In psychiatry, this has led to the creation ...

In psychiatry, this has led to the creation of noradrenergic and serotonergic antidepressant action (venlafaxine, milnacipran, duloxetine), thereby providing a more balanced effect on neurotransmission and "synergy" psychopharmacological effects. The emergence of these drugs has provided an opportunity to reconsider the criterion of specificity in the implementation of the clinical effects of antidepressants "selective" action. Venlafaxine, as a representative of this new group of antidepressants, its structure differs from the tricyclic, tetracyclic and other existing drugs. He was placed on the U.S. pharmaceutical market in 1994, is now registered in over 50 countries worldwide and is considered as first-line antidepressant therapy for depression. Its mechanism of action, including a dose-dependent inhibition of all known neurotransmitters involved in the pathogenesis of depression - serotonin, norepinephrine and dopamine, can consider it as being effective for a wide range of depression - an outpatient, hospital, neurotic and psychotic, typical and atypical, endogenous and reactive, agitated and retardirovannyh, bipolar and unipolar, and at various stages of their treatment - acute, supportive, preventive. Lack of affinity for the M-cholinergic receptors, H1-gistaminoretseptoram and a1-adrenoreceptors suggests the absence of drug side effects associated with the excitation of these receptors. Clinical practice has long been confirmed these assumptions. Mega-and meta-analysis carried out in recent years have shown the superiority of venlafaxine over selective serotonin reuptake inhibitors and equally effective when compared with the most powerful tricyclic antidepressants. At the same time the number and range of adverse effects arising from the use of venlafaxine, it is little different from placebo and was comparable with well-tolerated antidepressants like selective serotonin reuptake inhibitors. Thus, venlafaxine is an "ideal" niche, having absorbed the best features of well-known antidepressants - tricyclic high efficiency and good tolerability "selective." Venlafaxine is safe and well tolerated by elderly patients for whom there are no recommendations to reduce the designated doses. It can be administered to patients with renal pathology, not accompanied by a significant decrease in kreatininovogo clearance. Toxic potential of venlafaxine is extremely low and comparable with the selective serotonin reuptake inhibitors. The use of megadoses of the drug in any case is not fatal: the most frequent consequence of such incidents was expressed somnolentsiya. Most popular in clinical practice is a feature of the venlafaxine speed of onset of antidepressant effect, which is defined as the first and second weeks of therapy. Moreover, as shown in some studies, the rate of appearance of clinical effects is in direct relation with the level of dosage of the drug - the higher the dose, the sooner comes the antidepressant effect.