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Third-generation antidepressants:
do they offer advantages over the SSRIs?
Olver JS, Burrows GD, Norman TR.
Department of Psychiatry,
University of Melbourne,
Austin & Repatriation Medical Centre,
West Heidelberg, Victoria, Australia.
CNS Drugs 2001;15(12):941-54
ABSTRACT
Third-generation antidepressants
are a group of antidepressant agents of variable action, not confined to
serotonin reuptake inhibition. These agents include venlafaxine, reboxetine,
nefazodone and mirtazapine. Claims have been made for these agents in
terms of improved efficacy, faster speed of onset of effect and greater
safety in the treatment of depression compared with previous medications,
such as the selective serotonin reuptake inhibitors (SSRIs). This
article reviews the evidence for these improvements. Thirty active
comparator studies were reviewed involving the third-generation
antidepressant agents. While there were isolated reports of
improvements over comparator agents for venlafaxine, reboxetine and
mirtazepine, there were no convincing differences between third-generation
agents and comparators in terms of overall efficacy, relapse prevention and
speed of onset. The third-generation antidepressants were, however, of
equivalent safety to SSRIs and maintained improvements in safety over
first-generation agents.
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