SNaRIs, NaSSAs, and NaRIs: new agents for the treatment of depression

Lancet. 2000 Mar 11;355(9207):911-8. doi: 10.1016/S0140-6736(99)11381-3.

Abstract

A major goal of antidepressant development is to improve on preceding drug classes with agents with greater specificity (and therefore fewer unwanted side-effects) and with more rapid onset of antidepressant action. To this end, four antidepressants with significantly distinct pharmacological characteristics have been recently introduced: venlafaxine, nefazodone, mirtazapine, and reboxetine. Venlafaxine is the first antidepressant in a new drug class referred to as the serotonin noradrenergic reuptake inhibitors (SNaRIs). Nefazodone is a weaker serotonin and norepinephrine reuptake inhibitor, but a potent serotonin 5-HT2 receptor antagonist. Mirtazapine is a potent antagonist of central 2alpha-adrenergic autoreceptors, and heteroreceptors and is an antagonist of serotonin 5-HT2 and 5-HT3 receptors. The result of these actions is to increase both noradrenergic and specific (5-HT1) serotonergic transmission, and mirtazapine has therefore been termed a noradrenergic and specific serotonergic antidepressant (NaSSA). Reboxetine is the first selective noradrenaline reuptake inhibitor (NaRI) to be introduced since the tricyclics, and lacks immediate serotonergic effects.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Antidepressive Agents, Second-Generation / adverse effects
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Cyclohexanols / adverse effects
  • Cyclohexanols / therapeutic use
  • Depressive Disorder / drug therapy*
  • Humans
  • Mianserin / adverse effects
  • Mianserin / analogs & derivatives
  • Mianserin / therapeutic use
  • Mirtazapine
  • Morpholines / adverse effects
  • Morpholines / therapeutic use
  • Piperazines
  • Reboxetine
  • Structure-Activity Relationship
  • Treatment Outcome
  • Triazoles / adverse effects
  • Triazoles / therapeutic use
  • Venlafaxine Hydrochloride

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Second-Generation
  • Cyclohexanols
  • Morpholines
  • Piperazines
  • Triazoles
  • Mianserin
  • nefazodone
  • Venlafaxine Hydrochloride
  • Reboxetine
  • Mirtazapine