Antidepressants in the 1990s.

The development of antidepressants is a continuing process and starting or finishing a review in any particular year risks the creation of arbitrary breaks. However a decade is as reasonable as any other time period to choose for a look to take stock. This editorial will not attempt to be comprehensive, but is a personal view of some issues which have emerged, as seen by a clinician and clinical psychopharmacologist. It is forty years since the spectacular developments in the late 1950s brought us the two major classes of antidepressants, the reuptake inhibitors and the MAO inhibitors. There are now many such antidepressants licensed and available. In the UK, in 1999 there were 28, ten of them tricyclics, five SSRIs, four other reuptake inhibitors, three older MAO inhibitors, one RIMA and five drugs with other actions. It was in the 1990s that the SSRIs came to particular prominence, although some of them were available a little earlier. They have now been followed by newer drugs with other actions such as venlafaxine, a non-tricyclic serotonin and noradrenaline reuptake inhibitor, reboxetine, a noradrenaline reuptake inhibitor, nefazodone and mirtazepine, with other actions. With the expiry of the patent for fluoxetine it is unlikely that we will see further new SSRIs.