New developments in the treatment of depression.

Depression is a widespread, recurrent disease that sometimes remains inadequately managed by current drug therapy. There is a need to develop better antidepressants that ideally would have a more rapid onset of action, a higher response rate, and improved long-term efficacy. The latest generation of antidepressants have novel dual modes of action, and the results of recent clinical trials indicate that they may have superior efficacy to established drug therapies such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Dual acting drugs, such as venlafaxine, a serotonin-norepinephrine reuptake inhibitor, and mirtazapine, a noradrenergic and specific serotonergic antidepressant, have been shown to have a rapid onset of action. The long-term efficacy of mirtazapine and of venlafaxine was also found to be superior to that of TCAs. Pindolol was found to accelerate response to SSRI therapy. However, these results were dependent on the patient population. These studies clearly suggest that the latest generation of antidepressants offer a more rapid response to treatment, an improved response rate, and superior long-term efficacy than conventional therapy. The clinical importance of these results should not be overlooked.