Depression is a mood disorder characterized by persistent feelings of sadness and loss of interest. It affects person feelings, behavior and thinking the process and can lead to various physical and emotional problems. It is not surprising that when new drugs come out, people automatically suspects they are better, but in fact, the approval of a new drug is followed by a heavy marketing making them believe this new substance is groundbreaking. Antidepressant which is new and “probably better” tends to be appealing to patients who had experience with other older drugs and which didn’t work for them for some reason.
New antidepressants are modulated ingredients and types of drugs already used in treatment (SSRI and SNRI), having the same mechanism of action which works as a reuptake inhibitor. Probably the only drug having completely unique pharmacological attributes is ALKS 5461. Other option for drug-free treatment of depression would be low-field magnetic stimulation which can be an option for depression (LFMS).
Most antidepressants which are currently on the pharmaceutical market are unfortunately not causing wanted effects, thus leaving people to wait for the new one. Every now and then, a new drug comes to the market and the marketing chaos begins. It can be popular initially, but the real effective drug will have its effects throughout its usage among patients.
A moderated version of Milnacipran from SNRI group of drugs used from 1996 in the treatment of major depression and fibromyalgia outside of United States. Milnacipran did not pass the clinical trials in the United States, but Levomilcipan containing “levo” which is a stereoisomer of Milnacipran did pass it in July 2013.
Mechanisms of Action: It differs from others SNRIs while it causes a greater inhibition of norepinephrine reuptake in comparison to the reuptake of serotonin.
Side effects are quite close to the older drugs from the same group such as insomnia, nausea, blood pressure variations, dizziness, etc.
It has been approved for the treatment of a major depression since September 2013. It has been released after the Fetzima, so it is a bit older. There are some speculations it could be approved in the future for multiple anxiety disorders treatments. Four trials found Brintellix worked for depression when compared to the Hamilton Depression Rating Scale (HAM-D) where it proved its effectiveness in two out of four clinical cases. It did show some similarities to the placebo effect, but the fourth study proved it did still work, measured by MADRS.
Mechanisms of Action: serotonin modulator and stimulator (SMS). To less degree, it affects adrenergic receptors and concentrations of histamine and acetylcholine.
Side effects: diarrhea, nausea, for some it was sexual dysfunction and it appeared to cause dizziness.
This unique antidepressant was approved in 2011 for the treatment of major depression. This drug got its popularity in the pharmaceutical market due to the fact that is not associated with sexual dysfunction and weight gain, which can be a game changer for the ones taking the drug.
Mechanisms of Action: Inhibition of serotonin reuptake-similarly to a SSRI. Additionally, it is a partial agonist of 5-HT1A receptors. Next to the Brintellix, Viibryd is the next drug which is considered new and also not a drug moderation, but a new formulation.
Side Effects: Among many people, the most common side effect reported is diarrhea. This is usually aggravated with Imodium which is often simultaneously taken together with Viibryd and it can trigger such occurrence.
Present as an antidepressant drug, Trazodone is an old medicine, released and approved many years ago (1981). The pharmaceutical company recently (2010) created an extended-release pill which is called Oleptro. Still, even though it is an extended release of the pill, it is not a different variation and also not a modulation of the drug. However, it is just a repackaging of an old drug, so this is not considered an improvement of the drug active ingredients.
Mechanisms of Action: This drug belongs to atypical antidepressants and reaches its effects reacting on a level of 5-HT receptors, and it is also a partial agonist which reacts on different receptors called 5-HT1A.
The best description of this drug is the comparison where the Pristiq is being described as similar to Effexor like the Lexapro is when compared to Celexa. Better explained, this a different modulation of the Effexor. The antidepressant effect is caused by synthetic active metabolite it contains. Patent for Effexor has expired leading to this modified formula of the drug as a good way to get back premium business Effexor gave them. The company which released Pristiq works hard on a drug marketing in intention to replace the spot of Effexor. Despite the chemical similarities of these two antidepressants, patients which have been using both of these drugs have noticed some differences even though they have similar active ingredients. This is a classic example of the new drug release which is a newer version of the older one, but just a repacked version of it.
Emsam Patch (Selegiline)
The effectiveness of Selegiline in treating a depression is used in medical treatment since 1967. It was only in 2006 that it started with transdermal patch form of production and it was approved. This form of using has important advantages in comparison to the peroral usage. This can be seen in a way of metabolism where the transdermal patch bypasses the liver and the intestines which are important in hypertensive crisis prevention which was frequently associated with MAOIs. Using it as a patch does not require a change of diet and the drug maintain steadier levels inside the bloodstream. Emsam is an antidepressant present for a longer time, it’s rebranded form as a transdermal patch is what some may find more appealing.
Mechanisms Of Action: Emsam belongs to a MAOI group of antidepressant, which can be utilized for both major depression as well as Parkinson’s disease.
Cymbalta is a drug used for the treatment of neuropathic pain and major depression as well. It was released in 2004. Although it has passed over 10 years since the approval of Cymbalta, it is still popular and it did become the most prescribed, most popular and top sold antidepressant in the near past. The higher popularity of this drug in comparison to other antidepressants on the market is its ability to provide clinically effective pain relief.
Antidepressants in Development
Development of a drug is just one step in a long process for medical approval. This process can take years; this is caused by FDAs rigorous standards for all medications. There are numerous studies which tend to prove the efficacy of a new drug used in various conditions. They all tend to get to the approved stage of the drug production in order to overflow the market. Here are a few of them.
ALKS 5461 is a drug which is described as a modification of the Suboxone. Its active ingredient Samidorphan is marked as non-addictive, so this is a good property of the drug. There are documented proofs which show advance improvement in the life of depression treated patients. This drug does come with the small amount of side effects which makes it popular and highly rated on the market. It is planned to be released during 2016.
SNDRIs (Triple Reuptake Inhibitors)
This is a new variation of the drug type which is called Serotonin-Norepinephrine Dopamine Reuptake Inhibitors (SNDRIs) and it affects three neurotransmitters: norepinephrine, dopamine, and serotonin which makes it “Triple Reuptake Inhibitors”.
Mechanisms of Action: Basically, the triple reuptake inhibitors are trying to affect norepinephrine and also serotonin and dopamine which are all important in causing the depression. Some researchers have discussed the most beneficial way of dealing with depression and which of these three neurotransmitters are the most responsible for it. They agreed that majority of the depression symptoms could be solved when targeting each of these neurotransmitters at once. They are not considered a new medication since there are each of these already on the market, so this is some sort of mix of the medications which is released as a new type. When we put it in that way, the pharmaceutical company again tricked the masses into believing they found a new solution for depression. In reality, this can be all conquered by taking each of these drug types separately such as Wellbutrin or Adderall so they affect every neurotransmitter.
Ketamine is marked as an illicit drug due to the fact that it can cause hallucinogenic effects which can be abused. It is often used in suicide attempts therapy but also in hospitals for major depression symptoms. Although it is considered a potentially dangerous medicine, it does give an impressive effect which is seen in a very short of time, for some even in a few hours. This is not that often among antidepressant medications. The study is still concentrated on getting the approval from the FDA for using the drug for depression matter. There is some research proving the effectiveness of the ketamine in improving the neurotransmitter/receptor activity. There was a new nasal spray medicine on the market used as an antidepressant and it is considered to be beneficial.
Psilocybin (Magic Mushrooms)
For a majority of people, the use of psilocybin was helpful when dealing with depression symptoms. They are also considered illicit substances which can cause hallucinogenic effects and euphoric state. It is the reason this substance is frequently being abused and used as a mood booster. Many have claimed that while being under the influence of Magic Mushrooms their entire perception of the world has changed, not just during the effect of the substance. This type of changing the way they think was kept for a long time. This discovery has given some researchers an idea how they could make the different form of medication which still gives the benefits of treating the depression, but without the symptoms of euphoria and hallucinogenic actions.
Is There Really Something New?
In general, mostly the answer is “no.” This is mostly marketing trick that pharmaceutical companies use to sell the old products over via new advertising, new look and branding of the drug which tends to get appealing for the masses. While in reality, the drugs that are new and recently released as just as good as the old one, since they have similar or same active ingredient as the previous drug which was moderated. This is only the way for most people to get caught up in the hype of a new drug, believing it will bring a great change.
However, nor everything is the same, where there are some trials and researchers which revolve around finding new drugs and becoming more efficient. Anything which has different action mechanism than SSRI, SNRI and some other. ALKS 5461 is mentioned above as being one of those medicines which show a lot of potentials.
Genetic therapy is most certainly the most promising treatment in the near future. Led by this statement the future treatment of depression is going to be changed by finding the genetic modification that led to the condition of depression and targeting that area with genetic therapy. This would, for the first time, be the real try for a new treatment of depression other than a pharmaceutical war over the medical market.