Newer Generation Antidepressant Medications. Worth the Hype?

by Dr. Steven Mee

As you have no doubt heard on television, radio and Internet discussions, patients now have more options for treatment of mental health conditions than ever before. But, are these new agents really ‘Game changers’ or marketing ploys on older standard medication classes? In many respects, a little of both. Dr. Mee will briefly review and provide opinion on these newer agents so that you can be armed with the vital information you need to make informed choices in your care.

All currently available antidepressant medications exert their effects through largely unknown interactions with signaling chemicals in the brain called neurotransmitters. Specifically, these include serotonin, norepinephrine, dopamine, glutamate, and the endorphin system. The various classes of medications differ in how they interact with these chemical signaling pathways. Importantly, there is no single antidepressant medication that is accepted by science and medicine as having proven itself to be more effective than the others on a large scale, however, individuals certainly do differ in their response to different medications and often times a beneficial response to a medication by a close family member is predictive of a positive response in you.

Trintellix (Vortioxetine)—This agent is thought to exert therapeutic effectiveness through the neurotransmitter serotonin (which it increases between brain cells in a similar fashion to older medications like Prozac), but has effects on numerous types of serotonin receptors. The sum effect of this is to increase serotonin levels in some areas while blocking it in others that would otherwise cause side-effects such as sexual dysfunction. In this way, Trintellix may have lower levels of sexual dysfunction than SSRI type medications. In addition, some of these other activities may contribute to improved cognitive effects in depression but this still needs to be proven on a larger scale. Of note as well, there is thought to be minimal to no weight gain with this agent.

Fetzima (Levomilnacipran)—Also relatively new to the U.S. market, this medication belongs to the antidepressant class SNRI (Serotonin-norepinephrine Reuptake Inhibitor). In this way, it causes an increase in serotonin and norepinephrine within certain brain cell pathways. Like Trintellix, weight gain is unusual but sexual side-effects are likely to be more common. Like other SNRI medications such as Effexor or Cymbalta, Fetzima may have pain relieving qualities although this needs much more research to firmly conclude.

Viibryd (Vilazodone)—This agent has been available in the U.S. for a few years and shows some similarities to SSRI medications like Prozac in increasing serotonin but also exhibits unique anti-anxiety effects like the anti-anxiety medication Buspar. It is unlikely to cause weight gain or sleepiness and unlike most commonly used medications for treating depression Viibryd appears less likely to cause sexual side-effects.

In our next installment, Dr. Mee will briefly review other medications that have been approved as ‘Add-on’ medications for depression. At AIP, we want you to be an informed and critical part of the ‘Team’.


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