Clinical Efficacy of Reboxetine in Major Depression

The past decade has witnessed the advent of selective serotonin reuptake inhibitors (SSRIs) asfirst-line treatments for major depression. Still, there is considerable debate as to whether these agentsare as effective or as potent as the first-generation tricyclic antidepressants (TCAs) or the mixed reuptakeinhibitor, venlafaxine, all of which exert considerable effect on norepinephrine (NE) reuptake.Recently, reboxetine, a selective NE reuptake inhibitor (selective NRI), has been introduced in Europe.This drug has only a minimal affinity for muscarinic acetylcholine receptors and thereforecauses less dry mouth, constipation, or other such effects than do the TCAs. Reboxetine does notblock serotonin reuptake or a₁ receptors and, thus, does not appear to produce significant nausea, diarrhea, or hypotension. Unlike other antidepressants, reboxetine appears to be nonsedating. Data onacute and long-term clinical efficacy and safety from double-blind, placebo-controlled, and activecomparator studies with reboxetine are reviewed. These studies indicate that reboxetine is significantlymore effective than placebo and as effective as fluoxetine in reducing depressive symptoms.Improvements in social adjustments were reported to be more favorable with reboxetine than withfluoxetine. Further, data from controlled clinical trials have shown that the side effect profile forreboxetine is relatively benign. The clinical implications of studies on reboxetine are discussed withan eye toward understanding the potential role NE reuptake blockers may play in the treatment of patientswith major depression.