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."[1]
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
Serotonin norepinephrine reuptake inhibitors (SNRI)
- Duloxetine
- Venlafaxine (generic)
Norepinephrine uptake inhibitor
Dopamine reuptake inhibitor
Mechanism of action
Depression may be due to the monoamine-deficiency hypothesis, which is a "deficiency in serotonin or norepinephrine neurotransmission in the brain."[2]
By blocking the reuptake of norepinephrine and serotonin, second-generation antidepressants may overcome the mono-amine deficiency.[3]
Effectiveness
Regarding the use of second-generation antidepressants, clinical practice guidelines by the American College of Physicians recommend:[4] [5]
- "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."
Meta-analyses conflict about the relative effectiveness of the second-generation antidepressants with no difference reported[6] and superiority of sertraline and escitalopram reported. [7]
References
- ↑ Anonymous (2024), Second-generation antidepressants (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Belmaker RH, Agam G (2008). "Major depressive disorder". N. Engl. J. Med. 358 (1): 55–68. DOI:10.1056/NEJMra073096. PMID 18172175. Research Blogging.
- ↑ Katzung, Bertram G. (2006). “Antidepressant Agents”, Basic and Clinical Pharmacology, 10th. New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6.
- ↑ Gartlehner, Gerald; Bradley N. Gaynes, Richard A. Hansen, Patricia Thieda, Angela DeVeaugh-Geiss, Erin E. Krebs, Charity G. Moore, Laura Morgan, Kathleen N. Lohr (2008-11-18). "Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians". Ann Intern Med 149 (10): 734-750. Retrieved on 2008-11-18.
- ↑ Qaseem, Amir; Vincenza Snow, Thomas D. Denberg, Mary Ann Forciea, Douglas K. Owens, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (2008-11-18). "Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians". Ann Intern Med 149 (10): 725-733. Retrieved on 2008-11-18.
- ↑ Gartlehner, Gerald; Bradley N. Gaynes, Richard A. Hansen, Patricia Thieda, Angela DeVeaugh-Geiss, Erin E. Krebs, Charity G. Moore, Laura Morgan, Kathleen N. Lohr (2008-11-18). "Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians". Ann Intern Med 149 (10): 734-750. Retrieved on 2008-11-18.
- ↑ Cipriani A. et al (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. The Lancet DOI:10.1016/s0140-6736(09)60046-5