History of Pharmacological Treatment

TCAs/tetracyclics Amitriptyline Amoxapine Clomipramine Desipramine Doxepin Maprotiline Nortriptyline Protriptyline Trimipramine 

MAOls Brofaromine Isocarboxizide Moclobemide Phenelzine Tranylcypromine 

SSRls Citalopram Escitalopram Flnoxetine Flnvoxamine Paroxetine Sertraline 

Atypical antidepressants Bupropion Duloxetine Mianserin Mirtazapine Nefazodone Reboxetine Trazodone Venlafaxine 

The traditional scheme is complicated by the fact that some antidepressants exhibit characteristics of more than one class. For example, clomipramine, a tricyclic antidepressant (TCA) with side effects and toxicity similar to other TCAs, works more like the selective serotonin reuptake inhibitors (SSRls). Similarly, venlafaxine and duloxetine, which are usually grouped with the atypical antidepressants, have a side effect and safety profile comparable to the SSRls. Although a classihcation system based on mechanism of action offers some advantage (see Table 3.7), even this scheme is limited by the fact that antidepressants that work in the same way may have widely divergent side effect and safety profiles. In the following discussion, the traditional classification system is adopted. Although fraught with problems and inconsistencies. 

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As noted earlier, prior to the advent of DSM-IIl in 1980, the anxiety disorders were collectively subsumed under some variation of the single diagnostic entity, anxiety neurosis. Consequently, the history of pharmacological treatment for the discrete anxiety syndromes is relatively brief, only approximately 20 years. Prior to 1980, we can only speak in a general manner as to how well medicines relieved anxiety in the broad sense of the term. Consequently, weTl present the more extensive history of pharmacological treatment for anxiety in this broader sense before launching into a more detailed discussion of the treatment of the individual anxiety disorders. 

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