Antidepressants: Difference between revisions

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'''Antidepressants''' (a term whose accuracy is sometimes questioned — see [[#Terminology|Terminology]] below) are a class of medicines used principally in the treatment of major depressive disorder, and also in a range of other conditions including anxiety disorders, post-traumatic stress disorder, obsessive–compulsive disorder, and certain chronic pain syndromes. For post-traumatic stress disorder, selective serotonin reuptake inhibitors are recommended as first-line pharmacotherapy in major treatment guidelines, and two — sertraline and paroxetine — carry specific regulatory approval for that indication.<ref name="williams2022">Williams T, Phillips NJ, Stein DJ, Ipser JC (2022). Pharmacotherapy for post traumatic stress disorder (PTSD). ''Cochrane Database Syst Rev'' 3(3):CD002795. PMID 35234292.</ref>

'''Antidepressants''' (a term whose accuracy is sometimes questioned — see [[#Terminology|Terminology]] below) are a class of medicines used principally in the treatment of major depressive disorder, and also in a range of other conditions including anxiety disorders, post-traumatic stress disorder, obsessive–compulsive disorder, and certain chronic pain syndromes. For post-traumatic stress disorder, selective serotonin reuptake inhibitors are recommended as first-line pharmacotherapy in major treatment guidelines, and two — [[sertraline]] and [[paroxetine]] — carry specific regulatory approval for that indication.<ref name="williams2022">Williams T, Phillips NJ, Stein DJ, Ipser JC (2022). Pharmacotherapy for post traumatic stress disorder (PTSD). ''Cochrane Database Syst Rev'' 3(3):CD002795. PMID 35234292.</ref>

== Origins ==

The first two medicines specifically recognized as antidepressants were both introduced in the 1950s, and both were discovered by accident. Iproniazid had been developed as a treatment for tuberculosis; clinicians observed that it elevated mood in some patients, and in 1957 Nathan Kline's group reported its effect in depressed patients without tuberculosis. It became the first of the monoamine oxidase inhibitors (MAOIs).<ref name="lopezmunoz2009">López-Muñoz F, Alamo C (2009). Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today. ''Curr Pharm Des'' 15(14):1563–86. PMID 19442174.</ref> At roughly the same time, imipramine — tested without success as an antipsychotic — was found by the Swiss psychiatrist Roland Kuhn to relieve depression, and became the first of the tricyclic antidepressants (TCAs).<ref name="lopezmunoz2009"/>

The first two medicines specifically recognized as antidepressants were both introduced in the 1950s, and both were discovered by accident. Iproniazid had been developed as a treatment for tuberculosis; clinicians observed that it elevated mood in some patients, and in 1957 Nathan Kline's group reported its effect in depressed patients without tuberculosis. It became the first of the monoamine oxidase inhibitors (MAOIs).<ref name="lopezmunoz2009">López-Muñoz F, Alamo C (2009). Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today. ''Curr Pharm Des'' 15(14):1563–86. PMID 19442174.</ref> At roughly the same time, [[imipramine]] — tested without success as an antipsychotic — was found by the Swiss psychiatrist Roland Kuhn to relieve depression, and became the first of the tricyclic antidepressants (TCAs).<ref name="lopezmunoz2009"/>

These accidental discoveries had an influence beyond treatment: the observation that medicines affecting monoamine neurotransmitters could alter mood contributed to the first biological theories of depression.<ref name="lopezmunoz2009"/>

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== The SSRI era ==

The next major shift came with the selective serotonin reuptake inhibitors (SSRIs). Fluoxetine, developed by Eli Lilly and marketed as Prozac, received United States FDA approval in December 1987 and reached the market in January 1988 as the first SSRI.<ref name="wong2005">Wong DT, Perry KW, Bymaster FP (2005). Case history: the discovery of fluoxetine hydrochloride (Prozac). ''Nat Rev Drug Discov'' 4(9):764–74. PMID 16121130.</ref> SSRIs were not necessarily more effective than the older medicines, but were generally regarded as better tolerated and safer in overdose, and they were prescribed very widely in the decades that followed.<ref name="wong2005"/>

The next major shift came with the selective serotonin reuptake inhibitors (SSRIs). [[Fluoxetine]], developed by Eli Lilly and marketed as Prozac, received United States FDA approval in December 1987 and reached the market in January 1988 as the first SSRI.<ref name="wong2005">Wong DT, Perry KW, Bymaster FP (2005). Case history: the discovery of fluoxetine hydrochloride (Prozac). ''Nat Rev Drug Discov'' 4(9):764–74. PMID 16121130.</ref> SSRIs were not necessarily more effective than the older medicines, but were generally regarded as better tolerated and safer in overdose, and they were prescribed very widely in the decades that followed.<ref name="wong2005"/>

== Terminology ==

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