Other Antidepressants

Venlafaxine (Effexor, Effexor XR) is a serotonin and noradrenergic reuptake inhibitor with a better side effect profile than TCAs or MAOIs. A May 2002 meta-analysis of prior antidepressant trials suggested that venlafaxine and TCAs may have a greater remission rate than SSRIs. Further study is needed including more head-to-head comparison trials. Nefazodone (Serzone) and trazodone (Desyrel) are serotonin-modulating antidepressants. Trazodone is prescribed rarely as a sole antidepressant but is often prescribed as an adjunct to an SSRI for sleep because it has strong sedative properties (at higher doses it serves as an antidepressant). In addition to sedation, trazodone can on rare occasions induce priapism (prolonged, painful penile erection) that can cause permanent damage. Patients must be instructed to seek emergency treatment should such an erection occur. Nefazodone is similar to trazodone but is less sedating at therapeutic doses. It appears to have a low rate of sexual dysfunction.

Bupropion (Wellbutrin, Wellbutrin SR, Zyban) appears to work by inhibiting the uptake of dopamine and norepinephrine. Bupropion has a low incidence of sexual side effects. In addition to its efficacy in treating major depression, bupropion has been shown to be effective in smoking cessation (marketed as Zyban) and attention deficit disorder. Bupropion has a higher than average risk of seizures compared with other antidepressants. The risk of seizures is greatest above a daily dose of 450mg or alter a single dose of greater than 150mg of immediate-release bupropion.

Mirtazapine (Remeron) is classified as a modulator of norepinephrine and serotonin. It is quite sedating in some individuals, and has a low incidence of sexual dysfunction.

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Chapter 12 / Antidepressants, ECT, and Phototherapy ■ 67

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