Mechanism of action of antidepressant medications

J Clin Psychiatry. 1999:60 Suppl 4:4-11; discussion 12-3.

Abstract

The psychopharmacology of depression is a field that has evolved rapidly in just under 5 decades. Early antidepressant medications--tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)--were discovered through astute clinical observations. These first-generation medications were effective because they enhanced serotonergic or noradrenergic mechanisms or both. Unfortunately, the TCAs also blocked histaminic, cholinergic, and alpha1-adrenergic receptor sites, and this action brought about unwanted side effects such as weight gain, dry mouth, constipation, drowsiness, and dizziness. MAOIs can interact with tyramine to cause potentially lethal hypertension and present potentially dangerous interactions with a number of medications and over-the-counter drugs. The newest generation of antidepressants, including the single-receptor selective serotonin reuptake inhibitors (SSRIs) and multiple-receptor antidepressants venlafaxine, mirtazapine, bupropion, trazodone, and nefazodone, target one or more specific brain receptor sites without, in most cases, activating unwanted sites such as histamine and acetylcholine. This paper discusses the new antidepressants, particularly with regard to mechanism of action, and looks at future developments in the treatment of depression.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Antidepressive Agents / pharmacology*
  • Antidepressive Agents / therapeutic use
  • Antidepressive Agents, Tricyclic / history
  • Antidepressive Agents, Tricyclic / pharmacology
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Cyclohexanols / pharmacology
  • Cyclohexanols / therapeutic use
  • Depressive Disorder / drug therapy*
  • Down-Regulation / drug effects
  • History, 20th Century
  • Humans
  • Monoamine Oxidase Inhibitors / history
  • Monoamine Oxidase Inhibitors / pharmacology
  • Monoamine Oxidase Inhibitors / therapeutic use
  • Receptors, Adrenergic / drug effects
  • Receptors, Adrenergic, beta / drug effects
  • Receptors, Dopamine / drug effects
  • Receptors, Glucocorticoid / drug effects
  • Receptors, Serotonin / drug effects
  • Selective Serotonin Reuptake Inhibitors / pharmacology
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Venlafaxine Hydrochloride

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Cyclohexanols
  • Monoamine Oxidase Inhibitors
  • Receptors, Adrenergic
  • Receptors, Adrenergic, beta
  • Receptors, Dopamine
  • Receptors, Glucocorticoid
  • Receptors, Serotonin
  • Selective Serotonin Reuptake Inhibitors
  • Venlafaxine Hydrochloride