NEW YORK, Mar 10 (Reuters Health) -- A new wave of antidepressant
medications offers more choices to keep depression -- and drug side effects --
under control, according to a report.
Not all cases of depression are the same, but until the early 1980s,
treatment choices were limited to a few drugs, including lithium and medications
called tricyclic antidepressants and monoamine oxidase inhibitors, according to
Dr. Justine M. Kent, of the New York State Psychiatric Institute. Though
effective in many patients, these early antidepressants can cause both mild and
serious side effects, Kent notes in the March 11th issue of The Lancet.
The next class of antidepressants to be introduced, selective serotonin
reuptake inhibitors (SSRIs) like Prozac, are safer and easier to take than
earlier drugs, according to Kent. However, these medications can also cause
unwanted side effects, such as sexual dysfunction and weight gain.
But four relatively new antidepressants -- venlafaxine (Effexor), nefazodone
(Serzone), mirtazapine (Remeron) and reboxetine (Vestra, which is not yet
available in the US) -- are more effective than the first generation of
antidepressants, Kent reports. And while the newer drugs are about as effective
as SSRIs, their side effects differ, making them an option for people who have
trouble taking SSRIs. For example, mirtazapine might be a good choice for people
who lose weight while depressed, since the drug increases appetite. Or
nefazodone might be appropriate for people who have trouble sleeping, since it
has been shown to relieve insomnia in depressed people.
For the most part, the newer drugs function differently than SSRIs, so
physicians are able to choose a drug based on a patient's individual symptoms,
Kent explains. Depressed people who have a lack of energy might benefit from
reboxetine, while nefazodone or mirtazapine, which tend to be more sedating,
might be better choices for people who are anxious or agitated, the author
suggests.
Since the characteristics of depression vary from person to person, there is
a need for a wide variety of antidepressant drugs, Kent notes.
Selecting medications based on an individual's illness may lead to more
effective treatment of mental illness, she states in the report.
"To this end, these new classes of antidepressants significantly broaden the
physician's and patient's choice," Kent concludes.
