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Clinical Efficacy of Reboxetine in Major Depression
Alan F. Schatzberg, M.D.
The past decade has witnessed the advent of selective serotonin reuptake inhibitors (SSRIs) as first-line treatments for major depression. Still, there is considerable debate as to whether these agents are as effective or as potent as the first-generation tricyclic antidepressants (TCAs) or the mixed reuptake inhibitor, venlafaxine, all of which exert considerable effect on norepinephrine (NE) reuptake. Recently, reboxetine, a selective NE reuptake inhibitor (selective NRI), has been introduced in Europe. This drug has only a minimal affinity for muscarinic acetylcholine receptors and therefore causes less dry mouth, constipation, or other such effects than do the TCAs. Reboxetine does not block serotonin reuptake or α1 receptors and, thus, does not appear to produce significant nausea, diarrhea, or hypotension. Unlike other antidepressants, reboxetine appears to be nonsedating. Data on acute and long-term clinical efficacy and safety from double-blind, placebo-controlled, and active comparator studies with reboxetine are reviewed. These studies indicate that reboxetine is significantly more effective than placebo and as effective as fluoxetine in reducing depressive symptoms. Improvements in social adjustments were reported to be more favorable with reboxetine than with fluoxetine. Further, data from controlled clinical trials have shown that the side effect profile for reboxetine is relatively benign. The clinical implications of studies on reboxetine are discussed with an eye toward understanding the potential role NE reuptake blockers may play in the treatment of patients with major depression.
(J Clin Psychiatry 2000;61[suppl 10]:31–38)
From the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.
Presented at the symposium "Norepinephrine: Neurotransmitter for the Millennium," held May 15, 1999, in Washington, D.C. This symposium was held in conjunction with the 152nd annual meeting of the American Psychiatric Association and was supported by an unrestricted educational grant from Pharmacia Corporation.
Reprint requests to: Alan F. Schatzberg, M.D., Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Room 300, Stanford, CA 94305-5717.