SNRIs (Duloxetine, Venlafaxine)
Common brand names: Cymbalta, Effexor, Pristiq, Fetzima
Two nutrients listed against this medication. The most severe is marked critical.
At a glance
One of the two is marked well documented. The other one carries its own evidence level.
At a glance
- Sodium (Hyponatremia risk)Critical · Well documented
- Bone Mineral Density (Calcium/D3)Moderate · Moderate evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, SNRIs can cause SIADH, leading to sodium depletion. Risk highest in elderly patients and those on concurrent diuretics.
Common signs, Confusion, nausea, headache, fatigue, seizures (severe), falls in elderly
De Picker et al. (Psychosomatics, 2014; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 25262043): review of antidepressant-associated SIADH and hyponatremia, with the highest risk in elderly patients.
Serum sodium is monitored, especially in the first 30 days and in elderly patients, under physician monitoring.
Mechanism, Serotonin directly regulates bone remodeling via 5-HT2A receptors on osteoblasts. SNRIs reduce bone serotonin signaling, accelerating bone loss.
Common signs, Accelerated bone loss, increased fracture risk
SSRIs are associated with lower bone mineral density and higher fracture risk in cohort studies An observational study that follows a group of people over time and compares what happens to them., reviewed by Haney et al. (2010; PMID 19664737); the review concerns SSRIs, and evidence for SNRIs specifically is thinner. This is an association, not a direct calcium or vitamin D depletion.
Vitamin D3 2,000–4,000 IU with K2 100 mcg daily, and calcium 600–800 mg from food and supplement, is the pattern in common use, not from a trial cited on this row. The cited paper reviews the effect of serotonergic antidepressants on bone health and screening; it tested no supplement and no exercise program.
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Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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