Selection of an antidepressant: mirtazapine.
The number of antidepressants has expanded dramatically in the last decade as a result of the ability to design psychiatric medications in a rational manner. This paper provides a broad overview of these options while focusing on the most recently approved antidepressant, mirtazapine. The paper discusses the five major features that a physician needs to consider when selecting a medication for a patient: safety, tolerability, efficacy, payment, and simplicity. These five features are summarized by the mnemonic STEPS. The paper also proposes a pharmacologically based classificatory system that divides current antidepressants into eight groups based on the mechanism of action thought to underlie their antidepressant efficacy. Such a classificatory system can serve as an organizing principle for the practicing physician.
Preskorn
S H
SH
Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita 67214, USA.
D000929:Antidepressive Agents, Tricyclic / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D001711:Biotransformation; D002986:Clinical Trials as Topic; D003657:Decision Making; D003866:Depressive Disorder / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000078785:Mirtazapine; D018579:Patient Selection; D017981:Receptors, Neurotransmitter / Q000187:drug effects
D000929:Antidepressive Agents, Tricyclic; D017981:Receptors, Neurotransmitter; D008803:Mianserin; D000078785:Mirtazapine