Second-generation antidepressants in the pharmacologic treatment of adult depression: An update of the 2007 comparative effectiveness review. Comparative Effectiveness Review, Number 46
Depressive disorders such as major depressive disorder (MDD), dysthymia, and subsyndromal depression (including minor depression) may be serious disabling illnesses. MDD is the most prevalent, affecting more than 16 percent (lifetime) of U.S. adults. In 2000, the U.S. economic burden of depressive disorders was estimated to be $83.1 billion. Likely, this number has increased during the past 10 years. More than 30 percent of these costs are attributable to direct medical expenses.
Pharmacotherapy dominates the medical management of depressive disorders and may include first-generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) and more recently developed second-generation antidepressants. These second-generation
treatments include selective serotonin reuptake inhibitors (SSRIs: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs: duloxetine), serotonin and norepinephrine reuptake inhibitors (SNRIs:
desvenlafaxine, mirtazapine, venlafaxine), and other second-generation antidepressants (bupropion, nefazodone, trazodone). The mechanism of action of most of these agents is poorly understood.