This is a serotonin, and noradrenaline reuptake inhibitor (SNRI); it lacks the sedative and antimuscarinic effects of the tricyclic antidepressants.

Indications: depressive illness.

Cautions: may cause blood pressure increase; hepatic or renal impairment; close supervision of patients with high risk of suicidal tendencies during initial treatment; cardiac disease; history of mania. Should not be withdrawn immediately.

Contra-indications: conditions associated with high risk of cardiac arrhythmia, uncontrolled hypertension; pregnancy and breast-feeding; severe renal and hepatic impairment.

Side Effects: nausea, anorexia; sexual dysfunction; insomnia, nervousness, abnormal dreams; hypertension, palpitation; visual disturbances.

Dose: initially 75 mg daily in 2 divided doses increased if necessary after several weeks to 150 mg daily in 2 divided doses. Severly depressed or hospitalized patients, initially 150 mg daily in 2 divided doses increased if necessary in steps of up to 75 mg every 2-3 days to max. 375 mg daily then gradually reduced.