s. They are also called dual reuptake inhibitors, dual-acting antidepressants and selective serotonin-norepinephrine reuptake inhibitors (SSNRIs).

SNRIs are used to treat mental disorders (like depression and anxiety), behavioral disorders (such as OCD and ADHD), chronic neuropathic pain and fibromyalgia, stress urinary incontinence (SUI) in women, migraines and some syndromes of menopause.

SNRIs block or delay the absorption of brain chemicals called neurotransmitters (such as serotonin and norepinephrine). By doing this, SNRIs increase the level of neurotransmitters in the brain which enhances a person’s mood, alertness and decreases pain sensations.

Serotonin and norepinephrine are neurotransmitters that are responsible for regulating not just mental but also physical processes in your body. One of them is the regulation of pain sensations.

Because of that, like with other antidepressants, SNRIs also have off-label uses such as being a pain reliever to treat chronic pain conditions. SNRIs modify the way in which nerve fibers send impulses to the spinal cord to produce pain.

If you describe your vulvar pain as stabbing or shooting, and you have suspicion that your vulvodynia can originate from nerve malfunction (due to, for example, injury, surgery or diseases) called neuropathic pain, then your pain might be altered with SNRIs.

The most popular SNRIs used in modulating vulvar pain are:

The most popular SNRIs for vulvodynia are Cymbalta and Effexor.

Oral doses start with a low dose, to avoid side effects. They are increased gradually every one to two weeks until the final dose is reached.

Some doctors start Effexor with a dose of 37.5 mg per day administered in the morning, with an increase to 75 mg daily after one to two weeks. If needed, the dose is changed every one to two weeks till the maximum dose of 150-225 mg is reached.

Some doctors start Cymbalta with a dose of 30 mg for one week. If symptoms persist, they increase the dose to total of 60 mg per day.

SNRIs don’t work overnight. Response to treatment can take up to several weeks nevertheless the first reduction in pain might be already noticeable after one to two weeks. However, it might take up to six to eight weeks of treatment to see full effects. The best results (as per patients’ experiences) are seen with daily doses of Effexor (150 – 225 mg) and Cymbalta (60 mg).

Effexor and Cymbalta have been used to treat vulvodynia, but their effectiveness has not been proven in large controlled studies.

Serotonin and norepinephrine are heavily involved in physiological activities in your body. That is why while administering SNRIs for vulvodynia you might experience the following side effects:

SNRIs interact with:

Like with other antidepressants, SNRIs can produce a withdrawal – also called discontinuation syndrome – if you suddenly stop taking them or miss several doses of the drug.

You can minimize these symptoms by introducing a washout period – reducing your dosage over a period of at least 15 to 20 days and up to several months.

You might experience more withdrawal symptoms while taking venlafaxine and desvenlafaxine.

Withdrawal symptoms might include: