Dual serotonin and noradrenaline uptake inhibitor class of antidepressants potential for greater efficacy or just hype?
by
Wong DT, Bymaster FP.
Department of Psychiatry,
Indiana University Medical School,
Indianapolis 46202, USA
Prog Drug Res 2002;58:169-222

ABSTRACT

Preclinical and clinical studies support the rationale that development of single molecules, which would promote serotonergic and noradrenergic neurotransmission by inhibiting simultaneously the uptake of both monoamines, would potentially result in improved antidepressant drugs. Currently, the dual inhibitors of serotonin and noradrenaline uptake are venlafaxine, milnacipran and duloxetine. Based on the preclinical studies, the three drugs do show properties of inhibiting uptake of both monoamines in vitro and in vivo in the following order of decreasing potency: duloxetine, venlafaxine and milnacipran, and all exhibit low affinity at neuronal receptors of neurotransmitters, suggesting low side-effect potential. In double-blind, controlled studies, venlafaxine and milnacipran were repeatedly shown to be as efficacious as tricyclic antidepressant drugs in treating major depressive disorder, while one double-blind, placebo-controlled trial showed the antidepressant efficacy of duloxetine. Specifically designed comparative trials of dual uptake inhibitors against the other agents are needed to establish whether the dual uptake inhibitors show improvement in efficacy, rate of responders, antidepressive effects and/or remission.

SSRIs
NARIs
SNRIs
Serotonin
Dopamine
Milnacipran
Venlafaxine
Noradrenaline
Duloxetine and depression
Duloxetine-induced nausea
Duloxetine: a sceptical view
Duloxetine (Cymbalta): structure
Duloxetine: efficacy and tolerability
Duloxetine and urinary incontinence
Duloxetine (Cymbalta): pharmacology
Duloxetine for pain-ridden depressives
Physical symptoms comorbid with depression
New antidepressants : duloxetine (Cymbalta)
Dual-action antidepressants and slimming-drugs
Duloxetine, a balanced serotonin-noradrenaline reuptake inhibitor

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