[1+1 or 2x1? Another form of dual antidepressive mechanism of action].
The primary aim of this review is to summarize the result of clinical trials comparing tricyclic antidepressants with first generation SSRIs, dual action (serotonergic and noradrenergic) agents like venlafaxine or mirtazapine with SSRIs and escitalopram with other SSRIs and venlafaxine. The review analyzes the relationship between the clinical efficacy and tolerability data and the mode of action. The clinical data suggest that multiple mode of action can substantially improve efficacy, however the relative risk of side-effects also increases if a drug affects multiple neurotransmitters. A new opportunity of development is the molecule of escitalopram introduced to the market some years ago. Its unique dual action on serotonergic transmission offers improved efficacy without compromising the favourable side-effect profile due to selectivity. Based on clinical trials escitalopram shows improved efficacy, faster onset of action and higher remission rates compared to first generation SSRIs. Remission rates with escitalopram are at least as high as with venlafaxine and escitalopram shows faster onset of action, earlier sustained remission and better tolerability. The good clinical efficacy data of escitalopram may be explained by its unique dual serotonergic effect on serotonin transporter protein.
Lakatos
László
L
Pszichiátriai magánrendelés, Székesfehérvár, Budapest.
Rihmer
Zoltán
Z
D018759:Adrenergic Uptake Inhibitors / Q000494:pharmacology; D000928:Antidepressive Agents / Q000009:adverse effects / Q000494:pharmacology*; D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology; D000929:Antidepressive Agents, Tricyclic / Q000494:pharmacology; D015283:Citalopram / Q000494:pharmacology; D002986:Clinical Trials as Topic; D003511:Cyclohexanols / Q000494:pharmacology; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives / Q000494:pharmacology; D000078785:Mirtazapine; D050486:Serotonin Plasma Membrane Transport Proteins / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology; D000069470:Venlafaxine Hydrochloride
D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D015283:Citalopram; D003511:Cyclohexanols; D008803:Mianserin; D000078785:Mirtazapine; D050486:Serotonin Plasma Membrane Transport Proteins; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride