Neuropharmacology of antidepressants that modify central noradrenergic and serotonergic function: a short review
✍ Scribed by B. E. Leonard
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 103 KB
- Volume
- 14
- Category
- Article
- ISSN
- 0885-6222
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✦ Synopsis
The ®rst generation of antidepressants largely act as dual' action drugs in that they facilitate both noradrenergic and serotonergic activity either by blocking the reuptake of noradrenaline and serotonin (tricyclic antidepressants) or by inhibiting the catabolism of these amines (monoamine oxidase inhibitors). Largely as a consequence of their unacceptable side eects, these drugs have been partly replaced by the second generation drugs that showed selectivity of either the noradrenaline (viloxazine, maprotiline, reboxetine) or serotonin ( ¯uoxetine, sertraline, etc.) transporter. While these second generation drugs have undoubted advantages in terms of their safety and tolerability, there is growing evidence that the ecacy of some of these selective uptake inhibitors (e.g. SSRIs) in the treatment of the more severe forms of depression is less than that of the TCAs. This has led to the view that dual action' antidepressants may oer superiority in the treatment of severe depression. Two groups of novel antidepressants have been developed to meet the need of combining increased ecacy with safety. These include the mixed amine reuptake inhibitors such as lofepramine, venlafaxine and milnacipran and the novel tetracyclic antidepressant mirtazepine that facilitates the functional activity of both noradrenaline and serotonin without aecting the reuptake sites.