Antidepressants: update on new agents and indications

2013

Selective serotonin reuptake inhibitors (SSRIs) are the frontline class of antidepressant drugs. They are widely used because of their safety, tolerability, and demonstrated efficacy. In this review, we are pointing at other indications of SSRIsapart from depression.This article is based on a selective review of the relevant literature retrieved by a PubMed search and ScienceDirect search. The results of electronic searches show SSRIs to be of great importance in pharmacotherapy of many conditions outside depression. Medical literature supports the use of SSRIs for the treatment of premature ejaculation (especially short-acting SSRI -dapoxetine), eating disorders (especially bulimia nervosa and binge eating disorder), obsessive-compulsive disorder and social anxiety disorder.

2018

Depression [major depressive disorder (MDD)] is a mood disturbance of multifactorial origin, associated with high rates of morbidity and mortality, lack of work productivity, adverse health behaviors, and increased healthcare expenses. MDD is a leading cause of suicide, and it affects the prognosis of chronic conditions (heart diseases, diabetes, and cancer, among others). Current pharmacological treatment for MDD covers different classes of drugs, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants. The aim of this chapter is to review the literature, highlight the side effects of newer antidepressants, and especially point out themost important aspects of the latest agents approved for the treatment ofMDD in adults: desvenlafaxine, levomilnacipran, vilazodone, and vortioxetine. Desvenlafaxine is a SNRI and the primary...

Antidepressants are primarily prescribed for the treatment of depression but also have FDA approval for several other mental health disorders, including obsessive-compulsive disorder, social phobia, panic disorder, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Additionally, these medications are frequently used offlabel for various conditions. This review aims to provide a comprehensive overview of antidepressant therapy, covering indications, contraindications, mechanisms of action, adverse events, and essential clinical considerations. By offering detailed insights into these aspects, this article serves as a valuable resource for interprofessional teams involved in the management of patients receiving antidepressant medications, ensuring the safe and effective use of these drugs in diverse clinical scenarios.

Primary care companion to the Journal of clinical psychiatry, 2004

Because major depression has negative effects on other disease states, proper recognition and treatment of depression are important in the primary care setting. Although the perfect antidepressant does not yet exist, newer antidepressants have advanced the field. This article will summarize key features of 3 newer antidepressants that represent advances in psychopharmacology: mirtazapine, which has a dual effect on serotonergic and noradrenergic systems; escitalopram, the latest selective serotonin reuptake inhibitor, which is the first pure antidepressant stereoisomer in clinical use; and duloxetine, a dual reuptake inhibitor of norepinephrine and serotonin that is expected to be clinically available in the near future.

InTech eBooks, 2018

Depression [major depressive disorder (MDD)] is a mood disturbance of multifactorial origin, associated with high rates of morbidity and mortality, lack of work productivity, adverse health behaviors, and increased healthcare expenses. MDD is a leading cause of suicide, and it affects the prognosis of chronic conditions (heart diseases, diabetes, and cancer, among others). Current pharmacological treatment for MDD covers different classes of drugs, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants. The aim of this chapter is to review the literature, highlight the side effects of newer antidepressants, and especially point out the most important aspects of the latest agents approved for the treatment of MDD in adults: desvenlafaxine, levomilnacipran, vilazodone, and vortioxetine. Desvenlafaxine is a SNRI and the primary active metabolite of venlafaxine; also a SNRI, levomilnacipran is an enantiomer of the racemate milnacipran. Vilazodone and vortioxetine are multimodal antidepressants, which combine SSRI activity with additional receptor activity. Although they have proven efficacy in treating MDD and are being investigated for other possible indications, further detailed clinical trials are needed to establish their pharmacotoxicological profile, following prolonged administration in patients who may suffer from various comorbidities.

Cureus

This review article aims to provide insight into the mechanisms of action, pharmacokinetics, clinical efficacy, safety and tolerability of four novel antidepressants including desvenlafaxine, vortioxetine, vilazodone, and levomilnacipran. Following keywords are used in PubMed and Scopus to search for relevant articles: (depression) AND (psychopharmacology OR desvenlafaxine OR levomilnacipran OR vortioxetine OR vilazodone). Patients with a lack of effectiveness or tolerability to certain antidepressants may get benefit from selecting a new antidepressant with different mechanism of action. These medications can be an option in the selection of newer antidepressants. Depression may not be caused by the simple deficiency of serotonin in the brain, but rather a complex interplay of various neurotransmitters including serotonin, norepinephrine, glutamate, and histamine at certain brain areas. The abovementioned novel antidepressants exert their therapeutic benefits by acting on multiple neurotransmitters. The complexity of underlying the neurobiological mechanism should be considered while formulating a plan of care.

International Journal of Scientific Research in Science and Technology, 2019

Depression is a life-threatening, debilitating, and common disease affecting different segments of community. Chemical and synthetic drugs available to treat this disease cause many adverse effects and may lead to complete recovery in only 50% of patients. Antidepressants are effective and accessible treatment options that can reduce suffering and prevent relapse of symptoms. They are recommended as first line treatment options in moderate and severe depression or mild or sub threshold depression that has persisted despite other interventions All current antidepressants, with the exception of agomelatine, increase the transmission of the monoamines, particularly serotonin, nor adrenaline and dopamine. The antidepressants are crucial for the treatment of depressive episodes in the acute phase when untreated symptoms are at their worst. With long-term use, however, the brain sets to work compensating for the drug-induced changes with a process he calls oppositional tolerance. Antidepressant drugs are the mainstay for the treatment of depression. Usually, antidepressants are given in combination with some form of limited supportive psychotherapy.

Journal of Medicinal Chemistry, 1995

Psychotherapy and psychosomatics, 2016

Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of f...

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, 2016

Pleasurable sexual activity is an essential component of many human relationships, providing a sense of physical, psychological, and social well-being. Epidemiological and clinical studies show that depressive symptoms and depressive illness are associated with impairments in sexual function and satisfaction, both in untreated and treated patients. The findings of randomized placebocontrolled trials demonstrate that most of the currently available antidepressant drugs are associated with the development or worsening of sexual dysfunction, in a substantial proportion of patients. Sexual difficulties during antidepressant treatment often resolve as depression lifts but can endure over long periods and may reduce self-esteem and affect mood and relationships adversely. Sexual dysfunction during antidepressant treatment is typically associated with many possible causes, but the risk and type of dysfunction vary with differing compounds and should be considered when making decisions about the relative merits and drawbacks of differing antidepressants. A range of interventions can be considered when managing patients with sexual dysfunction associated with antidepressants, including the prescription of phosphodiesterase-5 inhibitors, but none of these approaches can be considered "ideal. " As treatment-emergent sexual dysfunction is less frequent with certain drugs, presumably related to differences in their pharmacological properties, and because current management approaches are less than ideal, a reduced burden of treatment-emergent sexual dysfunction represents a tolerability target in the development of novel antidepressants.