Atypical Agents

a. Bupropion (Wellbutrin, Wellbutrin SR): Bupropion is a mildly stimulating antidepressant, and is particularly useful in patients who have had sexual impairment from other drugs. The short half-life of bupropion requires multiple daily doses, complicating compliance. There is a low incidence of sexual dysfunction.

b. Venlafaxine (Effexor, Effexor XR): Venlafaxine is a selective inhibitor of norepinephrine and serotonin reuptake. Insomnia, nervousness and nausea are common. It can elevate diastolic blood pressure and requires monitoring of blood pressure.

c. Nefazodone (Serzone): Nefazodone is a serotonergic antidepressant, but it is not considered a SSRI because of other receptor effects. It tends to be more sedating than the SSRIs and can have a calming or antianxiety effect in some patients. It is also useful in patients who experience sexual impairment with other antidepressants.

d. Mirtazapine (Remeron): Mirtazapine is a selective alpha-2 adrenergic antagonist which enhances noradrenergic and serotonergic neurotransmission. Marked sedation often occurs which usually decreases over the first weeks of treatment. Weight gain is also common (average of 2 kg). There is a low incidence of sexual dysfunction.

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