Second-generation antidepressant

Second-generation antidepressants are used to treat depression and are a "structurally and mechanistically diverse group of drugs that are not tricyclics or monoamine oxidase inhibitors. The most clinically important appear to act selectively on serotonergic systems, especially by inhibiting serotonin reuptake."

Classification

Second-generation antidepressants are classified by the biogenic amine receptor that they affect.

Selective serotonin reuptake inhibitors(SSRI)

• Citalopram (generic)
• Fluoxetine (generic)
• Sertraline

Serotonin 5-HT2–receptor agonist

• Nefazodone

Serotonin norepinephrine reuptake inhibitors (SNRI)

• Duloxetine
• Venlafaxine (generic)

Norepinephrine uptake inhibitor

• Maprotiline

Dopamine reuptake inhibitor

• Bupropion

Effectiveness

Regarding the use of second-generation antidepressants, clinical practice guidelines by the American College of Physicians recommend:

• "when clinicians choose pharmacologic therapy to treat patients with acute major depression, they select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences"
• "second-generation antidepressants did not significantly differ in efficacy, effectiveness, or quality of life. Mirtazapine had a significantly faster onset of action"
• "when treating symptom clusters in patients with accompanying depression, second-generation antidepressants did not differ in efficacy in treating accompanying anxiety, pain, and somatization. Limited evidence suggests that some agents may be more effective in treating insomnia"
• "most of the second-generation antidepressants had similar adverse effects...paroxetine was associated with an increased risk for sexual dysfunction."