Other Antidepressant Drugs

Mirtazapine, a presynaptic alpha2-adrenoreceptor antagonist, increases central noradrenergic and serotonergic neurotransmission. It has few antimuscarinic effects, but causes sedation during initial treatment. Venlafaxine is a serotonin and noradrenaline re-uptake inhibitor (SNRI); it lacks the sedative and antimuscarinic effects of the tricyclic antidepressants. Tianeptine is an antidepressant agent with a novel neurochemical profile. It increases serotonin (5-hydroxytryptamine; 5-HT) uptake in the brain (in contrast with most antidepressant agents) and reduces stress-induced atrophy of neuronal dendrites. Like the selective serotonin reuptake inhibitors (SSRIs) and in contrast with most tricyclic antidepressant agents, tianeptine does not appear to be associated with adverse cognitive, psychomotor, sleep, cardiovascular or bodyweight effects and has a low propensity for abuse.

MIRTAZAPINE:

Indications: major depression.

Contraindications: Manic Bipolar Disorder, Severe Chronic Neutropenia, And Suicidal Ideation.

Dose and Administration: Initially 15 mg daily at bedtime increased within 2–4 weeks according to response; max. 45 mg daily as a single dose at bedtime or in 2 divided doses; child and adolescent under 18 years not recommended.

VENLAFAXINE:

Indications: Depression, Generalized Anxiety Disorder, Neuropathic Pain, And Post Traumatic Stress Disorder, Social Phobia, Vasomotor Symptoms associated with Menopause.

Contraindications: Hypertension, Narrow Angle Glaucoma, Ocular Hypertension, Prolonged QT Interval, Recovery Phase Following Myocardial Infarct, Severe Uncontrolled Hypertension, Suicidal Ideation, Upper GI Bleed.

Dose and Administration: Depression, adult over 18 years, 75 mg daily as a single dose, increased if necessary after at least 2 weeks to 150 mg once daily; max. 225 mg once daily; child under 18 years not recommended. Generalised anxiety disorder, adult over 18 years, 75 mg daily as a single dose; discontinue if no response after 8 weeks. Social anxiety disorder, adult over 18 years, 75 mg daily as a single dose; discontinue if no response after 12 weeks.

TIANEPTINE:

Indications: Indicated for depressive states of mild, moderate and sever intensity.

Contraindications: Children under 15 years age, pregnancy, breast-feeding or not to be used in combination with other drugs for depression such as non­selective MAOI.

Dose and Administration: The mean dosage is 3 tablets per day (37.5mg per day) to be taken just before the three meals.