Selective Versus Multi-Transmitter Antidepressants: Are Two Mechanisms Better Than One?

The issue of selectivity versus efficacy has now reappeared as newer agents have emerged that areless selective than the selective serotonin reuptake inhibitors (SSRIs) but more selective than the tricyclicantidepressants (TCAs). This article provides a critical examination of the clinical literatureconcerning what evidence there is for differential efficacy. Two broad areas will be discussed: (1)comparisons of SSRIs to TCAs and (2) comparisons of the SSRIs to a somewhat more selective compound(by comparison to the TCAs), venlafaxine. This review should caution one in accepting claimsof superiority of any agent based on purported mechanism of action.