Catecholaminergic strategies for the treatment of major depression.
Although the selective serotonin reuptake inhibitors have become the first line medications for the treatment of depression, drugs primarily targeting the norepinephrine (NE) and/or the dopamine catecholaminergic systems are also effective. These include selective NE reuptake inhibitors, such as desipramine and reboxetine, the NE releaser bupropion and the alpha2-adrenergic antagonists mianserin and mirtazapine. Dopamine type 2 agonists are also effective in treating depression, although they are rarely used. Since the NE, dopamine and serotonin systems have reciprocal interactions, it is virtually impossible to act on a specific neuronal element without affecting in a cascade effect the two other systems. In this review, the primary actions of the catecholaminergic strategies upon their acute and long-term administration are described, as well as their impact on other systems. Their use in treatment-resistant depressed patients is also addressed.
Institute of Mental Health Research, Lady Grey Building, suite 2043, Royal Ottawa Hospital, University of Ottawa, Ottawa, Canada.
Philippe
P
Tremblay
Pierre
P
Blier
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects* / Q000201:enzymology / Q000378:metabolism; D002395:Catecholamines / Q000378:metabolism*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000201:enzymology / Q000378:metabolism; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D009638:Norepinephrine / Q000378:metabolism
D000317:Adrenergic alpha-Antagonists; D000928:Antidepressive Agents; D002395:Catecholamines; D018491:Dopamine Agonists; D008996:Monoamine Oxidase Inhibitors; D009638:Norepinephrine