Reuptake in Mental Health Medications

Reuptake is an important brain process to understand if you have a mental health condition such as borderline personality disorder (BPD) or depression. Why? Because many medications used to treat mental health disorders work by altering several neurotransmitters in the brain. Reuptake is a crucial part of this process.

How Reuptake Works

Neurotransmitters are chemical messengers that provide a pathway for transmitting signals released by nerve cells (neurons) across synapses (the spaces between cells) from one nerve cell to another.

Reuptake is essential for synaptic functioning. It allows neurotransmitters to be reused and helps regulate neurotransmitter levels present in the synapse. 

Why Is Reuptake Important in Treatment?

Depression and other mental health disorders may be influenced by the activity of certain brain chemicals, including serotonin, dopamine, and norepinephrine.

If you are taking medication to treat depression (in other words, an antidepressant), you may be taking a selective serotonin reuptake inhibitor or SSRI. The most commonly prescribed antidepressants, SSRIs, are often used to treat people with BPD by reducing the symptoms of moderate to severe depression.

SSRIs increase the amount of the neurotransmitter serotonin in the brain by, as you're now aware, slowing its reuptake into the cells that transmitted it. As a result, higher-than-normal serotonin levels are left to circulate in the brain.

As you can see, SSRIs don't help the body to produce more serotonin. Instead, they help the body circulate more of the serotonin it has.

Types of Reuptake Medications

There are a variety of reuptake medications available in addition to SSRIs. While these medications work in similar ways, they differ in terms of which neurotransmitters they target. Types of medications that affect reuptake include:

• Selective-serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine reuptake inhibitors (NRIs)
• Serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)

Examples of SSRIs

Here are the names of the SSRIs available for your doctor to prescribe:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Prozac, Sarafem (fluoxetine)
• Luvox (fluvoxamine)
• Paxil, Paxil XR, Pexeva (paroxetine)
• Zoloft (sertraline)

Types of SNRIs

SNRIs block transporters that are involved in the reuptake of serotonin and norepinephrine. Some common types of SNRIs include:

• Cymbalta (duloxetine)
• Fetzima (levomilnacepran)
• Pristiq (desvenlafaxine)

Types of NRIs

NRIs block the actions of the transporters involved in the reuptake of norepinephrine. Common NRIs include:

• Ludiomil (maprotiline)
• Strattera (atomoxetine)

Types of SNDRIs

These triple reuptake inhibitors block the actions of transporters involved in the reuptake of serotonin, norepinephrine, and dopamine. These medications include:

• Effexor (venlafaxine)
• Mazanor (mazindol)
• Serzone (nefazodone)

Types of NDRIs

These medications block the transporters involved in the reuptake of norepinephrine and dopamine. Some of these medications include:

• Ritalin (methylphenidate)
• Wellbutrin (bupropion)

Warning for Serotonin Syndrome

The process of reuptake also plays a role in this rare but dangerous condition, which generally occurs when a person takes more than one medication that increases the level of serotonin in the body. This can result in dangerously high serotonin levels in the brain.

Signs and symptoms of serotonin syndrome include:

• Rapid heart rate
• Agitation
• Lack of coordination
• Confusion
• Sweating
• Tremors
• Restlessness
• High fever
  

Serotonin syndrome is more likely to occur when you first start taking a serotonin-boosting medication or increase the dose.

Serotonin syndrome is rare, mainly because doctors are very careful about prescribing medications that could cause it. Nevertheless, because this syndrome is so dangerous, the FDA has asked the makers of these types of medications to put warning labels on them to alert you to this risk.