Atypical Antidepressants
Article Sections
Introduction
Atypical antidepressants are medications that have different mechanisms of action than the 4 main classes of antidepressants (ie, selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], and monoamine oxidase inhibitors [MAOIs]). Atypical antidepressants include bupropion and mirtazapine; the serotonin modulators trazodone, vilazodone, and vortioxetine; the NMDA receptor antagonists ketamine and esketamine; as well as the neuroactive steroids, zuranolone and brexanolone. They all vary in pharmacologic properties, clinical indications, and safety profile.
Bupropion
Bupropion inhibits reuptake of dopamine and norepinephrine at neuronal synapses and enhances noradrenergic and dopaminergic neurotransmission. Bupropion has minimal serotonergic activity, distinguishing it from most other antidepressants.
By enhancing dopamine neurotransmission in the nucleus accumbens, bupropion attenuates nicotine withdrawal symptoms in those who use nicotine, reducing cravings.
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