page_title: Development and discovery of SSRI drugs
section_title: Phenoxyphenylpropylamine derivatives
hierarchical_section_title: Development and discovery of SSRI drugs / Structural and mechanical differences between the SSRIs / Structure-activity relationship (SAR) / Phenoxyphenylpropylamine derivatives
context_page_description: Selective serotonin reuptake inhibitors, or serotonin-specific re-uptake inhibitor, are a class of chemical compounds that have contributed to the major advances as antidepressants where they have revolutionised the treatment of depression and other psychiatric disorders. The SSRIs are therapeutically useful in the treatment of panic disorder, posttraumatic stress disorder, social anxiety disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder and anorexia. There is also clinical evidence of SSRIs efficiency in the treatment of the negative symptoms of schizophrenia and their ability to prevent cardiovascular diseases.
  SSRIs primarily inhibit serotonin transporter in the brain and have negligible effects on dopamine transporter and norepinephrine transporter. Inhibiting the binding of the neurotransmitter, serotonin, to SERT results in increased 5-HT concentration in the synaptic cleft leading to increased binding of 5-HT to postsynaptic receptors which results in improvement of depression symptoms.
context_section_description: Compounds containing an aryloxypropylamine motif in their structure, demonstrated in figure 3a, are known as monoamine reuptake inhibitors. Drugs containing this privileged structural motif, where R¹ and R² are aryls or heteroaryls, preferable phenyl, possess a selectivity profile for NET and SERT. While compounds containing a substituent in the 2'-position of the aroxyl ring of the structure (figure 3b) exhibits selectivity and high affinity for NET, and are therefore generally SNRIs, compounds having substituent in the 4'-position exhibits selectivity and high affinity for SERT and are therefore generally SSRIs, e.g. fluoxetine and paroxetine.
  Fluoxetine is a racemic mixture of (R)- and (S)-fluoxetine where both enantiomers contribute to its biological activity. Since mono-substitution in the 4-para position of the phenoxy group (figure 4) results in selective inhibition of 5-HT re-uptake, a disubstitution i.e. 2,3- or 2,4- substitution therefore results in a loss of SERT selectivity. Fluoxetine has the widest spectrum of activity since it is the least SERT selective of all the SSRIs. Fluoxetine also has a 5-HT2C antagonist activity where it blocks the 5-HT activity of 5-HT2C receptors enhancing the release of both NE and DA. A 5-HT2C antagonist do not only help out with therapeutic effects of fluoxetine but also the tolerability of the drug. The advantage of being 5-HT2C antagonist is that it has a stimulatory effect and many patients have experienced an increase in energy, concentration and focus and a decrease in fatigue from the very first dose. The stimulant activity of 5-HT2C antagonist can however, be a disadvantage for patients with agitation, insomnia and anxiety. Another feature of fluoxetine is a weak NE re-uptake inhibition which can have clinical effect in higher doses. Fluoxetine also has a long half-life which can reduce withdrawal symptoms which are characteristic for some SSRIs after abrupt discontinuation, but it also means that it takes a long time to clear the drug and its active metabolite after discontinuing fluoxetine treatment.
  Paroxetine is a constrained structural analogue of fluoxetine where the linear phenylpropylamine group of fluoxetine has been folded into a piperidine ring (figure 5). The compound has the possibility of four stereoisomers because it contains two chiral centers, but one of them, the (3S,4R)-isomer, is marketed as paroxetine. Research has shown that stereochemical factors affect affinity of the molecule for SERT where substitution into the 2-ortho-position of either aromatic rings decreases affinity for rat SERT by as much as 10–100 times, where the greatest loss occurs in the phenoxy ring.
  Paroxetine is the most potent SSRI drug available, but it is less selective for SERT than fluvoxamine and sertraline. Paroxetine also has weak NET inhibition which could contribute to its efficacy in depression, especially at higher doses. As demonstrated in table 2, paroxetine also inhibits the NOSs enzyme which could be the reason for its sexual dysfunction adverse effect, especially in men. Paroxetine shows the highest affinity for muscarinic receptors of all the SSRIs which results in weak anticholinergic activity and therefore undesirable adverse effects.
  While scientists were trying to create a new antidepressant to inhibit the NE re-uptake they accidentally synthesised two new compounds, named talopram and talsupram. The two compounds where not marketed in spite of being potent SNRIs because of the fact that number of suicide attempts were reported in clinical trials. With minor changes to the chemical structure of talopram (figure 6), including a single 6-cyano (CN) substitution, scientists were able to convert talopram into a potent SSRI, called citalopram. But citalopram can also be viewed as a constrained analogue of paroxetine.
  Citalopram has the second most selectivity for SERT, no effects on NE or DA re-uptake and nor does it have affinity to other neuroreceptors. Citalopram is composed of two enantiomers, (R)- and (S)-, which are mirror images of each other (figure 7). Re
caption: Figure 5 Chemical structure of (–)-(3S,4R)-paroxetine