Second-generation antidepressant: Difference between revisions

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imported>Robert Badgett
imported>Robert Badgett
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By blocking the ''reuptake'' of [[norepinephrine]] and [[serotonin]], second-generation antidepressants may overcome the mono-amine deficiency.<ref name="isbn0-07-145153-6">{{cite book |author=Katzung, Bertram G. |authorlink= |editor= |others= |title=Basic and Clinical Pharmacology |edition=10th |chapter=Antidepressant Agents |chapterurl= |language= |publisher=McGraw-Hill Medical Publishing Division |location=New York |year=2006 |origyear= |pages= |quote= |isbn=0-07-145153-6 |oclc= |doi= |url=http://www.accessmedicine.com/resourceTOC.aspx?resourceID=16 |accessdate=}}</ref>
By blocking the ''reuptake'' of [[norepinephrine]] and [[serotonin]], second-generation antidepressants may overcome the mono-amine deficiency.<ref name="isbn0-07-145153-6">{{cite book |author=Katzung, Bertram G. |authorlink= |editor= |others= |title=Basic and Clinical Pharmacology |edition=10th |chapter=Antidepressant Agents |chapterurl= |language= |publisher=McGraw-Hill Medical Publishing Division |location=New York |year=2006 |origyear= |pages= |quote= |isbn=0-07-145153-6 |oclc= |doi= |url=http://www.accessmedicine.com/resourceTOC.aspx?resourceID=16 |accessdate=}}</ref>
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! heading !! heading
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==Effectiveness==
==Effectiveness==
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* "when treating symptom clusters in patients with accompanying depression, second-generation antidepressants did not differ in efficacy in treating accompanying [[anxiety]], [[pain]], and [[Somatoform disorder|somatization]]. Limited evidence suggests that some agents may be more effective in treating [[insomnia]]"
* "when treating symptom clusters in patients with accompanying depression, second-generation antidepressants did not differ in efficacy in treating accompanying [[anxiety]], [[pain]], and [[Somatoform disorder|somatization]]. Limited evidence suggests that some agents may be more effective in treating [[insomnia]]"
* "most of the second-generation antidepressants had similar adverse effects...paroxetine was associated with an increased risk for sexual dysfunction."
* "most of the second-generation antidepressants had similar adverse effects...paroxetine was associated with an increased risk for sexual dysfunction."
The effectiveness is antidepressants depends on the severity of a patient's depression. This relationship may be due to thedeclining effect of placebo among more severely depressed patients.<ref name="pmid20042812">{{cite journal| author=Lo B| title=Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead. | journal=Acad Med | year= 2010 | volume= 85 | issue= 1 | pages= 9-11 | pmid=20042812
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20042812 | doi=10.1097/ACM.0b013e3181c46e96 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
{| class="wikitable" align="right"
|+ The effectiveness of antidepressants depending on severity of depression<ref name="pmid20042812">{{cite journal| author=Lo B| title=Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead. | journal=Acad Med | year= 2010 | volume= 85 | issue= 1 | pages= 9-11 | pmid=20042812
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20042812 | doi=10.1097/ACM.0b013e3181c46e96 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
!American Psychiatric Association classification of severity<ref name="isbn1-58562-218-4">{{cite book |author=First, Michael B. |title=Handbook of Psychiatric Measures, Second Edition |publisher=American Psychiatric Publishing, Inc |location= |year=2007 |pages= |isbn=1-58562-218-4 |oclc= |doi= |accessdate=}}</ref>!! [http://healthnet.umassmed.edu/mhealth/HAMD.pdf Hamilton Depression Rating Scale] (HDRS)!![[Number needed to treat]]!!Clinical significance (NICE)<ref>National Institute for Clinical Excellence. [http://guidance.nice.org.uk/CG90 Depression: Management of Depression in Primary and Secondary Care]. London, England: National Institute for Clinical Excellence; 2004.</ref>
|-
| Mild to moderate|| < 19|| 16|| No
|-
| Severe|| 19 - 22|| 11|| No
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| Very severe|| > 22|| 4|| Yes
|}


[[Meta-analysis|Meta-analyses]] conflict about the relative effectiveness of the second-generation antidepressants with no difference reported<ref>{{Cite journal | volume = 149 | issue = 10 | pages = 734-750 | last = Gartlehner | first = Gerald | coauthors = Bradley N. Gaynes, Richard A. Hansen, Patricia Thieda, Angela DeVeaugh-Geiss, Erin E. Krebs, Charity G. Moore, Laura Morgan, Kathleen N. Lohr | title = Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians | journal = Ann Intern Med | accessdate = 2008-11-18 | date = 2008-11-18 | url = http://www.annals.org/cgi/content/abstract/149/10/734 }}</ref> and superiority of [[sertraline]] and [[escitalopram]] reported. <ref>Cipriani A. et al (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. The Lancet {{doi|10.1016/s0140-6736(09)60046-5}}</ref>
[[Meta-analysis|Meta-analyses]] conflict about the relative effectiveness of the second-generation antidepressants with no difference reported<ref>{{Cite journal | volume = 149 | issue = 10 | pages = 734-750 | last = Gartlehner | first = Gerald | coauthors = Bradley N. Gaynes, Richard A. Hansen, Patricia Thieda, Angela DeVeaugh-Geiss, Erin E. Krebs, Charity G. Moore, Laura Morgan, Kathleen N. Lohr | title = Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians | journal = Ann Intern Med | accessdate = 2008-11-18 | date = 2008-11-18 | url = http://www.annals.org/cgi/content/abstract/149/10/734 }}</ref> and superiority of [[sertraline]] and [[escitalopram]] reported. <ref>Cipriani A. et al (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. The Lancet {{doi|10.1016/s0140-6736(09)60046-5}}</ref>

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Second-generation antidepressants are used to treat depression and are a "structurally and mechanistically diverse group of drugs that are not tricyclics or monoamine oxidase inhibitors. The most clinically important appear to act selectively on serotonergic systems, especially by inhibiting serotonin reuptake."[1]

Classification

Second-generation antidepressants are classified by the biogenic amine receptor that they affect.

Selective serotonin reuptake inhibitors(SSRI)

Serotonin 5-HT2–receptor agonist

Serotonin norepinephrine reuptake inhibitors (SNRI)

Norepinephrine uptake inhibitor

Dopamine reuptake inhibitor

Mechanism of action

Depression may be due to the monoamine-deficiency hypothesis, which is a "deficiency in serotonin or norepinephrine neurotransmission in the brain."[2]

By blocking the reuptake of norepinephrine and serotonin, second-generation antidepressants may overcome the mono-amine deficiency.[3]


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heading heading
cell cell
cell cell


Effectiveness

Regarding the use of second-generation antidepressants, clinical practice guidelines by the American College of Physicians recommend:[4] [5]

  • "when clinicians choose pharmacologic therapy to treat patients with acute major depression, they select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences"
  • "second-generation antidepressants did not significantly differ in efficacy, effectiveness, or quality of life. Mirtazapine had a significantly faster onset of action"
  • "when treating symptom clusters in patients with accompanying depression, second-generation antidepressants did not differ in efficacy in treating accompanying anxiety, pain, and somatization. Limited evidence suggests that some agents may be more effective in treating insomnia"
  • "most of the second-generation antidepressants had similar adverse effects...paroxetine was associated with an increased risk for sexual dysfunction."

The effectiveness is antidepressants depends on the severity of a patient's depression. This relationship may be due to thedeclining effect of placebo among more severely depressed patients.[6]

The effectiveness of antidepressants depending on severity of depression[6]
American Psychiatric Association classification of severity[7] Hamilton Depression Rating Scale (HDRS) Number needed to treat Clinical significance (NICE)[8]
Mild to moderate < 19 16 No
Severe 19 - 22 11 No
Very severe > 22 4 Yes

Meta-analyses conflict about the relative effectiveness of the second-generation antidepressants with no difference reported[9] and superiority of sertraline and escitalopram reported. [10]

References

  1. ↑ Anonymous (2024), Second-generation antidepressants (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Belmaker RH, Agam G (2008). "Major depressive disorder". N. Engl. J. Med. 358 (1): 55–68. DOI:10.1056/NEJMra073096. PMID 18172175. Research Blogging.
  3. ↑ Katzung, Bertram G. (2006). “Antidepressant Agents”, Basic and Clinical Pharmacology, 10th. New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6. 
  4. ↑ Gartlehner, Gerald; Bradley N. Gaynes, Richard A. Hansen, Patricia Thieda, Angela DeVeaugh-Geiss, Erin E. Krebs, Charity G. Moore, Laura Morgan, Kathleen N. Lohr (2008-11-18). "Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians". Ann Intern Med 149 (10): 734-750. Retrieved on 2008-11-18.
  5. ↑ Qaseem, Amir; Vincenza Snow, Thomas D. Denberg, Mary Ann Forciea, Douglas K. Owens, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (2008-11-18). "Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians". Ann Intern Med 149 (10): 725-733. Retrieved on 2008-11-18.
  6. ↑ 6.0 6.1 Lo B (2010). "Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead.". Acad Med 85 (1): 9-11. DOI:10.1097/ACM.0b013e3181c46e96. PMID 20042812. Research Blogging.
  7. ↑ First, Michael B. (2007). Handbook of Psychiatric Measures, Second Edition. American Psychiatric Publishing, Inc. ISBN 1-58562-218-4. 
  8. ↑ National Institute for Clinical Excellence. Depression: Management of Depression in Primary and Secondary Care. London, England: National Institute for Clinical Excellence; 2004.
  9. ↑ Gartlehner, Gerald; Bradley N. Gaynes, Richard A. Hansen, Patricia Thieda, Angela DeVeaugh-Geiss, Erin E. Krebs, Charity G. Moore, Laura Morgan, Kathleen N. Lohr (2008-11-18). "Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians". Ann Intern Med 149 (10): 734-750. Retrieved on 2008-11-18.
  10. ↑ Cipriani A. et al (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. The Lancet DOI:10.1016/s0140-6736(09)60046-5
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