Mandrioli Roberto, Protti Michele, Mercolini Laura
Department for Life Quality Studies (QuVi), Alma Mater Studiorum - University of Bologna, Rimini Campus, Corso d'Augusto 237, 47921 Rimini, Italy.
Pharmaco-Toxicological Analysis Laboratory (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy.
Curr Med Chem. 2018;25(7):772-792. doi: 10.2174/0929867324666170712165042.
New-generation antidepressants (NGAs) are the latest additions to the clinician's arsenal in the fight against depression. After the introduction of selective serotonin reuptake inhibitors (SSRIs), a plethora of other groups followed, identified by their main mechanisms of activity: serotonin and norepinephrine reuptake inhibitors (SNRI); serotonin modulators and stimulators (SMS); serotonin antagonists and reuptake inhibitors (SARI); noradrenergic and selective serotonergic antidepressants (NaSSA); norepinephrine reuptake inhibitors (NeRI); serotonin, norepinephrine and dopamine reuptake inhibitors (SNDRI) or triple reuptake inhibitors (TRI); and melatonin and serotonin agonists (MaSA). Although SSRIs are still the most widely used and well known NGAs, the other groups are increasingly being used in the current therapeutic settings obtaining comparable clinical results, and with tolerability and safety profiles that can often provide significant advantages over those of SSRIs.
Scopus and PubMed databases were searched for the most significant papers centered on the medicinal chemistry, pharmacodynamics, pharmacokinetics and analysis in human biological fluids of the following antidepressants: venlafaxine, duloxetine, milnacipran, trazodone, vortioxetine, vilazodone.
The main characteristics of commercially available non-SSRI NGAs (belonging to the SNRI, SARI and SMS classes) are described, focusing on the role of analytical methods that can be applied to perform therapeutic drug monitoring (TDM), but also including drug pharmacokinetics, metabolism and interactions.
新一代抗抑郁药（NGAs）是临床医生对抗抑郁症的最新武器。在选择性5-羟色胺再摄取抑制剂（SSRIs）问世后，随后出现了大量其他类别药物，根据其主要作用机制进行分类：5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）；5-羟色胺调节剂和刺激剂（SMS）；5-羟色胺拮抗剂和再摄取抑制剂（SARI）；去甲肾上腺素能和选择性5-羟色胺能抗抑郁药（NaSSA）；去甲肾上腺素再摄取抑制剂（NeRI）；5-羟色胺、去甲肾上腺素和多巴胺再摄取抑制剂（SNDRI）或三重再摄取抑制剂（TRI）；褪黑素和5-羟色胺激动剂（MaSA）。尽管SSRI类药物仍是使用最广泛且最知名的新一代抗抑郁药，但其他类别药物在当前治疗环境中使用得越来越多，能获得相当的临床效果，且其耐受性和安全性往往比SSRI类药物具有显著优势。
在Scopus和PubMed数据库中搜索以下抗抑郁药在药物化学、药效学、药代动力学以及人体生物体液分析方面的最重要文献：文拉法辛、度洛西汀、米那普明、曲唑酮、伏硫西汀、维拉唑酮。
描述了市售非SSRI类新一代抗抑郁药（属于SNRI、SARI和SMS类别）的主要特性，重点关注可用于进行治疗药物监测（TDM）的分析方法的作用，同时也包括药物的药代动力学、代谢和相互作用。
