Treatment Studies

Since the early 1950s, when MAOIs and imipramine were serendipitously discovered to have therapeutic effects in the treatment of depression (Loomer et al., 1957), a steady stream of new medications for depression have become available for clinical use. The first of these drugs were simple modifications of the original tricyclic antide-pressant TCA or MAO inhibitor compounds. However, as our understanding of the pharmacology of these compounds has evolved, newer drugs have been tailored to have specific neurochemical effects. The vast majority of newer compounds have been designed to potently enhance NE and/or 5-HT neurotransmission without anticholiner-gic, antihistaminergic, or antiadrenergic properties. It was hoped that this would lead to drugs with fewer side effects and/or greater efficacy and faster onset of action.

The following sections provide a selected review of data from clinical studies investigating the efficacy of several drugs with potent effects of NE and/or 5-HT for treatment of major depression and several anxiety disorders. Table 8.4 lists currently available antidepressant drugs (and selected nonpharmacological treatments), grouping them based on the pharmacological effects of the parent compound that most likely underlie the therapeutic effects. The sections that follow describe important characteristics of medications in each category.

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