SNaRIs, NaSSAs, and NaRIs: new agents for the treatment of depression.
A major goal of antidepressant development is to improve on preceding drug classes with agents with greater specificity (and therefore fewer unwanted side-effects) and with more rapid onset of antidepressant action. To this end, four antidepressants with significantly distinct pharmacological characteristics have been recently introduced: venlafaxine, nefazodone, mirtazapine, and reboxetine. Venlafaxine is the first antidepressant in a new drug class referred to as the serotonin noradrenergic reuptake inhibitors (SNaRIs). Nefazodone is a weaker serotonin and norepinephrine reuptake inhibitor, but a potent serotonin 5-HT2 receptor antagonist. Mirtazapine is a potent antagonist of central 2alpha-adrenergic autoreceptors, and heteroreceptors and is an antagonist of serotonin 5-HT2 and 5-HT3 receptors. The result of these actions is to increase both noradrenergic and specific (5-HT1) serotonergic transmission, and mirtazapine has therefore been termed a noradrenergic and specific serotonergic antidepressant (NaSSA). Reboxetine is the first selective noradrenaline reuptake inhibitor (NaRI) to be introduced since the tricyclics, and lacks immediate serotonergic effects.
Kent
J M
JM
New York State Psychiatric Institute, Unit 41, New York, NY 10032, USA. JMK14@columbia.edu
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D003511:Cyclohexanols / Q000009:adverse effects / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078785:Mirtazapine; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D010879:Piperazines; D000077593:Reboxetine; D013329:Structure-Activity Relationship; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use; D000069470:Venlafaxine Hydrochloride
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D009025:Morpholines; D010879:Piperazines; D014230:Triazoles; D008803:Mianserin; C051752:nefazodone; D000069470:Venlafaxine Hydrochloride; D000077593:Reboxetine; D000078785:Mirtazapine