Why be selective? (original) (raw)

Does selectivity matter?
by
Deakin JFW
University Department of Psychiatry,
Manchester Royal Infirmary, UK.
Int Clin Psychopharmacol, 1996 Mar, 11 Suppl 1:, 13-7

ABSTRACT

An important aim of drug development has been to retain efficacy while reducing side effects and toxicity. It is now clear that selective serotonin reuptake inhibitors (SSRIs) are more effective than noradrenaline reuptake inhibitors (NARIs) in the treatment of obsessional compulsive disorder, and obsessional features in depression predict a responsivity to SSRIs. Furthermore, panic disorder and depression may be more responsive to SSRIs than NARIs. However, there is evidence that inhibition of both sites produces slightly greater efficacy and the addition of an NARI has been reported to potentiate the antidepressant effect of SSRIs. Tricyclic noradrenaline-serotonin uptake inhibitors have many other pharmacological properties, which probably relate to high rates of side effects and cardiotoxicity. Whether in practice these features reduce compliance or increase deaths from suicide is debatable, but it seems wrong to subject patients to burdensome side effects. Certainly, in overdose, older non-selective antidepressants are far more likely to kill than SSRIs. SSRIs have their own side effects, such as nausea and anorgasmia, due to their potency at the uptake site, but these are reversible and sometimes treatable. Clearly, selectivity for specific uptake sites matters for efficacy, and selectivity for uptake over other sites matters for tolerability and safety.

SSRIs SNRIs Serotonin Duloxetine Reboxetine Tomoxetine Venlafaxine Noradrenaline Antidepressants New antidepresants Serotonin reuptake inhibition Dopamine reuptake inhibition Neurotransmitter transporters Noradrenaline reuptake inhibition SSRIs compared with tricyclic antidepressants

Refs and further reading

****HOME** HedWeb Nootropics cocaine.wiki Future Opioids BLTC Research MDMA/Ecstasy Superhapiness? Utopian Surgery? The Abolitionist Project The Hedonistic Imperative The Reproductive Revolution Critique of Huxley's Brave New World

****** The Good Drug Guide The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family