Many newer anti-depressants have come out or are coming out which have definite value.  They are not necessarily better, but they work in different ways and may benefit patients not helped by other anti-depressants.  They are a very welcome addition to the treatment choices, but are not great advances in the field of psychiatric treatment. 

Venlafaxine (Effexor) is currently the most heavily advertised anti-depressant medication to the general public.  While it is a very good dual action anti-depressant, other dual action anti-depressants such as nortriptyline are just as good and SSRIs such as fluoxetine do benefit many individuals.  It is a good addition to available anti-depressants, but is not the major leap forward that some psychiatrists who work for pharmaceutical companies are claiming it is.  I have found an inexpensive international source. 

Duloxetine (Cymbalta) is an unimpressive dual action anti-depressant, increasing both the norepinephrine and serotonin effects.  It will not be available in the U.S. until at least summer, 2004, and I have not found an inexpensive supplier internationally.  While drug company affiliated psychiatrists have claimed that it is faster and better than SSRIs, these are common claims for new anti-depressants, which have always later been proven false.  In fact, it is no better than standard tricyclics like norepinephrine and probably not as good.  Because of its high cost and because of the available of many less expensive alternatives, it does not seem reasonable for it to be an early choice in treating patients with depression.

Mirtazapine (Remeron) is an alpha-2 noradrenergic receptor antagonist which increases both norepinepherine and serotonin release without reuptake inhibition.  It works a little faster than SSRIs, although has not done as well as tricyclics in several studies.  It has fewer side-effects than venlafaxine and reportedly has few sexual side-effects, but it does cause lots of drowsiness and some patients gain a fair amount of weight.  While it is somewhat more expensive, a generic equivalent is available from abroad with a doctor's prescription. 

Nefazadone (Serzone) is a dangerous a 5-HT2 receptor antagonist with weak serotonin uptake-blocking effects.  It has not been found superior to any other anti-depressant in the studies which I have seen.  It does have few sexual side-effects, but on average has just as many side-effects as the average anti-depressant.  It has caused 20 deaths and is banned in Canada and Europe. It is quite expensive and there are many alternatives as good or better as a much lower cost.  

Reboxetine very selectively inhibits pre-synatic reuptake of norepinephrine.  It is more selective for increasing just the norepinephrine effects than any other anti-depressant.  It does induce adaptive changes in the alpha1-adrenergic receptors, especially it enhances their functional responsiveness. However, whether this functional responsiveness is important for the clinical antidepressant efficacy or not is unknown.  It is as good as other anti-depressants and will probably help a small percentage unaided by other anti-depressants.  While it is not yet available in the U.S., but I have found an inexpensive international source.  It has been approved by the FDA for a physician and his or her patient to import a medication which is unavailable in the U.S. for needed treatment.

Gepirone is an old relative of buspirone, a weak anti-anxiety agent.  It has been slightly modified to an extended release version to make it patentable.  It is not yet on the market, but the initial studies have been definitely unimpressive.  Its development might make the drug company Organon money, but it appears a waste of money from the public's perspective.

Substance P Receptor Antagonist Helps Depression: A joint Merck Pharmaceutical and University of Pennsylvania DB PC 6 week study of major depression with melancholia in 126 patients has found that a highly selective substance P (NK(1) receptor antagonist L-759274 helps somewhat more than placebo with few gastrointestinal or sexual side-effects.  This is the second such medication to help depression. Demonstration of the Efficacy and Safety of a Novel Substance P (NK(1)) Receptor Antagonist in Major Depression. Kramer MS, Winokur A, Kelsey J, Preskorn SH, Rothschild AJ, Snavely D, Ghosh K, Ball WA, Reines SA, Munjack D, Apter JT, Cunningham L, Kling M, Bari M, Getson A, Lee Y. Neuropsychopharmacology. 2003 Jun 9