Newer antidepressants in the primary care setting.

Because major depression has negative effects on other disease states, proper recognition and treatment of depression are important in the primary care setting. Although the perfect antidepressant does not yet exist, newer antidepressants have advanced the field. This article will summarize key features of 3 newer antidepressants that represent advances in psychopharmacology: mirtazapine, which has a dual effect on serotonergic and noradrenergic systems; escitalopram, the latest selective serotonin reuptake inhibitor, which is the first pure antidepressant stereoisomer in clinical use; and duloxetine, a dual reuptake inhibitor of norepinephrine and serotonin that is expected to be clinically available in the near future.