I would like to make 2 points regarding the informative and important article by Dunlop and Nemeroff1 on the role of dopamine in the pathophysiology of depression.
First, although their article alludes to this concept, the authors do not specifically state that norepinephrine transporters in prefrontal cortex remove dopamine from the synapse.2,3 Because of the ability of norepinephrine transporters to remove dopamine, blockade of these transporters by agents such as desipramine can acutely increase dopamine levels in the brain.4 Of course the long-term effects of this action remain unknown, but it should encourage clinicians to consider more strongly older, currently neglected antidepressants like desipramine in cases of depression that do not respond to other pharmacologic agents.
Saxon AJ. Dopamine and Depression. Arch Gen Psychiatry. 2007;64(9):1101. doi:10.1001/archpsyc.64.9.1101