Saturday, 1 June 2013

Comparative Efficacy of Antidepressants

Nowadays there are so many different antidepressants with which GPs and psychiatrists are asked to be acquainted with sufficiently in order to make the best decisions when it comes to prescribing to their patients. They must weigh up two crucial things in their decision: risk and gain... To what extent can they expect the drug to harm the patient and what benefit is the patient likely to derive from the medication. On top of this in countries that don't have our wonderful Australian Medicare program the GP/psychiatrist may need to additionally way up the cost of the medication.

There are a number of different, major classes of antidepressants and they include:

  • Selective Serotonin Reuptake Inhibitors (SSRIs)
    • Citalopram (Celexa, Cipramil)
    • Escitalopram (Lexapro)
    • Fluoxetine (Prozac)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
      • Desvenlafaxine (Pristiq)
      • Duloxetine (Cymbalta)
      • Milnacipran (Savella)#
      • Venlafaxine (Effexor)
    • Norepinephrine-dopamine reuptake inhibitors (NDRIs)
      • Bupropion (Wellbutrin, Zyban)
      • Methylphenidate (Concerta, Ritalin)*
    • Norepinephrine reuptake inhibitors (NRIs)
      • Atomoxetine (Strattera)*
      • Reboxetine (Edronax)
    • Noradrenergic and specific serotonergic antidepressants (NaSSAs)
      • Mianserin (Bolviden)
      • Mirtazapine (Avanza, Remeron, Zispin)
    • Serotonin antagonist and reuptake inhibitors (SARIs)
      • Nefazodone (Serzone)
      • Trazodone (Desyrel)
    • Tricyclic antidepressants (TCAs)
      • Amitriptyline (Elavil)
      • Clomipramine (Anafrinil)
      • Desipramine (Norpramin)
      • Dothiepin (Dopress)
      • Doxepin (Sinequan)
      • Imipramine (Trofanil)
      • Iprindole (Prondol)
      • Nortriptyline (Pamelor)
      • Protriptyline (Vivactil)
      • Tianeptine (Stablon)#
      • Trimipramine (Surmontil)
    • Tetracyclic antidepressants (TeCAs)
      • Amoxapine (Asendin)
      • Mianserin (Bolviden)
      • Mirtazapine (Avanza, Remeron, Zispin)
    • Monoamine Oxidase Inhibitors (MAOIs)
      • Isocarboxazid (Marplan)
      • Phenelzine (Nardil)
      • Rasagiline (Azilect)*
      • Selegiline (Eldepryl)
      • Tranylcypromine (Parnate)
    • Reversible Inhibitors of monoamine oxidase A (RIMAs)
      • Moclobemide (Aurorix, Manerix)
    • Melatonergic antidepressants (MAs)
      • Agomelatine (Valdoxan)

    * Not Therapeutic Goods Administration (TGA) approved for depression. Is TGA approved for other indications.
    # Not TGA approved for any indication.

    TCAs, TeCAs, NaSSAs, SARIs and MAOIs are usually left as last resort antidepressants by GPs/psychiatrists due to their side effects whereas RIMAs, SSRIs, SNRIs, NDRIs and NRIs are often viewed as first-line antidepressant treatments. 

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