Are Two Antidepressant Mechanisms Better Than One?

Stahl, Stephen M.

doi:10.4088/jcp.v58n0801

Cited by 19 publications

(6 citation statements)

References 8 publications

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“…The effects of galantamine on nicotinic receptors may be of clinical relevance, as activation of presynaptic nicotinic receptors increases the release of acetylcholine and other neurotransmitters, such as glutamate, thought to be involved in memory and learning [16]. Therefore, the dual mechanism of action of galantamine may enhance efficacy, analogous to the improved efficacy of other classes of dual action drugs used in psychiatric illnesses [17,18].…”

Section: Galantamine: a Novel Treatment For Admentioning

confidence: 99%

Galantamine: Therapeutic Effects beyond Cognition

Blesa

2000

Dement Geriatr Cogn Disord

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Decline in cognitive function, especially memory, is the core feature of Alzheimer’s disease (AD). However, other characteristic aspects of the disease are also important. These include patients’ activities of daily living (ADL), including quality of sleep, behavioural disturbances and the impact of the disease on the caregiver. Therefore, increasing attention is being paid to clinically meaningful outcome measures, such as the Disability Assessment for Dementia (DAD) scale, the Neuropsychiatric Inventory (NPI), caregiver time and the Pittsburgh Sleep Quality Index (PSQI). Galantamine is a new treatment for AD that combines modulation of nicotinic receptors with inhibition of acetylcholinesterase. The present review outlines the positive and sustained effects of this agent on patients’ behaviour and daily functioning as well as on caregiver time. In studies of up to 5 months’ duration, galantamine-treated patients had a significantly better outcome on ADL than placebo-treated patients, and after 12 months of treatment with galantamine, patients’ functional ability was preserved. Galantamine also significantly benefits behavioural disturbances in patients with AD. These functional and behavioural benefits are associated with a decrease in the burden on caregivers, as indicated by a reduction, relative to placebo, in the time spent supervising and assisting patients. These clinical benefits are not offset by disruption of patients’ sleep, as has been reported with other cholinergic treatments.

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Section: Galantamine: a Novel Treatment For Admentioning

confidence: 99%

Galantamine: Therapeutic Effects beyond Cognition

Blesa

2000

Dement Geriatr Cogn Disord

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“…How is this more aggressive goal best achieved? Some experts have suggested that drugs with multiple mechanisms of antidepressant action provide greater efficacy than drugs with a single mechanism of action (12). Venlafaxine is one of the best studied in the serotonin–noradrenaline reuptake inhibitor class of antidepressant agents (13).…”

Section: Introductionmentioning

confidence: 99%

Achieving remission from depression with venlafaxine and venlafaxine extended release: a literature review of comparative studies with selective serotonin reuptake inhibitors

Rudolph¹

2002

Acta Psychiatr Scand

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Objective: To evaluate data supporting the ability of venlafaxine, an antidepressant with a dual mechanism of action, to produce remission from depression. Method: Review of multicentre, double‐blind, randomized studies comparing venlafaxine or venlafaxine extended release (XR) with a selective serotonin reuptake inhibitor (SSRI), using Hamilton Depression Rating Scale total scores in the range of ≤7 and <10 as the final outcome measure, to evaluate the ability of venlafaxine/venlafaxine XR to produce full remission from depression. Results: Venlafaxine/venlafaxine XR demonstrated higher rates of remission than did the SSRIs and placebo. Conclusion: With full remission rather than response as the measure of outcome, venlafaxine/venlafaxine XR demonstrated more robust antidepressant efficacy than the SSRIs and placebo. This finding suggests that venlafaxine/venlafaxine XR are appropriate standard‐of‐care therapies for the treatment of patients with major depressive disorder.

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“…Given the heterogeneous nature of severe depression as well as reports that suggest that more severe depressive states are more likely to be associated with disturbances of neurobehavioral response systems regulated by both noradrenergic and serotonergic systems [Thase, 1996;Stahl 1997], it is not surprising that the dual action antidepressant clomipramine, the most serotonergic TCA, as well as SSRI-TCA combination treatment have demonstrated considerable efficacy in treating severe depression. In randomized comparison studies with over 100 inpatients each, the Danish University Antidepressant Group (DUAG) reported clomipramine (n=52 1986 ; n=46 1990 ) to be superior to the SSRIs citalopram [DUAG, 1986] (n=50) and paroxetine [DUAG, 1990] (n=56) in the treatment of severe depression.…”

Section: Combination Therapymentioning

confidence: 99%