Title:New-Generation, Non-SSRI Antidepressants: Therapeutic Drug Monitoring and Pharmacological Interactions. Part 1: SNRIs, SMSs, SARIs
VOLUME: 25 ISSUE: 7
Author(s):Roberto Mandrioli*, Michele Protti and Laura Mercolini
Affiliation:Department for Life Quality Studies (QuVi), Alma Mater Studiorum - University of Bologna, Rimini Campus, Corso d'Augusto 237, 47921 Rimini, Pharmaco-Toxicological Analysis Laboratory (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Pharmaco-Toxicological Analysis Laboratory (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna
Keywords:Analysis, chemical-clinical correlations, drug-drug interactions, metabolism, pharmacological properties,
new-generation antidepressants (NGAs), therapeutic drug monitoring (TDM).
Abstract:Background: New-generation antidepressants (NGAs) are the latest additions to
the clinician’s arsenal in the fight against depression. After the introduction of selective serotonin
reuptake inhibitors (SSRIs), a plethora of other groups followed, identified by their main
mechanisms of activity: serotonin and norepinephrine reuptake inhibitors (SNRI); serotonin
modulators and stimulators (SMS); serotonin antagonists and reuptake inhibitors (SARI);
noradrenergic and selective serotonergic antidepressants (NaSSA); norepinephrine reuptake
inhibitors (NeRI); serotonin, norepinephrine and dopamine reuptake inhibitors (SNDRI) or
triple reuptake inhibitors (TRI); and melatonin and serotonin agonists (MaSA). Although
SSRIs are still the most widely used and well known NGAs, the other groups are increasingly
being used in the current therapeutic settings obtaining comparable clinical results, and with
tolerability and safety profiles that can often provide significant advantages over those of
SSRIs.
Methods: Scopus and PubMed databases were searched for the most significant papers centered
on the medicinal chemistry, pharmacodynamics, pharmacokinetics and analysis in human
biological fluids of the following antidepressants: venlafaxine, duloxetine, milnacipran,
trazodone, vortioxetine, vilazodone.
Results: The main characteristics of commercially available non-SSRI NGAs (belonging to
the SNRI, SARI and SMS classes) are described, focusing on the role of analytical methods
that can be applied to perform therapeutic drug monitoring (TDM), but also including drug
pharmacokinetics, metabolism and interactions.
