PsychoTropicalResearch, serotonin and serotonin syndrome research.
Antidepressants - Selectivity
Antidepressants - Selectivity
Date Created: 18/09/1999 Last Modified: 11/10/1999 Last Checked: 17/04/2004
The very use of the term 'selective', or 'specific' (the collective mind is still terminologically ambivalent about which word to use) subtlely, and perhaps insidiously, insinuates the notion selective is a good thing which makes the drugs better. The advertising 'spin-doctors' must be congratulated on achieving seemingly uncritical acceptance of this idea.
Time to sober up and take a wider perspective. First, of the 100 or more CNS receptors currently known, not to mention ion channels and enzymes, most of these drugs have not come within experimental shouting distance of one tenth of them. So exactly what they may or may not be specific for is largely unknown.
Second, if we look at those drugs that have evidence suggesting a superior efficacy over the 'average' do we find them to be more 'specific'. The answer is a resounding no.
Current drugs that may be considered to have evidence suggesting 'superior efficacy' are:--
- amitriptyline
- clomipramine
- clozapine
- olanzapine
- lithium
All of these are among the pharmacologically 'dirtiest' of available agents.
New drugs that are stated to be 'specific' should not be assumed to be in any way 'better'. It will be interesting to see whether direct acting post-synaptic receptor agonists are any different. Such drugs are already here for Parkinson's and dementia.
When new drugs arrive good evidence of long-term effectiveness is the over-riding issue.
All text ©Dr Ken Gillman MRC Psych - PsychoTropical Research®
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