After the traditional tricyclic ...

After the traditional tricyclic antidepressants, selective serotonin reuptake inhibitors to date were among the most widely used means for the differentiated treatment of endogenous depression with various psychiatric picture, and with varying degrees of severity. Being less toxic than TCA SSRI-compounds such as antidepressants and II generation, in general, inferior to them in the words of an antidepressant effect and, as is evident from tables 2-3, converge on this indicator with the "atypical" antidepressants II generation. When you create a better anti-depressants, whose main task - to minimize the inefficiencies that antidepressants I, II and III generation, purposeful synthesis tipoanaleptikov which action is directed to the simultaneous increase in noradrenergic and serotonergic neurotransmission with selective effects on the serotonin receptor 5-HT 1, associated with actually a manifestation of antidepressant drug action, and simultaneous blockade of 5-HT2 and 5NT3 receptors, preventing the development of side effects. These compounds are conventionally refer to IV generation antidepressants. They include a group of noradrenergic and specific serotonergic antidepressant (NaSSA) and a group of specific serotonin reuptake inhibitors and norepinephrine (SNRI). NaSSA-antidepressants have high antidepressant activity with virtually no side effects holinoliticheskogo. To this class of compounds include mirtazapine, registered in Russia under the name of remeron. Clinically, it seems to combines the positive qualities of the previous generations of antidepressants: the strength of antidepressant effects remeron associate with the action of TCA sedatikov and exceeds the "atypical" antidepressants II generation and SSRI-compound suppresses manifestations of anxiety and agitation, sleep disorders, suicidal behavior. Therapeutic effect remerona seen quickly, with the seventh day of treatment. In 80% of patients with endogenous depression by the end of a 4-week course of treatment showed a significant improvement. The drug is also effective in the treatment of treatment-resistant depression and is well tolerated even after long months of use. Another group of modern antidepressants - SNRI-drugs - also has a new perspective in optimizing antidepressant therapy of endogenous depressions. Representatives of this group of compounds: milnacipran (Ixelles) and venlafaxine (Effexor), as NaSSA-drugs - similar to detect TCA antidepressant activity in endogenous depression and surpass that of SSRI-compounds (see Table. 4). They differ in rapid detection of therapeutic effect, and the virtual absence of their effects on histamine, muscarinic and alpha-adrenergic receptors does SNRI drugs especially low-toxic and safe to use. Thus, the consistent introduction to the practice of psychiatry, different groups of antidepressants that developed at different stages of the pharmacotherapy of depression, indicates inexhaustible its capabilities and the need to improve by learning mechanisms of action of antidepressant drugs and determine the prospects for their direct synthesis.