Noradrenergic and Specific Serotonergic

MAOI, monoamine oxidase inhibitor NaSSA, noradrenergic and specific serotonergic antidepressant NDRI, norepinephrine and dopamine reuptake inhibitor SARI, serotonin antagonist and reuptake inhibitor SNRI, serotonin and norepinephrine reuptake inhibitor SSRI, selective serotonin reuptake inhibitor TCA, tricyclic antidepressant. 

Mirtazapine Piperazinoazepine Noradrenergic and specific serotonergic antidepressant (NaSSA) similar to mianserin... 

Reboxetine, was the first antidepressant to be developed to work specifically on noradrenaline (Wong et al., 2000). It is a specific noradrenergic reuptake inhibitor (NARI) and in a clinical study, it was found to improve the psycho-social functioning of depressed patients, as measured by the Social Adaptation Self-evaluation Scale (SASS), more than fluoxetine, a specific serotonergic reuptake inhibitor (SSRI) antidepressant (Dubini, Bose, and Polin, 1997). It has been suggested that social adaptation as measured on the scale used (SASS) is associated with the concept of social motivation (Charles et al., 1999). The improvement, thus, appeared to be associated with enhancement of social motivation which might be important for the therapeutic recovery process (Hirschfeld, et al., 2000). However, the mechanism by which the changes in noradrenaline induced by reboxetine led to improvement on the SASS is unknown. 

Mirtazepine has specific noradrenergic and serotonergic receptor activity. It also has significant histamine Hi and serotonin 5-HT2 receptor blocking activity which probably underlay its propensity to cause weight gain, both acutely and in the long term (Cassano and Fava 2004). 

The use of antidepressants outside the treatment of MDD tends to require specific agents. For example, the TCAs and SNRIs appear to be useful in the treatment of pain conditions, but other antidepressant classes appear to be far less effective. SSRIs and the highly serotonergic TCA, clomipramine, are effective in the treatment of OCD, but noradrenergic antidepressants have not proved to be as helpful for this condition. Bupropion and nortriptyline have usefulness in the treatment of smoking cessation, but SSRIs have not been proven useful. Thus, outside the treatment of depression, the choice of antidepressant is primarily dependent on the known benefit of a particular antidepressant or class for a particular indication. 

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