Inhibitors of the serotonin transporter (SERT) and norepinephrine transporter (NET) are widely used in the treatment of major depressive disorder. Although SERT/NET selectivity is a key determinant for the therapeutic properties of these drugs, the molecular determinants defining SERT/NET selectivity are poorly understood. In this study, the structural basis for selectivity of the SERT selective inhibitor citalopram and the structurally closely related NET selective inhibitor talopram is delineated. A systematic structureactivity relationship study allowed identification of the substituents that control activity and selectivity toward SERT and NET and revealed a common pattern showing that SERT and NET have opposite preference for the stereochemical configuration of these inhibitors. Mutational analysis of nonconserved SERT/NET residues within the central substrate binding site was performed to determine the molecular basis for inhibitor selectivity. Changing only five residues in NET to the complementary residues in SERT transferred a SERT-like affinity profile for R-and S-citalopram into NET, showing that the selectivity of these compounds is determined by amino acid differences in the central binding site of the transporters. In contrast, the activity of R-and S-talopram was largely unaffected by any mutations within the central substrate binding site of SERT and NET and in the outer vestibule of NET, suggesting that citalopram and talopram bind to distinct sites on SERT and NET. Together, these findings provide important insight into the molecular basis for SERT/NET selectivity of antidepressants, which can be used to guide rational development of unique transporter inhibitors with fine-tuned transporter selectivity.monoamine | neurotransmitter | SLC6 transporter I mbalances in neurotransmission involving the monoamines serotonin (5-hydroxytryptamine; 5-HT) and norepinephrine (NE) are implicated in depression and anxiety disorders (1). In the brain, specific monoamine transporters, the 5-HT transporter (SERT) and the NE transporter (NET), curtail the lifetime of extracellular monoamines by performing active uptake (or reuptake) from the extracellular space into neurons. Medications for the treatment of depression and anxiety disorders act by increasing the extracellular concentration of 5-HT and/or NE by inhibiting SERT and/or NET mediated transmitter reuptake (2). SERT and NET belong to the solute carrier 6 (SLC6) transporter family, and they are integral membrane proteins that use cotransport of sodium as an energy source to convey neurotransmitters from the extracellular space to the cytoplasm (3). The first generation of drugs targeting SERT and NET were the tricyclic antidepressants (TCAs), but their activity across a variety of other neurotransmitter receptor systems (4) associate their use with severe side effects. Development of newer generations of monoamine transporter drugs have focused on compounds with an improved selectivity toward SERT and/or NET, exemplified by the selective 5-HT reuptake inh...