TABLE 2 Organization of antidepressant agents into three primary classes by punative mechanisms of action responsible for efficacya

Amine Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitorsb
(fluoxetine, sertraline, paroxetine, fluvoxamine)
Selective Norepinephrine Reuptake Inhibitorsb
(desipramine, maprotiline)
Combined Serotonin-Norepinephrine Reuptake Inhibitors
Selective (venlafaxine)b
Non-selectivec (tertiary amine tricyclics, nortriptyline)
Combined Dopamine-Norepinephrine Reuptake Inhibitor
Selective (bupropion)b
Inhibitors of Enzymatic Metabolism
Irreversible/nonselective Monoamine Oxidase Inhibitorsd
(phenelzine, tranylcypromine, isocarbozazid)
Reversible/selective Inhibitor of Monoamine Oxidase-A
Receptor Antagonistsf
5-HT 2A receptor antagonist
Nonselective (trazodone).c
Combined 5-HT 2A antagonist with Sertonin Reuptake Inhibition
Nonselective (nefazodone)c
Combined 5-HT 2A, 5-HT 2C and alpha-2 antagonism
Nonselective (mirtazipine)c

a Prominent action of a drug on biogenic amine transmission in the central nervous system

b At doses higher than those recommended for routine treatment of depression the selectivity may be lost.

c Nonselective refers to those drugs with potency for non-antidepressant mechanisms that is either greater than or within one order of magnitude of the potency for the putative antidepressant mechanism(s).

d Monamine oxidase inhibitors (MAOIs) by virtue of their fundamental effect on neurotransmission potentiate serotonin, norepinephrine and dopamine.

e Moclobemide is the first reversible inhibitor of monoamine oxidase-type A (RIMA); although marketed in Europe and South America this novel agent is not yet available in the United States.

f The class of receptor antagonists identifies only receptors currently believed to be involved in depression or correlated with antidepressant response. Subdivisions within this class are based on the pharmacology of the parent compound and data on the active metabolites where available.

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published 2000