Abstract

Therapies for depression include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and noradrenaline reuptake inhibitors (NARIs). Most of the available drugs included in each of these classes have limitations related to non-specific actions, side effects, and reduced efficacy in certain patient subgroups. Reboxetine is the first selective NARI with actions specific to the noradrenergic system. It has been shown to be efficacious in both short- and long-term treatment of depression and relatively free from side effects, such as gastrointestinal adverse reactions, agitation and nervousness. Herein we reviewed the efficacy of reboxetine in the treatment of depression, including additional benefits offered by this drug. We included an analysis comprising 1959 hospitalised patients or outpatients diagnosed with a major depressive disorder that have entered eight clinical trials of reboxetine. These studies compared the efficacy of reboxetine (4-6 mg/day in elderly; 8-10 mg/day in adults) with placebo, fluoxetine (20-40 mg/day), imipramine (150-200 mg/day), and desipramine (150-200 mg/day). The Hamilton Rating Scale for Depression (HAM-D) was used as the primary measure to assess clinical efficacy in depressive illness. Montgomery-Asberg Depression Rate Scale (MADRS) total score, Clinical Global Impression (CGI, Severity of Illness and Global Improvement), and the Social Adaptation Self-evaluation Scale (SASS) were also used. Reboxetine showed positive results in four placebo-controlled studies and in a subgroup of melancholic patients of a fifth study. In comparator-controlled trials, reboxetine had similar levels of efficacy to the TCAs imipramine and desipramine in the treatment of major depression. Reboxetine was also equal in efficiency to fluoxetine, but significantly more efficient than this SSRI in a subset of outpatients with severe depression (p<0.05). In addition, reboxetine was more advantageous over fluoxetine regarding social functioning, specifically in terms of energy, interest and motivation. Thus, the efficacy and additional gains of reboxetine make it a beneficial option in the treatment of depression.

(Unpublished sample)