|
Optimizing antidepressant treatment: efficacy and
tolerability.
Deakin B, Dursun S.
Neuroscience and Psychiatry Unit
University of Manchester, UK.
bill.deakin@man.ac.uk
Int Clin Psychopharmacol. 2002 Jun;17 Suppl 1:S13-24.
Abstract
It has been suggested that dual-action
antidepressants acting on both serotonin and noradrenaline pathways in the
brain may offer superior therapeutic benefit over classical
antidepressants, particularly in severe depression. Directly acting
dual-action antidepressant drugs include venlafaxine and milnacipran. In
addition, mirtazapine and nefazodone, may indirectly potentiate
serotonergic and noradrenergic transmission, although evidence that they
do indeed do so in vivo is limited. Meta-analysis of clinical trials
suggests that venlafaxine has a more rapid onset of action than selective
serotonin reuptake inhibitors (SSRIs), and the same may also be true for
milnacipran and mirtazapine. Efficacy, both in terms of extent of
antidepressant effect and in the proportion of patients responding, is
probably superior to that of SSRIs, at least for venlafaxine and
milnacipran. In terms of tolerability, all dual-action drugs clearly
appear to be better tolerated than tricyclic antidepressants. Mirtazapine
and nefazodone have specific side-effect profiles as a result of their
antagonist action at biogenic amine and other receptors. Milnacipran, and
to a lesser extent venlafaxine, are slightly better tolerated than SSRIs.
|
