Antidepressants: Difference between revisions
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Most antidepressants are understood to act on monoamine neurotransmitter systems — serotonin, norepinephrine, and dopamine — for example by inhibiting reuptake or by inhibiting their breakdown. How these immediate pharmacological actions relate to changes in mood is not fully established. One commonly cited puzzle is that the effect on neurotransmitter levels occurs within hours, whereas any improvement in depressive symptoms typically takes weeks; this gap has prompted alternative or supplementary models, including hypotheses centered on neuroplasticity.<ref name="liu2017">Liu B, Liu J, Wang M, Zhang Y, Li L (2017). From Serotonin to Neuroplasticity: Evolvement of Theories for Major Depressive Disorder. ''Front Cell Neurosci'' 11:305. PMID 29033793.</ref> The mechanism of antidepressant action should therefore be regarded as an area of active investigation rather than a settled question. | Most antidepressants are understood to act on monoamine neurotransmitter systems — serotonin, norepinephrine, and dopamine — for example by inhibiting reuptake or by inhibiting their breakdown. How these immediate pharmacological actions relate to changes in mood is not fully established. One commonly cited puzzle is that the effect on neurotransmitter levels occurs within hours, whereas any improvement in depressive symptoms typically takes weeks; this gap has prompted alternative or supplementary models, including hypotheses centered on neuroplasticity.<ref name="liu2017">Liu B, Liu J, Wang M, Zhang Y, Li L (2017). From Serotonin to Neuroplasticity: Evolvement of Theories for Major Depressive Disorder. ''Front Cell Neurosci'' 11:305. PMID 29033793.</ref> The mechanism of antidepressant action should therefore be regarded as an area of active investigation rather than a settled question. | ||
== Members == | |||
The antidepressants are conventionally grouped by their primary mechanism. The monoamine oxidase inhibitors (MAOIs) include [[phenelzine]], [[tranylcypromine]], and [[isocarboxazid]]; the tricyclic antidepressants (TCAs) include [[amitriptyline]], [[nortriptyline]], [[imipramine]], and [[clomipramine]]. The selective serotonin reuptake inhibitors (SSRIs) — [[fluoxetine]], [[sertraline]], [[paroxetine]], [[citalopram]], [[escitalopram]], and [[fluvoxamine]] — and the serotonin–norepinephrine reuptake inhibitors (SNRIs) — [[venlafaxine]], [[duloxetine]], [[desvenlafaxine]], and [[levomilnacipran]] — together account for most modern antidepressant prescribing. Further agents act through other mechanisms, including [[bupropion]], [[mirtazapine]], [[trazodone]], [[vilazodone]], [[vortioxetine]], [[agomelatine]], and the recently introduced rapid-acting agents [[esketamine]] and [[zuranolone]]. The list is not exhaustive. | |||
== Safety == | == Safety == | ||