COMPARISON OF THE TOLERABILITY OF BUPROPION, FLUOXETINE, IMIPRAMINE, NEFAZODONE, PAROXETINE, SERTRALINE, AND VENLAFAXINE

Drug development in psychiatry has evolved from a process dependent on chance discovery to one based on rationally targeting specific mechan isms of action believed to be important in the pathophysiology underly ing psychiatric syndromes. Antidepressant pharmacotherapy is the first area to have substantially benefited from this evolution. Serotonin s elective reuptake inhibitors (SSRIs) were the first class of psychiatr ic medications developed based on such molecular targeting. Nefazodone is a new antidepressant that combines blockade of the serotonin-2 rec eptor with serotonin uptake inhibition. Perhaps as a result of this du al action, nefazodone caused fewer complaints of nervousness (e.g., ag itation, anxiety), insomnia, and tremors and a higher incidence of con fusion, dizziness, and vision disturbance than do other advanced gener ation antidepressants based on several different ways of assessing the relative incidence of these adverse effects. Reports of sexual dysfun ction on nefazodone and bupropion treatment were tower than on treatme nt with other recently released antidepressants.