Fast Acting Antidepressants-What is the Path forward?
Murugaiah Andappan
Monday, 29 June 2009 17:22 UTC
Antidepressants are perhaps selling more than ever in this gloomy era of recession. But they (esp. frontline therapies-SSRI/SNRI) don’t offer any great benefit (poor efficacy, slow onset and side effects).Though there is a clear unmet need, the drug discovery efforts for novel antidepressants are not on top-gear (due to ultra-complexity of disease etiology, poor preclinical models and the perplexing placebo effect in the clinical trials?). Notwithstanding, what is the way forward for next-generation antidepressants (better efficacy, rapid onset & favourable side effect profile)? Addition of dopamine component (beware abuse risk!) to SSRI /SNRI towards a broad-spectrum SNDRI perhaps? Or other promising strategies?
Good thoughts are welcome from all directions!
Disclaimer: Views expressed on this page are those of the author and not those of his employer.
Updated 28 August 2009 19:42 UTC
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Replies
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I wouldn’t worry unduly about abuse if it works, unless addiction is a problem. Anything can be abused, even aspirin. Although the current range of antidepressants do not work very well, we should not forget the state of affairs before they came on the scene. It was not a pleasant sight.
“Depression” is not a very precise category unfortunately. Even subdivision into clinical and reactive depression isn’t precise enough. But it is reasonable to reject classifying at least certain cases of reactive depression as instances of disease. Which does not mean the some sort of medical treatment is contraindicated. This is just an indication of the etiological complexity you mentioned.
I wish I knew what the solution was. Clinical depression is a dreadful experience. It is not surprising that a number of sufferers wish they were dead. And there is a danger of suicide, even for those on the road to “recovery”. In such cases, a quicker-acting treatment would be beneficial.
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Dear Larry,
Thank you for your good thoughts. Triple reuptake inhibitors are being developed by various companies with the belief that a moderate increase in dopamine (along with a substantial increase of 5-HT & norepinephrine) will have beneficial effect with minimal or no abuse potential.Suicide risk (esp. among children and young adults) is another concern of existing antidepressants. All the antidepressants carry the black box warning (http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273).
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