Noradrenergic approaches to antidepressant therapy.
A decade of remarkable research in neuroscience has given us a much more complete picture of how the central nervous system works and, in some instances, how the brain does not work when patients develop depression. Preclinical and clinical studies have shown that stimulation of the serotonergic system leads to noradrenergic effects and vice versa, confirming that the serotonin and norepinephrine systems are intimately connected in the central nervous system. Although medications that target the serotonergic neurotransmitter system have recently dominated antidepressant therapy, atypical antidepressants--with either mixed serotonergic and noradrenergic effects or exclusively noradrenergic effects--have been shown to be clinically efficacious medications. This increased understanding of the interrelationship between neurotransmitter systems has renewed interest in the role of neurotransmitters other than serotonin in the treatment of depression. With the introduction of reboxetine, a very selective norepinephrine reuptake inhibitor, researchers have had an opportunity to study the unique effects of norepinephrine in the etiology and treatment of depression. Ultimately, differences in neurotransmitter profiles may influence therapeutic potentials of antidepressants. For example, influencing norepinephrine may affect the expression of energy and interest, while influencing serotonin may affect impulse control and influencing dopamine may affect drive. Clinicians now have a range of antidepressants with variable neurotransmitter effects, different side effect profiles, and some interesting differences in functional utility in their armamentarium for treating depression.
Gorman
J M
JM
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. jmg9@columbia.edu
Sullivan
G
G
D018759:Adrenergic Uptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000316:Adrenergic alpha-Agonists / Q000494:pharmacology / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000078785:Mirtazapine; D009025:Morpholines / Q000494:pharmacology / Q000627:therapeutic use; D009638:Norepinephrine / Q000502:physiology*; D000077593:Reboxetine; D011941:Receptors, Adrenergic / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D000316:Adrenergic alpha-Agonists; D018687:Antidepressive Agents, Second-Generation; D008803:Mianserin; D000078785:Mirtazapine; D009025:Morpholines; D009638:Norepinephrine; D000077593:Reboxetine; D011941:Receptors, Adrenergic; D017367:Selective Serotonin Reuptake Inhibitors