Noradrenaline and Serotonin Reuptake Inhibition As Clinical Principles: a Review of Antidepressant Efficacy

Imipramine and other subsequently developed antidepressants produce numerous neurochemical effects, some of which presumably represent active antidepressant principles. Numerous studies have compared the efficacy of selective serotonin reuptake inhibitors (SSRIs) with noradrenaline reuptake inhibitors (NRIs) with variable selectivity, such as desipramine, lofepramine, viloxazine, maprotiline or oxaprotiline. Most studies have failed to show differences in response rates or subtype responsivity. However, in some studies NRIs appear to be superior to SSRIs as regards retardation and, conversely, SSRIs appear superior as regards anxiety symptoms. Furthermore, NRIs may be more effective than SSRIs in severe depression. The novel selective NRI reboxetine has been shown to be at least as effective as imipramine, desipramine and fluoxetine in the treatment of major depression. Moreover, reboxetine may also improve social functioning significantly more than fluoxetine providing a better quality of the remission.