Many new antidepressants are available for use. The acute effects of administration are mainly manifested as side-effects, whereas the chronic effects take 2-3 weeks to set in and are responsible for therapeutic action. Such changes may include formation and release of neurotransmitters, changes in pre-synaptic uptake, and changes in receptor density and sensitivity. The noradrenergic and serotonergic systems are not separate, but are entwined with each other. The newer SSRI citalopram, and drugs from the SNRI, NaSSA and NAN classes, have been shown in controlled trials to be equivalent to, or more efficacious than, TCAs and/or SSRIs. They have an improved side-effect profile, especially when compared to TCAs, and hence are better tolerated.
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