Meta-analyses have demonstrated the efficacy of SSRIs (fluoxetine, sertraline, citalopram, escitalopram) as well as venlafaxine, mirtazapine, and nefazodone
with small to very small effect sizes.
The National Pregnancy Registry for Antidepressants (844-405-6185) is studying amitriptyline (Elavil), amoxapine (Asendin), bupropion (Forfivo XL and Wellbutrin), Citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), desvenlafaxine (Prisiq), doxepin (Sinequan), escitalopram (Lexapro), fluvoxamine (Luvox), fluoxetine (Prozac), imipramine (Tofranil), isocarboxazid (Marplan), levomilnacipran (Fetzima), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone
(Serzone), nortriptyline (Pamelor), paroxetine (Paxil), phenelzine (Nardill), protriptyline (Vivactil), selegiline (Emsam), sertraline (Zoloft), tranylcypromine (Parnate), trazodone (Desyrel), trimipramine (Surmontil), venlafaxine (Effexor), and vilazodone (Viibryd).
(6) Other recommended medications include the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, and nefazodone
, an atypical serotoninergic agent.
Starting with the 1990s, new classes of antidepressants appeared on the market and in clinical practice: SNRI (serotonin-norepinephrine reuptake inhibitors): venlafaxine, duloxetine, milnacipran; SARI (serotonin antagonist and reuptake inhibitor): nefazodone
, trazodone; NaSSA (noradrenergic and specific serotonergic antidepressants): mirtazapine; NRI (norepinephrine-reuptake inhibitors): reboxetine, atomoxetine; NDRI (norepinephrine dopamine reuptake inhibitors): bupropion.
The other medication in this class, Serzone (nefazodone
), increases REM with subjective reports of vivid dreams or even nightmares.
The second-generation antidepressants that were assessed included selective serotonin reuptake inhibitors (such as fluoxetine, sertraline, and paroxetine), serotonin norepinephrine reuptake inhibitors (such as venlafaxine and duloxetine), selective serotonin norepinephrine reuptake inhibitors, and bupropion, mirtazapine, nefazodone
, and trazodone.
An Agency for Healthcare Research and Quality (AHRQ) review of antidepressants found that paroxetine, citalopram, and venlafaxine, when compared with other antidepressants (fluoxetine, fluvoxamine, nefazodone
, sertraline), generally were associated with more reports of SD, specifically complaints of erectile dysfunction in men and decreased vaginal lubrication in women.
The second-line agents also include antidepressants with weaker evidence of effectiveness, such as mirtazapine, or medications effective for PTSD but associated with rare but potentially dangerous side effects, such as nefazodone
because of its hepatotoxicity.
The agency also noted that simvastatin should not be used along with the following drugs, which can increase the risk of myopathy: itraconazole, ketoconazole, posaconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, nefazodone
, gemfibrozil, cyclosporin and danazol.
The anti-depressants taken by women in this analysis included bupropion (113), citalopram (184), escitalopram (21), fluvoxamine (52), nefazodone
(49), paroxetine (148), mirtazepine (68), fluoxetine (61), trazodone (17), venlafaxine (154), and sertraline (61).
The search covered the Co chrane, Medline, EMBASE and LILACS databases, using combinations of the following MeSH terms: "diabetic neuropathy", "pain", "antidepressive agent", "duloxetine", "sertraline", "citalopram", "paroxetine", "fluoxetine", "venlafaxine", "fluvoxamine", "lofepramine", "milnazipram", "reboxetine", "sibutramine", "viloxacine", "mirtazapine", "nefazodone
", "treatment outcome", "investigational therapy" "neuropathy" and "treatment".
Clinically significant interactions have been reported with potent CYP4503A4 inhibitors including cyclosporine, macrolide antibiotics, azole antifungals, protease inhibitors, nefazodone
, amiodarone, danazole, diltiazem, and verapamil.