Atypical antidepressant

An atypical antidepressant is any antidepressant medication that acts in a manner that is different from that of most other antidepressants. Atypical antidepressants include agomelatine, bupropion, iprindole, mianserin, mirtazapine, nefazodone, opipramol, tianeptine, and trazodone.^[1]^[2]^[3] The agents vilazodone and vortioxetine are partly atypical. Typical antidepressants include the SSRIs, SNRIs, TCAs, and MAOIs, which act mainly by increasing the levels of the monoamine neurotransmitters serotonin and/or norepinephrine.^[1]^[2]^[3] Among TCAs, trimipramine is an atypical agent in that it appears not to do this.^[3] In August 2020, esketamine (JNJ-54135419) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of treatment-resistant depression with the added indication for the short-term treatment of suicidal thoughts.^[4]

Buprenorphine/samidorphan (ALKS-5461) is an antidepressant with a novel mechanism of action which was formerly under development and considered an atypical antidepressant.^[5] They act faster than available antidepressants.^[5]

^ ^a ^b Feighner JP (1999). "Mechanism of action of antidepressant medications". J Clin Psychiatry. 60 (Suppl 4): 4–11, discussion 12–3. PMID 10086478.
^ ^a ^b Stahl SM (1998). "Basic psychopharmacology of antidepressants, part 1: Antidepressants have seven distinct mechanisms of action". J Clin Psychiatry. 59 (Suppl 4): 5–14. PMID 9554316.
^ ^a ^b ^c Frazer A (1997). "Pharmacology of antidepressants". J Clin Psychopharmacol. 17 (Suppl 1): 2S – 18S. doi:10.1097/00004714-199704001-00002. PMID 9090573.
^ "FDA Approves A Nasal Spray To Treat Patients Who Are Suicidal". NPR.org. 4 August 2020. Retrieved 27 September 2020.
^ ^a ^b Garay RP, Zarate CA, Charpeaud T, Citrome L, Correll CU, Hameg A, Llorca PM (2017). "Investigational drugs in recent clinical trials for treatment-resistant depression". Expert Rev Neurother. 17 (6): 593–609. doi:10.1080/14737175.2017.1283217. PMC 5418088. PMID 28092469.