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Second-Generation Antidepressants for Treating Adult Depression—An Update

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Second-Generation Antidepressants Included in the 2011 Updated Review

Many second-generation drugs are now available generically, although newer agents such as desvenlafaxine (2008), duloxetine (2004), and escitalopram (2002) have remaining patent protection. Except for fluvoxamine (which is approved only for the treatment of obsessive-compulsive disorder), all second-generation antidepressants are approved for the treatment of major depressive disorder. This table summarizes the second-generation antidepressants that are available in the United States by their mechanism of action; it shows names, therapeutic class, and U.S. Food and Drug Administration–approved (labeled) uses. The mechanism of action of most second-generation antidepressants is poorly understood. In general, these drugs work through their effect on prominent neurotransmitters in the central nervous system. Although the drugs can be grouped as SSRIs, SNRIs, SSNRIs, and “other” antidepressants because of their primary mechanism of action, drugs within these groups are not homogenous, and the specific activity may differ among them.

Abbreviations: SNRI = serotonin and norepinephrine reuptake inhibitor; SSNRI = selective serotonin and norepinephrine reuptake inhibitors; SSRI = selective serotonin reuptake inhibitor