MULTIBINDING AGENTS THAT MODULATE THE 5-HT TRANSPORTER

Abstract: Disclosed are novel multibinding compounds (agents) which bind 5-HT transporters. The compounds of the invention comprise a plurality of ligands each of which can bind to such transporters, thereby modulating the biological processes and/or functions thereof. Each of the ligands is covalently attached to a linker or linkers which may be the same or different to provide for the multibinding compound. The linker is selected such that the multibinding compound so constructed demonstrates increased modulation of the biological processes mediated by the 5-HT transporter.

Description: MULTIBINDING AGENTS THAT MODULATE THE 5-HT TRANSPORTER CROSS REFRENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Application Serial Number 60/088.465. filed June 8, 1998, and U.S. Provisional Application Serial Number 60/093.068. filed July 16, 1998. BACKGROUND OF THE INVENTION Field of the Invention This invention relates to novel therapeutic agents which bind to cell membrane transporters and modulate their activity. More particularly, the invention relates to novel therapeutic agents that bind to and modulate the in vivo activity of the 5-HT transporter in mammals by acting as multi-binding compounds. The therapeutic agents or multi-binding compounds described herein comprise at least two ligands connected by a linker or linkers, wherein said ligands in their monovalent state bind to and/or are capable of modulating the activity of one or more transporters. The linking moiety is chosen such that the multi-binding compounds so constructed demonstrate increased biological activity or therapeutic effect related to membrane transport processes as compared to the same number of individual units of the ligand or ligands. The invention also relates to methods of using such compounds, to methods of preparing such compounds and to pharmaceutical compositions containing them. These multi-binding compounds are particularly useful in treating mammalian conditions that are mediated by levels of serotonin which are controlled by the 5-HT transporter targeted by the ligands. These conditions include depression, anxiety, alcoholism, chronic pain, emesis, and eating disorders such as obesity and bulimia. J. Med. Chem. 1988, 31:1412-1417. Accordingly, this invention also relates to pharmaceutical compositions comprising a pharmaceutically acceptable excipient and an effective amount of a multi-binding compound of this invention. This invention is also directed to general synthetic methods for generating large libraries of diverse multimeric compounds capable of binding cell membrane transporters which multimeric compounds are candidates for possessing multibinding properties. The diverse multimeric compound libraries provided by this invention are synthesized by combining a linker or linkers with a ligand or ligands to provide for a library of multimeric compounds wherein the linker and ligand each have complementary functional groups permitting covalent linkage. The library of linkers is preferably selected to have diverse properties such as valency, linker length, linker geometry and rigidity, hydrophilicity or hydrophobicity, amphiphilicity, acidity, basicity and polarization and/or polarizability. The library of ligands is preferably selected to have diverse attachment points on the same ligand, different functional groups at the same site of otherwise the same ligand, and the like. Publications cited herein are incorporated by reference in their entirety to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference in its entirety. State of the Art A transporter is a biological structure with one or more binding domains that reversibly complexes with one or more ligands, where that complexation has biological consequences. Cellular membranes form a selective permeability barrier to ions and small molecules thereby maintaining intracellular concentrations that are compatible with and optimized for physiological processes. This permeability barrier is comprised of a lipid bilayer, which restricts the passage of polar, charged and hydrophilic molecules and ions, and of cell membrane transporters. Cell membrane transporters include proteinaceous structures that open in a controlled manner to allow selected molecules or ions to flow passively into or out of the cell (e.g., ion channels), and proteins that actively pump ions and molecules into or out of the cell against a concentration gradient (e.g., H /K ATPases, MDR efflux pumps, neurotransmitter transporters). The proteins in the neurotransmitter transporter gene family are involved, inter alia, in the ion-dependent active uptake of amino acid (e.g., GAB A) and amine neurotransmitters (e.g., norepinephrine, dopamine and 5-HT) at presynaptic nerve terminals. The neurotransmitters are taken up into cells against a concentration gradient by coupling the transport to the flow of Na and Cl " down their transmembrane gradients. These transporters are clinically important targets for drugs useful in treating depression. See, e.g. , Chapter 12, in: Goodman & Gilman's "The Pharmacological Basis of Therapeutics", Ninth Edition, McGraw- Hill (1996). Cell membrane transporters are comprised of two or more homologous transmembrane protein domains/subunits which associate to form a translocation channel for ions and molecules. Cell membrane transporters are integral membrane proteins and thus are constrained in their rotational and translational mobility. They can be grouped into a small number of superfamilies on the basis of shared structural features (e.g., amino acid sequence homologies), may operate by similar molecular mechanisms, and in many cases may have a common evolutionary origin. Nevertheless, within a given superfamily there may be numerous subtypes with different tissue specificities resulting from combinations of different types and numbers of subunits. Determination of the amino-acid sequence of the 5-HT transporter from rat brain has lead to the proposal of a structure for the protein including twelve putative transmembrane regions (Blakely, R.D., et al, Nature, 1991. 354: p. 66- 70). This proposed topology for the receptor has recently been confirmed by site- directed chemical labeling (Chen, J.-G., S. Liu-Chen, and G. Rudnick, Determination of external loop topology in the serotonin transporter by site- directed chemical labeling. J. Biol. Chem., 1998. 273(20): p. 12675-12681). The human brain 5-HT transporter protein is a 70-kDa, 630-amino-acid polypeptide that shares 92% homology with the transporter from rat brain (Biessen, E.A.L., A.S. Horn, and G.T. Robillard, Purification of a human platelet serotonin transporter. Biochemistry, 1990. 29: p. 3349-3354; Lesch, K.-P., et al , Isolation of a cDNA encoding the human brain serotonin transporter. J. Neural Transm., 1993. 91: p. 67-73), and the proteins from human platelets and brain have identical primary structure (Lesch, K.-P., et al. , Primary structure of the human platelet serotonin uptake site: Identity with the brain serotonin transporter. J. Neurochem., 1993. 60: p. 2319-2322). Studies using transporter chimeras have indicated that regions in transmembrane spanning domains 1 (Barker, E.L., et al. , High affinity recognition of serotonin transporter antagonists defined by species- scanning mutagenesis. J. Biol. Chem., 1998. 273(31): p. 19459-19468) and 12 (Barker, E.L. and R.D. Blakely, Identification of a single amino acid, phenylalanine 586, that is responsible for high affinity interactions of tricyclic antidepressants with the human serotonin transporter. Mol. Pharmacol., 1996. 50: p. 957-965; Barker, E.L., H.L. Kimmel, and R.D. Blakely, Chimeric human and rat serotonin transporters reveal domains involved in recognition of transporter ligands. Mol. Pharmacol., 1994. 46: p. 799-807) are important for inhibitor potency and selectivity. The existence of two distinct binding sites in the 5-HT transporter is supported by studies showing that tricyclic antidepressants, such as imipramine, completely protect the 5-HT transporter from thiol alkylation-induced deactivation, while the non-tricyclic antidepressants, such as fluoxetine, do not (Biessen, E.A.L., et al. , Evidence for the existence of at least two different binding sites for 5-HT reuptake inhibitors within the 5-HT reuptake system from human platelets. Biochem. Pharm., 1988. 37(20): p. 3959-3966). A ligand is a binding partner for a specific transporter or family of transporters. A ligand may be the endogenous ligand for the transporter or alternatively may be a synthetic ligand for the transporter such as a drug, a drug candidate or a pharmacological tool. The ligands that bind to cellular transporters may be specifically classified as follows: 1. Agonist - ligand that when bound triggers activity seen by natural ligands; 2. Substrate - ligand that when bound is transported through the cell membrane; 3. Antagonist- ligand that when bound inhibits or prevents the activity arising from a natural ligand binding to the transporter. Antagonists may be of the surmountable class (results in the parallel displacement of the dose-response curve of the agonist to the right in a dose dependent fashion without reducing the maximal response for the agonist) or insurmountable class (results in depression of the maximal response for a given agonist with or without the parallel shift); 4. Allosteric modulators: ligand that when bound increases or decreases the transport rate of the transporter. There are four fundamental measurable properties that pertain to the interaction of a ligand with its transporter: 1) the affinity of the ligand for the transporter, which relates to the energetics of the binding; 2) the efficacy of the ligand for the transporter, which relates to the functional downstream activity of the ligand; 3) the kinetics of the ligand for the transporter, which defines the onset of action and the duration of action; and 4) the desensitization of the transporter for the ligand. With regard to the ligand, it is the combination of these properties that provides the foundation for defining the nature of the functional response. Thus, an activating ligand (or substrate) has affinity for the transporter and upregulates downstream efficacy. In contrast, an inhibiting ligand (antagonist) has affinity for the transporter but inhibits or slows upregulated activity. Selectivity defines the ratios of affinities or the ratios of efficacies of a given ligand compared across two transporters. It is the selectivity of a specific drug that provides the required biological profile. Current drugs (ligands) targeting 5-HT transporters have clinical shortcomings identified by one or more of low efficacy, low affinity, poor safety profile, lack of selectivity or overselectivity for the intended transporter, and suboptimal duration of action and onset of action. Accordingly, it would be beneficial to develop ligands that have improved affinity, efficacy, selectivity, onset of action and duration of action. Affmity of ligand for target transporter An increase in ligand affinity to the target transporter may contribute to reducing the dose of ligand required to induce the desired therapeutic effect. A reduction in ligand affinity will remove activity and may contribute to the selectivity profile for a ligand. Efficacy of ligand at a target transporter (functional effect) An increased ligand efficacy at a target transporter can lead to a reduction in the dose required to mediate the desired therapeutic effect. This increase in efficacy may arise from an improved positive functional response of the ligand. Reduced efficacy of a substrate to an antagonist may provide clinical benefit by modulating the biological response. Attempts have been made to synergistically couple 5-HT re-uptake inhibition with 5-HT 1A agonist or antagonist activities in a single molecule to improve efficacy. In these attempts, the des-alkyl versions of the 5-HT 1A selective ligands pindolol, propranolol, and penbutolol were covalently attached via two formats to the selective serotonin reuptake inhibitors (SSRIs) nor-fluoxetine, paroxetine, and milnacipran (Perez, M., et al. , Design and synthesis of new potent, silent 5-HT1A antagonists by covalent coupling of aminopropanol derivatives with selective serotonin reuptake inhibitors. Bioorg. Med. Chem. Lett., 1998. 8: p. 3423-3428). Although the 5-HT re-uptake inhibition activity of these hybrid molecules were slightly to significantly reduced relative to the parent SSRI portions, the 5 -HT 1A activity was significantly increased relative to pindolol and propranolol for several of these compounds. Selectivity of ligand compared across transporter subtypes An increase in the selectivity of the ligand across transporter subtypes requires that the affinity or efficacy of the ligand at other transporters is reduced relative to the desired transporter. Onset of Action More rapid onset of action of the ligand to effect a biological response is preferred. Duration of Action An increased duration of action of the ligand to effect a biological response may be preferred. Accordingly, novel ligands having a desired potency and therapeutic effect for the 5-HT transporter would be particularly desirable in order to increase serotonin levels, by inhibiting serotonin reuptake. Such novel ligands would preferably achieve the desired potency and therapeutic effect by modulating one or more of the ligand 's properties as to efficacy, affinity, safety profile, selectivity, duration of action and/or onset of action. This may have advantages in the effects on disease states or disorders such as depression, anxiety, alcoholism, chronic pain, emesis, and eating disorders such as obesity and bulimia. SUMMARY OF THE INVENTION This invention addresses the above-mentioned needs by providing novel multi-binding compounds that bind cell membrane transporters in biological systems. The binding of these compounds to such cell membrane transporters can be used to treat diseases and conditions mediated by such cells. In one embodiment, this invention is directed to general synthetic methods for generating large libraries of diverse multimeric compounds which multimeric compounds are candidates for possessing multibinding properties. The diverse multimeric compound libraries provided by this invention are synthesized by combining a linker or linkers with a ligand or ligands to provide for a library of multimeric compounds wherein the linker and ligand each have complementary functional groups permitting covalent linkage. The library of linkers is preferably selected to have diverse properties such as valency, linker length, linker geometry and rigidity, hydrophilicity or hydrophobicity, amphiphilicity, acidity, basicity and polarization and/or polarizability. The library of ligands is preferably selected to have diverse attachment points on the same ligand, different functional groups at the same site of otherwise the same ligand, and the like. This invention is also directed to libraries of diverse multimeric compounds which multimeric compounds are candidates for possessing multibinding properties. These libraries are prepared via the methods described above and permit the rapid and efficient evaluation of what molecular constraints impart multibinding properties to a ligand or a class of ligands targeting a transporter. Accordingly, in one of its composition aspects, this invention is directed to a multi-binding compound and salts thereof comprising 2 to 10 ligands, which may be the same or different and which are covalently attached to a linker or linkers which may be the same of different, wherein said ligands comprise a ligand domain capable of binding to a 5-HT transporter. The multi-binding compounds of this invention are preferably represented by formula I: ( p(X) q I wherein each L is independently selected from ligands comprising a ligand domain capable of binding to one or more 5-HT transporters; X is independently a linker; p is an integer of from 2 to 10; q is an integer of from 1 -^ 20; and pharmaceutically acceptable salts thereof; wherein, preferably, q is less than/? and wherein when one ligand is serotonin or tryptamine. at least one other ligand is not either serotonin or tryptamine. In another of its composition aspects, this invention is directed to a pharmaceutical composition comprising a pharmaceutically acceptable excipient and an effective amount of a multi-binding compound, or a pharmaceutically acceptable salt thereof, comprising 2 to 10 ligands which may be the same or different and which are covalently attached to a linker or linkers which may be the same or different, at least one of said ligands comprising a ligand domain capable of binding to one or more 5-HT transporters, with the proviso that when one ligand is serotonin or tryptamine, at least one other ligand is not either serotonin or tryptamine. Preferably, said ligands comprising a ligand domain capable of binding to one or more 5-HT transporters modulate serotonin uptake in mammals. More preferably, said ligands are selected from citalopram, dapoxetine, duloxetine, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, tianeptine, tramadol, venlafaxine, serotonin, tryptamine, and derivatives or analogs thereof, with the proviso that when one ligand is serotonin, tryptamine, or a derivative thereof, at least one other ligand is not serotonin, tryptamine, or a derivative thereof. In still another of its composition aspects, this invention is directed to a pharmaceutical composition comprising a pharmaceutically acceptable excipient and an effective amount of a multi-binding compound represented by formula I: (L) p (X) q I wherein each L is independently selected from ligands comprising a ligand domain capable of binding to a 5-HT transporter; X is a linker; p is an integer of from 2 to 10; q is an integer of from 1 to 20; and pharmaceutically acceptable salts thereof. Preferably, q is less than J, and more preferably the ligand is selected from citalopram, dapoxetine, duloxetine, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, tianeptine, tramadol, venlafaxine, serotonin, tryptamine, and derivatives or analogs thereof, with the proviso that when one ligand is serotonin, tryptamine, or a derivative thereof, at least one other ligand is not either serotonin, tryptamine or a derivative thereof. In one of its method aspects, this invention is directed to a method for decreasing serotonin uptake in a mammal mediated by one or more 5-HT transporters, which method comprises administering to said mammal an effective amount of a pharmaceutical composition comprising a pharmaceutically acceptable excipient and a multi-binding compound, or a pharmaceutically acceptable salt thereof, comprising 2 to 10 ligands which may be the same or different and which are covalently attached to a linker or linkers which may be the same or different, at least two of said ligands comprising a ligand domain capable of binding to one or more 5-HT transporters, with the proviso that when one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not either serotonin, tryptamine or a derivative thereof. In another of its method aspects, this invention is directed to a method for treating disorders affected by serotonin levels, including depression, anxiety, alcoholism, chronic pain, emesis, and eating disorders such as obesity and bulimia, in a mammal mediated by 5-HT transporters which method comprises administering to said mammal an effective amount of a pharmaceutical composition comprising a pharmaceutically acceptable excipient and a multi- binding compound represented by formula I: (L) p (X) q I wherein each L is independently selected from ligands comprising a ligand domain capable of binding to a 5-HT transporter mediating serotonin uptake; X is a linker; p is an integer of from 2 to 10; q is an integer of from 1 to 20 and pharmaceutically acceptable salts thereof, with the proviso that when one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not either serotonin, tryptamine or a derivative thereof. Preferably, q is less than/?, and more preferably, the ligand is selected from the group consisting of 5-HT transporter ligands selected from citalopram, dapoxetine, duloxetine, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, tianeptine, tramadol, venlafaxine, serotonin, tryptamine, and derivatives or analogs thereof . In one embodiment, at least one of the ligands in said multi- binding compound is selected from serotonin, tryptamine or a derivative thereof, with the proviso that at least one other ligand is not either serotonin, tryptamine or a derivative thereof. Accordingly, in one of its method aspects, this invention is directed to a method for identifying multimeric ligand compounds possessing multibinding properties which method comprises: (a) identifying a ligand or a mixture of ligands wherein each ligand contains at least one reactive functionality; (b) identifying a library of linkers wherein each linker in said library comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the ligand or mixture of ligands identified in (a) with the library of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands; and (d) assaying the multimeric ligand compounds produced in (c) above to identify multimeric ligand compounds possessing multibinding properties. In another of its method aspects, this invention is directed to a method for identifying multimeric ligand compounds possessing multibinding properties which method comprises: (a) identifying a library of ligands wherein each ligand contains at least one reactive functionality; (b) identifying a linker or mixture of linkers wherein each linker comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the library of ligands identified in (a) with the linker or mixture of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands; and (d) assaying the multimeric ligand compounds produced in (c) above to identify multimeric ligand compounds possessing multibinding properties. The preparation of the multimeric ligand compound library is achieved by either the sequential or concurrent combination of the two or more stoichiometric equivalents of the ligands identified in (a) with the linkers identified in (b). Sequential addition is preferred when a mixture of different ligands is employed to ensure heterodimeric or multimeric compounds are prepared. Concurrent addition of the ligands is preferred when at least a portion of the multimeric compounds prepared are homomultimeric compounds. The assay protocols recited in (d) can be conducted on the multimeric ligand compound library produced in (c) above, or preferably, each member of the library is isolated by preparative liquid chromatography mass spectrometry (LCMS). In one of its composition aspects, this invention is directed to a library of multimeric ligand compounds which may possess multivalent properties which library is prepared by the method comprising: (a) identifying a ligand or a mixture of ligands wherein each ligand contains at least one reactive functionality; (b) identifying a library of linkers wherein each linker in said library comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; and (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the ligand or mixture of ligands identified in (a) with the library of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands. In another of its composition aspects, this invention is directed to a library of multimeric ligand compounds which may possess multivalent properties which library is prepared by the method comprising: (a) identifying a library of ligands wherein each ligand contains at least one reactive functionality; (b) identifying a linker or mixture of linkers wherein each linker comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; and (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the library of ligands identified in (a) with the linker or mixture of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands. In a preferred embodiment, the library of linkers employed in either the methods or the library aspects of this invention is selected from the group comprising flexible linkers, rigid linkers, hydrophobic linkers, hydrophilic linkers, linkers of different geometry, acidic linkers, basic linkers, linkers of different polarization and/or polarizability and amphiphilic linkers. For example, in one embodiment, each of the linkers in the linker library may comprise linkers of different chain length and/or having different complementary reactive groups. Such linker lengths can preferably range from about 2 to 100A. In another preferred embodiment, the ligand or mixture of ligands is selected to have reactive functionality at different sites on said ligands in order to provide for a range of orientations of said ligand on said multimeric ligand compounds. Such reactive functionality includes, by way of example, carboxylic acids, carboxylic acid halides, carboxyl esters, amines, halides, pseudohalides, isocyanates, vinyl unsaturation, ketones, aldehydes, thiols, alcohols, anhydrides, boronates and precursors thereof. It is understood, of course, that the reactive functionality on the ligand is selected to be complementary to at least one of the reactive groups on the linker so that a covalent linkage can be formed between the linker and the ligand. In other embodiments, the multimeric ligand compound is homomeric (i.e., each of the ligands is the same 5-HT ligand, although it may be attached at different points) or heteromeric (i.e., at least one of the ligands is different from the other ligands). In addition to the combinatorial methods described herein, this invention provides for an iterative process for rationally evaluating what molecular constraints impart multibinding properties to a class of multimeric compounds or ligands targeting a transporter. Specifically, this method aspect is directed to a method for identifying multimeric ligand compounds possessing multibinding properties which method comprises: (a) preparing a first collection or iteration of multimeric compounds which is prepared by contacting at least two stoichiometric equivalents of the ligand or mixture of ligands which target a 5-HT transporter with a linker or mixture of linkers wherein said ligand or mixture of ligands comprises at least one reactive functionality and said linker or mixture of linkers comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand wherein said contacting is conducted under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands; (b) assaying said first collection or iteration of multimeric compounds to assess which if any of said multimeric compounds possess multibinding properties; (c) repeating the process of (a) and (b) above until at least one multimeric compound is found to possess multibinding properties; (d) evaluating what molecular constraints imparted multibinding properties to the multimeric compound or compounds found in the first iteration recited in (a)- (c) above; (e) creating a second collection or iteration of multimeric compounds which elaborates upon the particular molecular constraints imparting multibinding properties to the multimeric compound or compounds found in said first iteration; (f) evaluating what molecular constraints imparted enhanced multibinding properties to the multimeric compound or compounds found in the second collection or iteration recited in (e) above; (g) optionally repeating steps (e) and (f) to further elaborate upon said molecular constraints. Preferably, steps (e) and (f) are repeated at least two times, more preferably at least from 2-50 times, even more preferably from at least 3 to 50 times, and still more preferably at least 5-50 times. DETAILED DESCRIPTION OF THE INVENTION Biological systems in general are controlled by molecular interactions between bioactive ligands and their receptors, in which the receptor "recognizes" a molecule or a portion thereof (i.e., a ligand domain) to produce a biological effect. Thus, the cellular transport of ions and molecules involves "recognition" and interaction of these substrates with specific membrane-associated transporters. Accordingly, diseases or conditions that involve, or are mediated by, cell membrane transporters can be treated with pharmacologically active ligands that interact with such transporters to initiate, modulate or abrogate transporter activity. The interaction of a cell membrane transporter and a ligand may be described in terms of "affinity" and "specificity". The "affinity" and " specificity" of any given ligand-cell membrane transporter interaction is dependent upon the complementarity of molecular binding surfaces and the energetic costs of complexation (i.e., the net difference in free energy ΔG between bound and free states). Affinity may be quantified by the equilibrium constant of complex formation, the ratio of on/off rate constants, and/or by the free energy of complex formation. Specificity relates to the difference in binding affinity of a ligand for different receptors. The net free energy of interaction of a ligand with a cell membrane transporter is the difference between energetic gains (enthalpy gained through molecular complementarity and entropy gained through the hydrophobic effect) and energetic costs (enthalpy lost through decreased solvation and entropy lost through reduced translational, rotational and conformational degrees of freedom). The multi-binding compounds of this invention are capable of acting as multi-binding agents and the surprising activity of these compounds arises at least in part from their ability to bind in a multivalent manner with mammalian 5-HT transporter. Multivalent binding interactions are characterized by the concurrent interaction of multiple ligands with multiple ligand binding sites on one or more 5- HT transporters. Multivalent interactions differ from collections of individual monovalent interactions by imparting enhanced biological and/or therapeutic effect. Examples of multivalent binding interactions (e.g., trivalent) relative to monovalent binding interactions are shown below: Just as multivalent binding can amplify binding affinities, it can also amplify differences in binding affinities, resulting in enhanced binding specificity as well as affinity. Definitions: Prior to discussing this invention in further detail, the following terms will first be defined. The term "alkyl" refers to a monoradical branched or unbranched saturated hydrocarbon chain preferably having from 1 to 40 carbon atoms, more preferably 1 to 10 carbon atoms, and even more preferably 1 to 6 carbon atoms. This term is exemplified by groups such as methyl, ethyl, n-propyl, wø-propyl, /z-butyl, iso- butyl, n-hexyl, n-decyl, tetradecyl, and the like. The term "substituted alkyl" refers to an alkyl group as defined above, having from 1 to 5 substituents, and preferably 1 to 3 substituents, selected from the group consisting of alkoxy, substituted alkoxy, cycloalkyl, substituted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, acyl, acylamino, acyloxy, amino, substituted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substituted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO- heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. The term "alkylene" refers to a diradical of a branched or unbranched saturated hydrocarbon chain, preferably having from 1 to 40 carbon atoms, more preferably 1 to 10 carbon atoms and even more preferably 1 to 6 carbon atoms. This term is exemplified by groups such as methylene (-CH 2 -), ethylene (-CH 2 CH 2 -), the propylene isomers (e.g., -CH 2 CH 2 CH 2 - and -CH(CH 3 )CH 2 -) and the like. The term "substituted alkylene" refers to an alkylene group, as defined above, having from 1 to 5 substiments, and preferably 1 to 3 substituents, selected from the group consisting of alkoxy, substituted alkoxy, cycloalkyl, substituted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, acyl, acylamino, acyloxy, amino, substituted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substituted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, - SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. Additionally, such substituted alkylene groups include those where 2 substituents on the alkylene group are fused to form one or more cycloalkyl, substituted cycloalkyl, cycloalkenyl, substimted cycloalkenyl, aryl, heterocyclic or heteroaryl groups fused to the alkylene group. Preferably such fused groups contain from 1 to 3 fused ring structures. The term "alkaryl" refers to the groups -alkylene-aryl and -substituted alkylene-aryl where alkylene, substituted alkylene and aryl are defined herein. Such alkaryl groups are exemplified by benzyl, phenethyl and the like. The term "alkoxy" refers to the groups alkyl-O-, alkenyl-O-, cycloalkyl-O- , cycloalkenyl-O-, and alkynyl-O-, where alkyl, alkenyl, cycloalkyl, cycloalkenyl, and alkynyl are as defined herein. Preferred alkoxy groups are alkyl-O- and include, by way of example, methoxy, ethoxy, n-propoxy, iso- propoxy, n-butoxy, tert-butoxy, sec-butoxy, n-pentoxy, n-hexoxy, 1,2- dimethylbutoxy, and the like. The term "substimted alkoxy" refers to the groups substimted alkyl-O-, substituted alkenyl-O-, substituted cycloalkyl-O-, substituted cycloalkenyl-O-, and substimted alkynyl-O- where substituted alkyl, substituted alkenyl, substituted cycloalkyl, substimted cycloalkenyl and substituted alkynyl are as defined herein. The term "alkylalkoxy" refers to the groups -alkylene-O-alkyl, -alkylene-O-substituted alkyl, -substimted alkylene-O-alkyl and -substimted alkylene-O-substituted alkyl wherein alkyl, substituted alkyl, alkylene and substituted alkylene are as defined herein. Preferred alkylalkoxy groups are alkylene-O-alkyl and include, by way of example, methylenemethoxy (-CH 2 OCH 3 ), ethylenemethoxy (-CH 2 CH 2 OCH 3 ), n-propylene-wø-propoxy (-CH 2 CH 2 CH 2 OCH(CH 3 ) 2 ), methylene-t-butoxy (-CH 2 -O-C(CH 3 ) 3 ) and the like. The term "alkylthioalkoxy" refers to the group -alkylene-S-alkyl, alkylene-S-substituted alkyl, substituted alkylene-S-alkyl and substituted alkylene- S-substituted alkyl wherein alkyl, substimted alkyl, alkylene and substituted alkylene are as defined herein. Preferred alkylthioalkoxy groups are alkylene-S- alkyl and include, by way of example, methylenethiomethoxy (-CH 2 SCH 3 ), ethylenethiomethoxy (-CH 2 CH 2 SCH 3 ), n-propylene-wø-thiopropoxy (-CH 2 CH 2 CH 2 SCH(CH 3 ) 2 ), methylene-t-thiobutoxy (-CH 2 SC(CH 3 ) 3 ) and the like. The term "alkenyl" refers to a monoradical of a branched or unbranched unsaturated hydrocarbon group preferably having from 2 to 40 carbon atoms, more preferably 2 to 10 carbon atoms and even more preferably 2 to 6 carbon atoms and having at least 1 and preferably from 1-6 sites of vinyl unsaturation. Preferred alkenyl groups include ethenyl (-CH=CH 2 ), n-propenyl (-CH 2 CH=CH 2 ), iso- propenyl (-C(CH 3 )=CH 2 ), and the like. The term "substimted alkenyl" refers to an alkenyl group as defined above having from 1 to 5 substituents, and preferably 1 to 3 substituents, selected from the group consisting of alkoxy, substituted alkoxy, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, acyl, acylamino, acyloxy, amino, substituted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substimted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. The term "alkenylene" refers to a diradical of a branched or unbranched unsaturated hydrocarbon group preferably having from 2 to 40 carbon atoms, more preferably 2 to 10 carbon atoms and even more preferably 2 to 6 carbon atoms and having at least 1 and preferably from 1-6 sites of vinyl unsaturation. This term is exemplified by groups such as ethenylene (-CH=CH-), the propenylene isomers (e.g. , -CH 2 CH =CH- and -C(CH 3 ) =CH-) and the like. The term "substimted alkenylene" refers to an alkenylene group as defined above having from 1 to 5 substiments, and preferably from 1 to 3 substiments, selected from the group consisting of alkoxy, substituted alkoxy, cycloalkyl, substituted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, acyl, acylamino, acyloxy, amino, substimted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substimted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. Additionally, such substituted alkenylene groups include those where 2 substiments on the alkenylene group are fused to form one or more cycloalkyl, substimted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, aryl, heterocyclic or heteroaryl groups fused to the alkenylene group. The term "alkynyl" refers to a monoradical of an unsaturated hydrocarbon preferably having from 2 to 40 carbon atoms, more preferably 2 to 20 carbon atoms and even more preferably 2 to 6 carbon atoms and having at least 1 and preferably from 1-6 sites of acetylene (triple bond) unsamration. Preferred alkynyl groups include ethynyl (-C≡CH 2 ), propargyl (-CH 2 C≡CH) and the like. The term "substituted alkynyl" refers to an alkynyl group as defined above having from 1 to 5 substituents, and preferably 1 to 3 substiments, selected from the group consisting of alkoxy, substimted alkoxy, cycloalkyl, substituted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, acyl, acylamino, acyloxy, amino, substituted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substimted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. The term "alkynylene" refers to a diradical of an unsaturated hydrocarbon preferably having from 2 to 40 carbon atoms, more preferably 2 to 10 carbon atoms and even more preferably 2 to 6 carbon atoms and having at least 1 and preferably from 1-6 sites of acetylene (triple bond) unsaturation. Preferred alkynylene groups include ethynylene (-C≡C-), propargylene (-CHC≡C-) and the like. The term "substimted alkynylene" refers to an alkynylene group as defined above having from 1 to 5 substiments, and preferably 1 to 3 substiments, selected from the group consisting of alkoxy, substimted alkoxy, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substimted cycloalkenyl, acyl, acylamino, acyloxy, amino, substituted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substimted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO- heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. The term "acyl" refers to the groups HC(O)-, alkyl-C(O)-, substimted alkyl-C(O)-, cycloalkyl-C(O)-, substituted cycloalkyl-C(O)-, cycloalkenyl-C(O)-, substimted cycloalkenyl-C(O)-, aryl-C(O)-, heteroaryl-C(O)- and heterocyclic- C(O)- where alkyl, substituted alkyl, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substimted cycloalkenyl, aryl, heteroaryl and heterocyclic are as defined herein. The term "acylamino" refers to the group -C(O)NRR where each R is independently hydrogen, alkyl, substimted alkyl, aryl, heteroaryl, heterocyclic or where both R groups are joined to form a heterocyclic group (e.g., morpholino) wherein alkyl, substimted alkyl, aryl, heteroaryl and heterocyclic are as defined herein. The term "aminoacyl" refers to the group -NRC(O)R where each R is independently hydrogen, alkyl, substimted alkyl, aryl, heteroaryl, or heterocyclic wherein alkyl, substimted alkyl, aryl, heteroaryl and heterocyclic are as defined herein. The term "aminoacyloxy" refers to the group -NRC(O)OR where each R is independently hydrogen, alkyl, substimted alkyl, aryl, heteroaryl, or heterocyclic wherein alkyl, substimted alkyl, aryl, heteroaryl and heterocyclic are as defined herein. The term "acyloxy" refers to the groups alkyl-C(O)O-, substituted alkyl- C(O)O-, cycloalkyl-C(O)O-, substimted cycloalkyl-C(O)O-, aryl-C(O)O-, heteroaryl-C(O)O-, and heterocyclic-C(O)O- wherein alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, heteroaryl, and heterocyclic are as defined herein. The term "aryl" refers to an unsaturated aromatic carbocyclic group of from 6 to 20 carbon atoms having a single ring (e.g., phenyl) or multiple condensed (fused) rings (e.g., naphthyl or anthryl). Preferred aryls include phenyl, naphthyl and the like. Unless otherwise constrained by the definition for the aryl substituent, such aryl groups can optionally be substituted with from 1 to 5 substiments, preferably 1 to 3 substituents, selected from the group consisting of acyloxy, hydroxy, thiol, acyl, alkyl, alkoxy, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, substituted alkyl, substimted alkoxy, substituted alkenyl, substimted alkynyl, substituted cycloalkyl, substimted cycloalkenyl, amino, substituted amino, aminoacyl, acylamino, alkaryl, aryl, aryloxy, azido, carboxyl, carboxylalkyl, cyano, halo, nitro, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, aminoacyloxy, oxyacylamino, thioalkoxy, substimted thioalkoxy, thioaryloxy, thioheteroaryloxy, -SO-alkyl, -SO- substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO -aryl, -SO 2 -heteroaryl and trihalomethyl. Preferred aryl substiments include alkyl, alkoxy, halo, cyano, nitro, trihalomethyl, and thioalkoxy. The term "aryloxy" refers to the group aryl-O- wherein the aryl group is as defined above including optionally substimted aryl groups as also defined above. The term "arylene" refers to the diradical derived from aryl (including substituted aryl) as defined above and is exemplified by 1 ,2-phenylene, 1,3- phenylene, 1,4-phenylene, 1 ,2-naphthylene and the like. The term "amino" refers to the group -NH 2 . The term "substituted amino" refers to the group -NRR where each R is independently selected from the group consisting of hydrogen, alkyl, substituted alkyl, cycloalkyl, substimted cycloalkyl, alkenyl, substituted alkenyl, cycloalkenyl, substituted cycloalkenyl, alkynyl, substituted alkynyl, aryl, heteroaryl and heterocyclic provided that both R's are not hydrogen. The term "carboxy alkyl" refers to the groups "-C(O)O-alkyl" , "-C(O)O- substimted alkyl", "-C(O)O-cycloalkyl", "-C(O)O-substituted cycloalkyl", "- C(O)O-alkenyl", "-C(O)O-substituted alkenyl", "-C(O)O-alkynyl" and "-C(O)O- substituted alkynyl" where alkyl, substimted alkyl, cycloalkyl, substituted cycloalkyl, alkenyl, substituted alkenyl, alkynyl and substituted alkynyl are as defined herein. The term "cycloalkyl" refers to cyclic alkyl groups of from 3 to 20 carbon atoms having a single cyclic ring or multiple condensed rings. Such cycloalkyl groups include, by way of example, single ring structures such as cyclopropyl, cyclobutyl, cyclopentyl, cyclooctyl, and the like, or multiple ring strucmres such as adamantanyl, and the like. The term "substimted cycloalkyl" refers to cycloalkyl groups having from 1 to 5 substiments, and preferably 1 to 3 substiments, selected from the group consisting of alkoxy, substimted alkoxy, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substimted cycloalkenyl, acyl, acylamino, acyloxy, amino, substimted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substituted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. The term "cycloalkenyl" refers to cyclic alkenyl groups of from 4 to 20 carbon atoms having a single cyclic ring and at least one point of internal unsaturation. Examples of suitable cycloalkenyl groups include, for instance, cyclobut-2-enyl, cyclopent-3-enyl, cyclooct-3-enyl and the like. The term "substituted cycloalkenyl" refers to cycloalkenyl groups having from 1 to 5 substiments, and preferably 1 to 3 substituents, selected from the group consisting of alkoxy, substituted alkoxy, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substimted cycloalkenyl, acyl, acylamino, acyloxy, amino, substimted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substituted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. The term "halo" or "halogen" refers to fluoro, chloro, bromo and iodo. The term "heteroaryl" refers to an aromatic group of from 1 to 15 carbon atoms and 1 to 4 heteroatoms selected from oxygen, nitrogen and sulfur within at least one ring (if there is more than one ring). Unless otherwise constrained by the definition for the heteroaryl substituent, such heteroaryl groups can be optionally substimted with 1 to 5 substiments, preferably 1 to 3 substiments, selected from the group consisting of acyloxy, hydroxy, thiol, acyl, alkyl, alkoxy, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, substituted alkyl, substimted alkoxy, substimted alkenyl, substimted alkynyl, substituted cycloalkyl, substimted cycloalkenyl, amino, substituted amino, aminoacyl, acylamino, alkaryl, aryl, aryloxy, azido, carboxyl, carboxylalkyl, cyano, halo, nitro, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, aminoacyloxy, oxyacylamino, thioalkoxy, substimted thioalkoxy, thioaryloxy, thioheteroaryloxy, -SO-alkyl, -SO-substituted alkyl, -SO-aryl, -SO-heteroaryl, - SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl, -SO 2 -heteroaryl and trihalomethyl. Preferred aryl substituents include alkyl, alkoxy, halo, cyano, nitro, trihalomethyl, and thioalkoxy. Such heteroaryl groups can have a single ring (e.g., pyridyl or furyl) or multiple condensed rings (e.g., indolizinyl or benzothienyl). Preferred heteroaryls include pyridyl, pyrrolyl and furyl. The term "heteroaryloxy" refers to the group heteroaryl-O-. The term "heteroarylene" refers to the diradical group derived from heteroaryl (including substimted heteroaryl), as defined above, and is exemplified by the groups 2,6-pyridylene, 2,4-pyridiylene, 1,2-quinolinylene, 1,8- quinolinylene, 1,4-benzofuranylene, 2,5-pyridnylene, 2,5-indolenyl and the like. The term "heterocycle" or "heterocyclic" refers to a monoradical saturated unsaturated group having a single ring or multiple condensed rings, from 1 to 40 carbon atoms and from 1 to 10 hetero atoms, preferably 1 to 4 heteroatoms, selected from nitrogen, sulfur, phosphorus, and/or oxygen within the ring. Unless otherwise constrained by the definition for the heterocyclic substituent, such heterocyclic groups can be optionally substituted with 1 to 5, and preferably 1 to 3 substiments, selected from the group consisting of alkoxy, substituted alkoxy, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, acyl, acylamino, acyloxy, amino, substituted amino, aminoacyl, aminoacyloxy, oxyaminoacyl, azido, cyano, halogen, hydroxyl, keto, thioketo, carboxyl, carboxylalkyl, thioaryloxy, thioheteroaryloxy, thioheterocyclooxy, thiol, thioalkoxy, substimted thioalkoxy, aryl, aryloxy, heteroaryl, heteroaryloxy, heterocyclic, heterocyclooxy, hydroxyamino, alkoxyamino, nitro, -SO-alkyl, -SO- substituted alkyl, -SO-aryl, -SO-heteroaryl, -SO 2 -alkyl, -SO 2 -substituted alkyl, -SO 2 -aryl and -SO 2 -heteroaryl. Such heterocyclic groups can have a single ring or multiple condensed rings. Preferred heterocyclics include morpholino, piper idinyl, and the like. Examples of mtrogen heterocycles and heteroaryls include, but are not limited to, pyrrole, imidazole, pyrazole, pyridine, pyrazine, pyrimidine, pyridazine, indolizine, isoindole, indole, indazole, purine, quinolizine, isoquinoline, quinoline, phthalazine, naphthylpyridine, quinoxaline, quinazoline, cinnoline, pteridine, carbazole, carboline, phenanthridine, acridine, phenanthroline, isothiazole, phenazine, isoxazole, phenoxazine, phenothiazine, imidazolidine, imidazoline, piperidine, piperazine, indoline, morpholino, piperidinyl, tetrahydrofuranyl, and the like as well as N-alkoxy -nitrogen containing heterocycles. A preferred class of heterocyclics include "crown compounds" which refers to a specific class of heterocyclic compounds having one or more repeating units of the formula [-(CH 2 -) m Y-] where m is ≥ 2, and Y at each separate occurrence can be O, N, S or P. Examples of crown compounds include, by way of example only, [-(CH 2 ) 3 -NH-] 3 , [-((CH 2 ) 2 -O) 4 -((CH 2 ) 2 -NH) 2 ] and the like. Typically such crown compounds can have from 4 to 10 heteroatoms and 8 to 40 carbon atoms. The term "heterocyclooxy" refers to the group heterocyclic-O-. The term "thioheterocyclooxy" refers to the group heterocyclic-S-. The term "heterocyclene" refers to the diradical group formed from a heterocycle, as defined herein, and is exemplified by the groups 2,6-morpholino, 2,5-morpholino and the like. The term "oxyacylamino" refers to the group -OC(O)NRR where each R is independently hydrogen, alkyl, substituted alkyl, aryl, heteroaryl, or heterocyclic wherein alkyl, substimted alkyl, aryl, heteroaryl and heterocyclic are as defined herein. The term "pseudohalide" refers to functional groups which react in displacement reactions in a manner similar to a halogen. Such functional groups include, by way of example, mesyl, tosyl, azido and cyano groups. The term "thiol" refers to the group -SH. The term "thioalkoxy" refers to the group -S-alkyl. The term "substituted thioalkoxy" refers to the group -S-substituted alkyl. The term "thioaryloxy" refers to the group aryl-S- wherein the aryl group is as defined above including optionally substituted aryl groups also defined above. The term "thioheteroaryloxy" refers to the group heteroaryl-S- wherein the heteroaryl group is as defined above including optionally substimted aryl groups as also defined above. As to any of the above groups which contain one or more substiments, it is understood, of course, that such groups do not contain any substitution or substitution patterns which are sterically impractical and/or synthetically non- feasible. In addition, the compounds of this invention include all stereochemical isomers arising from the substitution of these compounds. The term "pharmaceutically acceptable salt" refers to salts which retain the biological effectiveness and properties of the multi-binding compounds of this invention and which are not biologically or otherwise undesirable. In many cases, the multi-binding compounds of this invention are capable of forming acid and/or base salts by virtue of the presence of amino and/or carboxyl groups or groups similar thereto. Pharmaceutically acceptable base addition salts can be prepared from inorganic and organic bases. Salts derived from inorganic bases, include by way of example only, sodium, potassium, lithium, ammonium, calcium and magnesium salts. Salts derived from organic bases include, but are not limited to, salts of primary, secondary and tertiary amines, such as alkyl amines, dialkyl amines, trialkyl amines, substimted alkyl amines, di(substituted alkyl) amines, tri(substituted alkyl) amines, alkenyl amines, dialkenyl amines, trialkenyl amines, substimted alkenyl amines, di(substituted alkenyl) amines, tri(substituted alkenyl) amines, cycloalkyl amines, di(cycloalkyl) amines, tri(cycloalkyl) amines, substimted cycloalkyl amines, disubstituted cycloalkyl amine, trisubstituted cycloalkyl amines, cycloalkenyl amines, di(cycloalkenyl) amines, tri(cycloalkenyl) amines, substimted cycloalkenyl amines, disubstituted cycloalkenyl amine, trisubstituted cycloalkenyl amines, aryl amines, diaryl amines, triaryl amines, heteroaryl amines, diheteroaryl amines, triheteroaryl amines, heterocyclic amines, diheterocyclic amines, triheterocyclic amines, mixed di- and tri-amines where at least two of the substiments on the amine are different and are selected from the group consisting of alkyl, substituted alkyl, alkenyl, substimted alkenyl, cycloalkyl, substimted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, aryl, heteroaryl, heterocyclic, and the like. Also included are amines where the two or three substiments, together with the amino nitrogen, form a heterocyclic or heteroaryl group. Examples of suitable amines include, by way of example only, isopropylamine, trimethyl amine, diethyl amine, tri(wo-propyl) amine, tri(n- propyl) amine, ethanolamine, 2-dimethylaminoethanol, tromethamine, lysine, arginine, histidine, caffeine, procaine, hydrabamine, choline, betaine, ethylenediamine, glucosamine, N-alkylglucamines, theobromine, purines, piperazine, piperidine, morpholine, N-ethylpiperidine, and the like. It should also be understood that other carboxylic acid derivatives would be useful in the practice of this invention, for example, carboxylic acid amides, including carboxamides, lower alkyl carboxamides, dialkyl carboxamides, and the like. Pharmaceutically acceptable acid addition salts may be prepared from inorganic and organic acids. Salts derived from inorganic acids include hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like. Salts derived from organic acids include acetic acid, propionic acid, glycolic acid, pyruvic acid, oxalic acid, malic acid, malonic acid, succinic acid, maleic acid, mmaric acid, tartaric acid, citric acid, benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonic acid, ?-toluene-sulfonic acid, salicylic acid, and the like. The term "pharmaceutically acceptable excipient" is intended to include vehicles and carriers capable of being coadministered with a multi-binding compound to facilitate the performance of its intended function. The use of such media for pharmaceutically active substances is well known in the art. Examples of such vehicles and carriers include solutions, solvents, dispersion media, delay agents, emulsions and the like. Any other conventional carrier suitable for use with the multi-binding compounds also falls within the scope of the present invention. The term "protecting group" or "blocking group" refers to any group which when bound to one or more hydroxyl, thiol, amino or carboxyl groups of the compounds (including intermediates thereof) prevents reactions from occurring at these groups and which protecting group can be removed by conventional chemical or enzymatic steps to reestablish the hydroxyl, thiol, amino or carboxyl group (Green, Protective Groups in Organic Synthesis, 2 Ed., John Wiley & Sons, NY, NY (1991)). The particular removable blocking group employed is not critical and preferred removable hydroxyl blocking groups include conventional substituents such as allyl, benzyl, acetyl, chloroacetyl, thiobenzyl, benzylidine, phenacyl, t-butyl-diphenylsilyl and any other group that can be introduced chemically onto a hydroxyl functionality and later selectively removed either by chemical or enzymatic methods in mild conditions compatible with the nature of the product. Preferred removable amino blocking groups include conventional substituents such as t-butyloxycarbonyl (t-BOC), benzyloxycarbonyl (CBZ), and the like which can be removed by conventional conditions compatible with the nature of the product. Preferred carboxyl protecting groups include esters such as methyl, ethyl, propyl, t-butyl, etc., which can be removed by mild hydrolysis conditions compatible with the nature of the product. The term "optional" or "optionally" means that the subsequently described event, circumstance or substiment may or may not occur, and that the description includes instances where said event or circumstance occurs and instances where it does not. As used herein, the terms "inert organic solvent" or "inert solvent" mean a solvent inert under the conditions of the reaction being described in conjunction therewith [including, for example, benzene, toluene, acetonitrile, tetrahydrofuran ("THF"), dimethylformamide ("DMF"), chloroform (CHC1 3 ), methylene chloride (or dichloromethane or "CH 2 C1 2 "), diethyl ether, ethyl acetate, acetone, methylethyl ketone, methanol, ethanol, propanol, isopropanol, tert-butanol, dioxane, pyridine, and the like]. Unless specified to the contrary, the solvents used in the reactions of the present invention are inert solvents. The "5-HT transporter" is a transporter which modulates the uptake of serotonin by the 5-HT receptor family. The 5-HT transporter is located on nerve terminals and on cell bodies and dendrites in the dorsal and median raphe nuclei. It is also present in glial cells, platelets, mast cells, endothelial cells and lymphocytes. The modulation of serotonin uptake is known to affect various conditions or diseases, such as depression, anxiety, alcoholism, chronic pain, emesis, and eating disorders such as obesity and bulimia. It should be recognized that the 5-HT transporter that participates in biological multivalent binding interactions is constrained by its location in the cell membrane, and therefore has little translational and rotational freedom. The term "library" refers to at least 3, preferably from 1(£ to 10^ and more preferably from 10^ to 10^ multimeric compounds. Preferably, these compounds are prepared as a multiplicity of compounds in a single solution or reaction mixmre which permits facile synthesis thereof. In one embodiment, the library of multimeric compounds can be directly assayed for multibinding properties. In another embodiment, each member of the library of multimeric compounds is first isolated and, optionally, characterized. This member is then assayed for multibinding properties. The term "collection" refers to a set of multimeric compounds which are prepared either sequentially or concurrently (e.g. , combinatorially). The collection comprises at least 2 members; preferably from 2 to 10^ members and still more preferably from 10 to 10^ members. The term "ligand binding site" as used herein denotes a site on a receptor, such as a cell membrane transporter, that recognizes a ligand domain and provides a binding partner for that ligand. The ligand binding site may be defined by monomeric or multimeric structures. This interaction may be capable of producing a unique biological effect, for example agonism, antagonism, modulatory effect and the like, or may maintain an ongoing biological event. "Ligand" as used herein denotes a compound that is a binding partner for a receptor, such as a cell membrane transporter, and is bound thereto by complementarity. The specific region or regions of the ligand that is (are) recognized by the ligand binding site of a receptor is designated as the "ligand domain" . A ligand may be either capable of binding to a transporter by itself, or may require the presence of one or more non-ligand components for binding (e.g., Ca +2 , Mg +2 or a water molecule). It is further understood that the term "ligand" is not intended to be limited to compounds known to be useful as transporter binding compounds (e.g., known drugs). It should also be understood that portions of the ligand structure that are not essential for specific molecular recognition and binding activity may be varied substantially, replaced with unrelated structures and, in some cases, omitted entirely without affecting the binding interaction. The primary requirement for the ligand is that it has a ligand domain as defined above. Those skilled in the art will understand that the term ligand can equally apply to a molecule that is not normally associated with transporter binding properties. In addition, it should be noted that ligands that exhibit marginal activity or lack useful activity as monomers can be highly active as multivalent compounds because of the benefits conferred by multi- valency. The only requirement for a ligand is that it has a ligand binding domain as defined above. A "multimeric compound" refers to a compound that is capable of multivalency as defined below, and which has 2 to 10 ligands covalently bound to one or more linkers which may be the same or different. The compound may or y *'° ά * PCT/US99/12724 -37- may not possess multibinding properties. At least one of the ligands comprises a ligand domain capable of binding to one or more 5-HT transporters. The multi- binding compound provides a biological and/or therapeutic effect greater than the aggregate of unlinked ligands equivalent thereto which may be the same or different which unlinked ligands comprise a ligand domain capable of binding to one or more 5-HT transporters. That is to say that the biological and/or therapeutic effect of the 5-HT transporter binding ligands attached to the multi- binding compound is greater than that achieved by the same amount of unlinked 5- HT transporter ligands made available for binding to the ligand binding sites. The term "modulatory effect" is intended to refer to the ability of a ligand to change the activity of a cell membrane transporter through binding to the transporter, regardless of whether the transporter is activated (or inhibited) by an endogenous ligand, or by the occurrence (or non-occurrence) of a physicochemical stimulus (e.g., a change in membrane potential or mechanical deformation in the case of certain classes of ion channels). The "modulatory effect" of compounds of this invention will often result in inhibition of transport processes. The phrase "increased biological or therapeutic effect" includes, for example increased affinity for a target, increased specificity for a target, increased selectivity for a target, increased potency, increased efficacy, decreased toxicity, improved duration of action, decreased side effects, increased therapeutic index, improved bioavailability, improved pharmacokinetics, improved activity spectrum, and the like. The multi-binding compounds of this invention will exhibit at least one and preferably more than one of the above mentioned effects. "Uni-valency" as used herein refers to a single binding interaction between one ligand as defined herein with one ligand binding site as defined herein. It should be noted that a molecule having multiple copies of a ligand (or ligands) exhibits uni-valency when only one ligand is interacting with a ligand binding site. Examples of a univalent interaction are depicted below. "Multi- valency" as used herein refers to the concurrent binding of from 2 to 10 linked ligands (which may be the same or different) and two or more corresponding ligand binding sites on the 5-HT transporters which 5-HT transporters may be the same or different. For example, two ligands connected by a linker that bind concurrently to two ligand binding sites would be considered as bi- valency; three ligands thus connected would be an example of tri- valency. An example of tri- valency illustrating a multi-binding agent bearing three ligands versus a monovalent binding interaction is shown below: univalent interaction trivalent interaction It should be understood that all compounds that contain multiple copies of a ligand attached to a linker do not necessarily exhibit the phenomena of multivalency, i.e., that the biological and/or therapeutic effect of the multi-binding agent is greater than the sum of the aggregate of unlinked ligands made available to the ligand binding site. For multivalency to occur, the ligands that are connected by a linker have to be presented to their receptors by the linker in a specific manner in order to bring about the desired ligand-orienting result, and thus produce a multi-binding agent. "Potency" as used herein refers to the minimum concentration at which a ligand is able to achieve a desirable biological or therapeutic effect. The potency of a ligand is typically proportional to its affinity for its ligand binding site. In some cases the potency may be non-linearly correlated with its affinity. In comparing the potency of two drugs, e.g., a multi-binding agent and the aggregate of its unlinked ligand, the dose-response curve of each is determined under identical test conditions (e.g. an in vitro or in vivo assay, in an appropriate animal model such as a human patient). The finding that the multi-binding agent produces an equivalent biological or therapeutic effect at a lower concentration than the aggregate unlinked ligand (e.g. on a per weight, per mole or per ligand basis) is indicative of enhanced potency. "Selectivity" or "specificity" is a measure of the binding preferences of a ligand for different ligand binding sites. The selectivity of a ligand with respect to its target ligand binding site relative to another ligand binding site is given by the ratio of the respective values of I j (i.e., the dissociation constants for each ligand- receptor complex) or in cases where a biological effect is observed below the Kψ the ratio of the respective EC 50 s (i.e., the concentrations that produce 50% of the maximum response for the ligand interacting with the two distinct ligand binding sites). The terms "agonism" and "antagonism" are well known in the art. As used herein, the term "agonist" refers to a ligand that when bound to a cell membrane transporter stimulates the functional activity of the transporter. The term "antagonist" refers to a ligand that when bound to a transporter inhibits the functional activity of the transporter. The term "allosteric modulator" refers to a ligand that when bound to a cell membrane transporter increases or decreases the transport rate of the transporter. The term "substrate" refers to a ligand that when bound to a cell membrane transporter is transported through the cell membrane. The term "treatment" refers to the treatment of a disease or condition in a mammal, particularly a human, and includes: (i) decreasing serotonin uptake in a subject; (ii) increasing extracellular serotonin levels; or (iii) preventing or alleviating the disease or condition in a subject. The term "disease or condition which is modulated by treatment with a ligand" covers all disease states and/or conditions that are generally acknowledged in the art to be usefully treated with a ligand for a cell membrane transporter in general, and those disease states and/or conditions that have been found to be usefully treated by a specific multi-binding compound of our invention. Such disease states include, by way of example only, depression, anxiety, alcoholism, chronic pain, emesis, and eating disorders such as obesity and bulimia. The term "therapeutically effective amount" refers to that amount of multi- binding compound which is sufficient to effect treatment, as defined above, when administered to a mammal in need of such treatment. The therapeutically effective amount will vary depending upon the subject and disease condition being treated, the weight and age of the subject, the severity of the disease condition, the manner of administration and the like, which can readily be determined by one of ordinary skill in the art. The term "linker," identified where appropriate by the symbol "X", refers to a group or groups that covalently link(s) from 2 to 10 ligands (as identified above) in a manner that provides for a compound capable of multi-valency when in the presence of at least one cellular receptor having 2 or more ligand binding sites. The linker is a ligand-orienting entity which may be chiral or achiral that permits attachment of multiple copies of a ligand (which may be the same or different) thereto. In some cases the linker may be biologically active. The term linker does not, however, extend to cover solid inert supports such as beads, glass particles, fibers and the like. But it is to be understood that the multi-binding compounds of this invention can be attached to a solid support if desired, for example, for use in separation and purification processes and for similar applications. The ligands and linkers which comprise the multibinding agents of the invention and the multibinding compounds themselves may have various stereoisomeric forms, including enantiomers and diastereomers. It is to be understood that the invention contemplates all possible stereoisomeric forms of multibinding compounds, and mixtures thereof. The extent to which multivalent binding is realized depends upon the efficiency with which the linker or linkers that joins the ligands presents them to their ligand binding sites on one or more receptors. Beyond presenting ligands for multivalent interactions with ligand binding sites, the linker spatially constrains these interactions to occur within dimensions defined by the linker. Thus the strucmral features of the linker (valency, geometry, orientation, size, flexibility, chemical composition) are features of multivalent compounds that play an important role in determining their activities. Methodology The linker, when covalently attached to the ligands, provides a biocompatible, substantially non-immunogenic multi-binding compound of this invention. The biological activity of the multi-binding compound is highly sensitive to the valency, geometry, composition, size, flexibility or rigidity, etc. of the linker as well as the presence or absence of anionic or cationic charge, the relative hydrophobicity /hydrophilicity of the linker, and the like on the linker. In general, the linker may be chosen from any organic molecule construct that orients two or more ligands to the receptors to permit multi-valency. In this regard, the linker can be considered as a "framework" on which the ligands are arranged in order to bring about the desired ligand-orienting result, and thus produce a multi- binding compound. Ancillary groups which enhance the water solubility/hydrophilicity of the linker and, accordingly, the resulting multi-binding compounds are useful in practicing this invention. Thus, it is within the scope of the present invention to use ancillary groups such as, for example, poly (ethylene glycols), alcohols, polyols, (e.g., glycerin, glycerol propoxylate, saccharides, including mono-, oligo- and polysaccharides, etc.) carboxylates, polycarboxylates, (e.g., polyglutamic acid, polyacrylic acid, etc.), amines, polyamines, (e.g., polylycine, poly(ethyleneimine), and the like) to enhance the water solubility and/or hydrophilicity of the multi-binding compounds of this invention. In preferred embodiments, the ancillary group used to improve water solubility/hydrophilicity will be a poly ether. In particularly preferred embodiments, the ancillary group will be a poly (ethylene glycol). The incorporation of lipophilic ancillary groups within the structure of the linker to enhance the lipophilicity and/or hydrophobicity of the multi-binding compounds described herein is within the scope of this invention. Lipophilic groups useful with the linkers of this invention include, by way of example only, aryl and heteroaryl groups which, as above, may be either unsubstituted or substimted with other groups, but are at least substituted with a group which allows their covalent attachment to the linker. Other lipophilic groups useful with the linkers of this invention include fatty acid derivatives which do not form bilayers in aqueous medium until higher concentrations are reached. Also within the scope of this invention is the use of ancillary groups which result in the multi-binding compound being incorporated into a vesicle such as a liposome or a micelle. The term "lipid" refers to any fatty acid derivative that is capable of forming a bilayer such that a hydrophobic portion of the lipid material orients toward the bilayer while a hydrophilic portion orients toward the aqueous phase. Hydrophilic characteristics derive from the presence of phosphato, carboxylic, sulfato, amino, sulfhydryl, nitro and other like groups well known in the art. Hydrophobicity could be conferred by the inclusion of groups that include, but are not limited to, long chain saturated and unsaturated aliphatic hydrocarbon groups of up to 20 carbon atoms and such groups substimted by one or more aryl, heteroaryl, cycloalkyl, and/or heterocyclic group(s). Preferred lipids are phosphoglycerides and sphingolipids, representative examples of which include phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, phosphatidic acid, palmitoyleoyl phosphatidylcholine, ly sophosphatidy lcholine , ly sophosphatidy 1-ethanolamine , dipalmitoylphosphatidy lcholine, dioleoylphosphatidy lcholine, distearoyl- phosphatidy lcholine or dilinoleoylphosphatidylcholine could be used. Other compounds lacking phosphorus, such as sphingolipid and glycosphingolipid families are also within the group designated as lipid. Additionally, the amphipathic lipids described above may be mixed with other lipids including triglycerides and sterols. The flexibility of the linker can be manipulated by the inclusion of ancillary groups which are bulky and/or rigid. The presence of bulky or rigid groups can hinder free rotation about bonds in the linker or bonds between the linker and the ancillary group(s) or bonds between the linker and the functional groups. Rigid groups can include, for example, those groups whose conformational lability is restrained by the presence of rings and/or multiple bonds, for example, aryl, heteroaryl, cycloalkyl and heterocyclic groups. Other groups which can impart rigidity include polypeptide groups such as oligo- or polyproline chains. Rigidity can also be imparted electrostatically. Thus, if the ancillary groups are either positively or negatively charged, the similarly charged ancillary groups will force the presenter linker into a configuration affording the maximum distance between each of the like charges. The energetic cost of bringing the like- charged groups closer to each other will tend to hold the linker in a configuration that maintains the separation between the like-charged ancillary groups. Further ancillary groups bearing opposite charges will tend to be attracted to their oppositely charged counterparts and potentially may enter into both inter- and intramolecular ionic bonds. This non-covalent mechanism will tend to hold the linker into a conformation which allows bonding between the oppositely charged groups. The addition of ancillary groups which are charged, or alternatively, bear a latent charge when deprotected, following the addition to the linker, include deprotectation of a carboxyl, hydroxyl, thiol or amino protecting group, by a change in pH, oxidation, reduction or other mechanisms known to those skilled in the art, is within the scope of this invention. Bulky groups can include, for example, large atoms, ions (e.g., iodine, sulfur, metal ions, etc.) or groups containing large atoms, polycyclic groups, including aromatic groups, non-aromatic groups and strucmres incorporating one or more carbon-carbon multiple bonds (i.e., alkenes and alkynes). Bulky groups can also include oligomers and polymers which are branched- or straight-chain species. Species that are branched are expected to increase the rigidity of the structure more per unit molecular weight gain than are straight-chain species. In preferred embodiments, rigidity is imparted by the presence of cyclic groups (e.g., aryl, heteroaryl, cycloalkyl, heterocyclic, etc.). In still further preferred embodiments, the ring is an aryl group such as, for example, phenyl or naphthyl. In other preferred embodiments, the linker comprises one or more six- membered rings or crown groups which, while not rigid, retain the conformation of the linker through conformational entropy. In view of the above, it is apparent that the appropriate selection of a linker group providing suitable orientation, entropy and physico-chemical properties is well within the skill of the art. Eliminating or reducing antigenicity of the multi- binding compounds described herein is also within the scope of this invention. As explained above, the multi-binding compounds described herein comprise 2-10 ligands for a 5-HT transporter attached to a linker that links the ligands in such a manner that they are presented to the 5-HT transporter for multivalent interactions. The linker spatially constrains these interactions to occur within dimensions defined by the linker, thus greatly increasing biological activity of the multi-binding compound as compared to the same number of ligands used in mono-binding form. The multi-binding compounds of this invention are preferably represented by the empirical formula (L) p (X) q where L, X, p and q are as defined above. This is intended to include the several ways in which the ligands can be linked together in order to achieve the objective of multi-valency, and a more detailed explanation is described below. As noted previously, the linker may be considered as a framework to which ligands are attached. Thus, it should be recognized that the ligands can be attached at any suitable position on this framework, for example, at the termini of a linear chain or at any intermediate position, forming a linear, branched or cyclic array. The simplest and most preferred multi-binding compound is a bivalent compound which can be represented as L-X-L, where L is a ligand and is the same or different and X is the linker. A trivalent compound could also be represented in a linear fashion, i.e., as a sequence of repeated units L-X-L-X-L, in which L is a ligand and is the same or different at each occurrence, as can X. However, a trimer can also be a multi-binding compound comprising three ligands attached to a central core, and thus represented as (L^X, where the linker X could include, for example, an aryl or cycloalkyl group. Tetravalent compounds can be represented, for example, in a linear array: L-X-L-X-L-X-L or in a tetrahedral array: where X and L are as defined herein. The same considerations apply to higher multibinding compounds of this invention containing 5-10 ligands. However, for multibinding agents attached to a central linker such as aryl or cycloalkyl, there is a self-evident constraint that there must be sufficient attachment sites on the linker to accommodate the number of ligands present; for example, a benzene ring could not directly accommodate more than 6 ligands, whereas a multi-ring linker (e.g., biphenyl) could accommodate a larger number of ligands. Certain of the above described compounds may alternatively be represented as cyclic chains of the form: X X and variants thereof. All of the above variations are intended to be within the scope of the invention defined by the formula (L) p (X) q . In view of the above description of the linker, it is understood that the term "linker" when used in combination with the term "multibinding compound" includes both a covalently contiguous single linker (e.g., L-X-L) and multiple covalently non-contiguous linkers (L-X-L-X-L) within the multibinding compound. Preparation of Multibinding Compounds The multibinding compounds of this invention can be prepared from readily available starting materials using the following general methods and procedures. It will be appreciated that where typical or preferred process conditions (i.e., reaction temperatures, times, mole ratios of reactants, solvents, pressures, etc.) are given, other process conditions can also be used unless otherwise stated. Optimum reaction conditions may vary with the particular reactants or solvent used, but such conditions can be determined by one skilled in the art by routine optimization procedures. Additionally, as will be apparent to those skilled in the art, conventional protecting groups may be necessary to prevent certain functional groups from undergoing undesired reactions. The choice of a suitable protecting group for a particular functional group as well as suitable conditions for protection and deprotection are well known in the art. For example, numerous protecting groups, and their introduction and removal, are described in T. W. Greene and G. M. Wuts, Protecting Groups in Organic Synthesis, Second Edition, Wiley, New York, 1991, and references cited therein. Any compound which acts as a ligand toward a 5-HT transporter can be used as a ligand in this invention. As discussed in further detail below, numerous such ligands are known in the art and any of these known compounds or derivatives thereof may be employed as ligands in this invention. Such known ligands are now further described. Known 5-HT transporter ligands include those illustrated below: Dapoxetine Citalopram Paroxetine Milnacipran Tramadol Serotonin NHBOC Tryptamine The known 5-HT transporter ligands suitable for use in the invention include the above known ligands, derivatives and analogs thereof, and other 5-HT transporter ligands, their derivatives and analogs thereof, known to those in the art which show specificity for the 5-HT transporter, with the proviso that when one ligand is serotonin, tryptamine or derivatives thereof, at least one other ligand is not serotonin, tryptamine or derivatives thereof. Preferentially, 5-HT transporter ligands or analogs or derivatives thereof used in the invention are bound to only the 5-HT transporter. Further herein, the 5-HT transporter ligands or related derivatives or analogs thereof suitable for use in the invention, including citalopram, dapoxetine, duloxetine, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, tianeptine, tramadol, venlafaxine, serotonin, tryptamine, are referred to as ligands L1-L13. Preparation of various multimeric ligands of the invention is exemplified in the Examples set forth herein. However, generally, the ligands may be joined by a linker by any method known in the art. For example, ligands having terminal amino groups may be linked by reaction with aldehyde linkers to form a Schiff s base, which can be used as a linker or, optionally, reduced to give a saturated linker. Alternatively, reaction with a disulfonyl halide would give a sulfonamide linker. Another alternative synthesis encompasses reaction of an amine with a diiminoester, which would afford an amidine linker. Ligands that include a free hydroxy group in their structure, such as an alcohol or phenolic hydroxy, may be connected using those hydroxy groups as linkage points by means well known in the art. For example, one synthetic strategy that could be used for linking ligands with free hydroxy groups involves treating the ligand with t-butyl bromoacetate in the presence of a suitable base (e.g. potassium carbonate, NaH) to convert the -OH group to an -O-CH 2 CO 2 -t- But group, which can be hydrolyzed to an O-CH 2 CO 2 H group using trifluoracetic acid. The oxyacetic group can then be used as the linking point for two ligands by making use of the linking strategies known for carboxylic acids. For example, reaction of two molar equivalents of the ligand with a diamine of the formula H 2 N-(CH 2 ) n -NH 2 , where n is an integer of 1-20, leads to two ligands being connected by a linker of the formula -CH 2 CONH-(CH 2 ) n -NHCOCH 2 . Alternatively, treating an alkoxy-bearing ligand with BOC-NHCH 2 CH 2 Br effectively converts the -OH group to an O-CH 2 CH 2 NH-BOC group, which can by deprotected to give an O-CH 2 CH 2 NH 2 group using trifluoracetic acid. The oxyethylamino group can then be used as the linking point for two ligands by making use of the linking strategies shown above for amines. For example, reaction of two molar equivalents of the ligand with a dicarboxylic acid of the formula HO 2 C-(CH 2 ) n -CO 2 H where n is an integer of 1-20, leads to two ligands being connected by a linker of the formula: -CH 2 CH 2 NHCO-(CH 2 ) n -CONHCH 2 CH 2 - . Alternatively, converting the hydroxy-group to a leaving group, for example by treatment with mesyl chloride or tosyl chloride, or converting the hydroxy group to a halide by means well known in the art, the ligand can then be linked directly by reaction with a diamine. The Mannich reaction can be used to link ligands that have an "active" hydrogen in their molecular structure. Examples of such active hydrogens are hydrogens that are adjacent to an electron withdrawing group such as a ketone, aldehyde, acid or ester, nitrile, and nitro group, and the like. The Mannich reaction is well known to those skilled in the art, and many reviews in the chemical literature and textbooks on the Mannich reaction are available. Of particular value is that a linker could be constructed on a ligand having an aromatic moiety, providing there is an active hydrogen. As those of skill in the art will appreciate, other art-recognized chemistries can be used to provide ligands with suitable functional groups for attachment to a linker. In view of the above, the chemistry for attaching ligands to linkers is well established in the art and is well within the level of ordinary skill in the art. Combinatorial Libraries Combinatorial approaches for identifying multimeric compounds which possess multibinding properties will now be discussed. Specifically, factors such as the proper juxtaposition of the individual ligands of a multibinding compound with respect to the relevant array of binding sites on a target or targets is important in optimizing the interaction of the multibinding compound with its target(s) and to maximize the biological advantage through multivalency. One approach is to identify a library of candidate multibinding compounds with properties spanning the multibinding parameters that are relevant for a particular target. These parameters include: (1) the identity of ligand(s), (2) the orientation of ligands, (3) the valency of the construct, (4) linker length, (5) linker geometry, (6) linker physical properties, and (7) linker chemical functional groups. Libraries of multimeric compounds potentially possessing multibinding properties (i.e., candidate multibinding compounds) and comprising a multiplicity of such variables are prepared and these libraries are then evaluated via conventional assays corresponding to the ligand selected and the multibinding parameters desired. Considerations relevant to each of these variables are set forth below. Selection of ligand(s) A single ligand or set of ligands is selected for incorporation into the library of candidate multi-binding compounds which library is directed against a particular biological target or targets. The only requirement for the ligands chosen is that they are capable of interacting with the selected target(s). Thus, ligands may be known drugs, modified forms of known drugs, substructures of known drugs or substrates of modified forms of known drugs (which are competent to interact with the target), or other compounds. Ligands are preferably chosen based on known favorable properties that may be projected to be carried over to or amplified in multibinding forms. Favorable properties include demonstrated safety and efficacy in human patients, increased response time, ability to modulate serotomn uptake, increase in cellular serotonin levels, and the like. However, it is crucial to note that ligands which display an unfavorable property from among the previous list may obtain a more favorable property through the process of multibinding compound formation; i.e., ligands should not necessarily be excluded on such a basis. For example, a ligand that is not sufficiently potent at a particular target so as to be efficacious in a human patient may become highly potent and efficacious when presented in multibinding form. A ligand that is potent and efficacious but not of utility because of a non-mechanism-related toxic side effect may have increased therapeutic index (increased potency relative to toxicity) as a multibinding compound. Compounds that exhibit short in vivo half-lives may have extended half-lives as multibinding compounds. Physical properties of ligands that limit their usefulness (e.g. poor bioavailability due to low solubility, hydrophobicity, hydrophilicity, and the like) may be rationally modulated in multibinding forms, providing compounds with physical properties consistent with the desired utility. Orientation: selection of ligand attachment points and linking chemistry Several points are chosen on each ligand at which to attach the ligand to the linker. The selected points on the ligand/linker for attachment are mnctionalized to contain complementary reactive functional groups. This permits probing the effects of presenting the ligands to their transporter(s) in multiple relative orientations, an important multibinding design parameter. The only requirement for choosing attachment points is that attaching to at least one of these points does not abrogate activity of the ligand. Such points for attachment can be identified by structural information when available. Alternatively, evaluation of ligand/target binding by nuclear magnetic resonance will permit the identification of sites non- essential for ligand/target binding. See, for example, Fesik, et al., U.S. Patent No. 5,891,643. When such structural information is not available, utilization of structure-activity relationships (SAR) for ligands will suggest positions where substantial structural variations are and are not allowed. In the absence of both structural and SAR information, a library is merely selected with multiple points of attachment to allow presentation of the ligand in multiple distinct orientations. Subsequent evaluation of this library will indicate what positions are suitable for attachment. It is important to emphasize that positions of attachment that do abrogate the activity of the monomeric ligand may also be advantageously included in candidate multibinding compounds in the library provided that such compounds bear at least one ligand attached in a manner which does not abrogate intrinsic activity. This selection derives from, for example, heterobivalent interactions within the context of a single target molecule. For example, consider a transporter antagonist ligand bound to its target transporter, and then consider modifying this ligand by attaching to it a second copy of the same ligand with a linker which allows the second ligand to interact with the same transporter molecule at sites proximal to the antagonist binding site, which include elements of the transporter that are not part of the formal antagonist binding site and/or elements of the matrix surrounding the transporter such as the membrane. Here, the most favorable orientation for interaction of the second ligand molecule with the transporter/matrix may be achieved by attaching it to the linker at a position which abrogates activity of the ligand at the formal antagonist binding site. Another way to consider this is that the SAR of individual ligands within the context of a multibinding structure is often different from the SAR of those same ligands in momomeric form. The foregoing discussion focused on bivalent interactions of dimeric compounds bearing two copies of the same ligand joined to a single linker through different attachment points, one of which may abrogate the binding/activity of the monomeric ligand. It should also be understood that bivalent advantage may also be attained with heterodimeric constructs bearing two different ligands that bind to common or different targets. For example, the 5-HT transporter ligands fluoxetine and serotonin may be joined to a linker through attachment points which do not abrogate the binding affinity of the monomeric ligands for their respective transporter sites. The dimeric compound may achieve enhanced affinity for the transporter (s) due to favorable interactions between the 5-HT transporter ligand and elements of the 5-HT transporter binding site. Thus, the dimeric compound may be a more potent and selective antagonist of serotonin uptake and a superior therapy for depression, as well as possibly anxiety, alcoholism, chronic pain, emesis and eating disorders such as obesity and bulimia. Once the ligand attachment points have been chosen, one identifies the types of chemical linkages that are possible at those points. The most preferred types of chemical linkages are those that are compatible with the overall structure of the ligand (or protected forms of the ligand), readily and generally formed, stable and intrinsically innocuous under typical chemical and physiological conditions, and compatible with a large number of available linkers. Amide bonds, ethers, amines, carbamates, ureas, and sulfonamides are but a few examples of preferred linkages. Linkers: spanning relevant multibinding parameters through selection of valency. linker length, linker geometry, rigidity, physical properties, and chemical functional groups In the library of linkers employed to generate the library of candidate multibinding compounds, the selection of linkers employed in this library of linkers takes into consideration the following factors. Valency. In most instances the library of linkers is initiated with divalent linkers. The choice of ligands and proper juxtaposition of two ligands relative to their binding sites permits such molecules to exhibit target binding affinities and specificities more than sufficient to confer biological advantage. Furthermore, divalent linkers or constructs are also typically of modest size such that they retain the desirable biodistribution properties of small molecules. Linker length. Linkers are chosen in a range of lengths to allow the spanning of a range of inter-ligand distances that encompass the distance preferable for a given divalent interaction. In some instances the preferred distance can be estimated rather precisely from high-resolution structural information of targets, typically enzymes and soluble transporter targets. In other instances where high-resolution structural information is not available, one can make use of simple models to estimate the maximum distance between binding sites either on adjacent transporters or at different locations on the same transporter. In situations where two binding sites are present on the same target (or target subunit for multisubunit targets), preferred linker distances are 2-20 A, with more preferred linker distances of 3-12 A. In situations where two binding sites reside on separate (e.g., protein) target sites, preferred linker distances are 20-100 A, with more preferred distances of 30-70 A. Linker geometry and rigidity. The combination of ligand attachment site, linker length, linker geometry, and linker rigidity determine the possible ways in which the ligands of candidate multibinding compounds may be displayed in three dimensions and thereby presented to their binding sites. Linker geometry and rigidity are nominally determined by chemical composition and bonding pattern, which may be controlled and are systematically varied as another spanning function in a multibinding array. For example, linker geometry is varied by attaching two ligands to the ortho, meta, and para positions of a benzene ring, or in cis- or trans-arrangements at the 1,1- vs. 1,2- vs. 1,3- vs. 1,4- positions around a cyclohexane core or in cis- or trans-arrangements at a point of ethylene unsamration. Linker rigidity is varied by controlling the number and relative energies of different conformational states possible for the linker. For example, a divalent compound bearing two ligands joined by 1,8-octyl linker has many more degrees of freedom, and is therefore less rigid than a compound in which the two ligands are attached to the 4,4' positions of a biphenyl linker. Linker physical properties. The physical properties of linkers are nominally determined by the chemical constitution and bonding patterns of the linker, and linker physical properties impact the overall physical properties of the candidate multibinding compounds in which they are included. A range of linker compositions is typically selected to provide a range of physical properties (hydrophobicity, hydrophilicity, amphiphilicity, polarization and/or polarizability, acidity, and basicity) in the candidate multibinding compounds. The particular choice of linker physical properties is made within the context of the physical properties of the ligands they join and, preferably, the goal is to generate molecules with favorable properties. For example, linkers can be selected to avoid those that are too hydrophilic or too hydrophobic to be readily absorbed and/or distributed in vivo. Linker chemical functional groups. Linker chemical functional groups are selected to be compatible with the chemistry chosen to connect linkers to the ligands and to impart the range of physical properties sufficient to span initial examination of this parameter. Combinatorial synthesis Having chosen a set of n ligands (n being determined by the sum of the number of different attachment points for each ligand chosen) and m linkers by the process outlined above, a library of (n\)m candidate divalent multibinding compounds is prepared which spans the relevant multibinding design parameters for a particular target. For example, an array generated from two ligands, one which has two attachment points (Al, A2) and one which has three attachment points (Bl, B2, B3) joined in all possible combinations provide for at least 15 possible combinations of multibinding compounds: Al-Al A1-A2 Al-Bl A1-B2 A1-B3 A2-A2 A2-B1 A2-B2 A2-B3 Bl-Bl B1-B2 B1-B3 B2-B2 B2-B3 B3-B3 When each of these combinations is joined by 10 different linkers, a library of 150 candidate multibinding compounds results. Given the combinatorial nature of the library, common chemistries are preferably used to join the reactive functionalities on the ligands with complementary reactive functionalities on the linkers. The library therefore lends itself to efficient parallel synthetic methods. The combinatorial library can employ solid phase chemistries well known in the art wherein the ligand and/or linker is attached to a solid support. Alternatively and preferably, the combinatorial library is prepared in the solution phase. After synthesis, candidate multibinding compounds are optionally purified before assaying for activity by, for example, chromatographic methods (e.g., HPLC). Analysis of array by biochemical, analytical, pharmacological, and computational methods Various methods are used to characterize the properties and activities of the candidate multibinding compounds in the library to determine which compounds possess multibinding properties. Physical constants such as solubility under various solvent conditions and logD/clogD values are determined. A combination of NMR spectroscopy and computational methods is used to determine low-energy conformations of the candidate multibinding compounds in fluid media. The ability of the members of the library to bind to the desired target and other targets is determined by various standard methods, such as radioligand displacement assays for receptor and ion channel targets, and kinetic inhibition analysis for many enzyme targets. In vitro efficacy is also determined. Pharmacological data, including oral absorption, everted gut penetration, other pharmacokinetic parameters and efficacy data are determined in appropriate models. In this way, key strucmre-activity relationships are obtained for multibinding design parameters which are then used to direct future work. The members of the library which exhibit multibinding properties, as defined herein, can be readily determined by conventional methods. First, those members which exhibit multibinding properties are identified by conventional methods as described above, including conventional assays (both in vitro and in vivo). Second, ascertaining the structure of those compounds which exhibit multibinding properties can be accomplished via art recognized procedures. For example, each member of the library can be encrypted or tagged with appropriate information allowing determination of the structure of relevant members at a later time. See, for example, Dower, et al., International Patent Application Publication No. WO 93/06121; Brenner, et al., Proc. Natl. Acad. Sci., USA, 89:5181 (1992); Gallop, et al., U.S. Patent No. 5,846,839; each of which is incorporated herein by reference in its entirety. Alternatively, the structure of relevant multivalent compounds can also be determined from soluble and untagged libraries of candidate multivalent compounds by methods known in the art, such as those described by Hindsgaul, et al., Canadian Patent Application No. 2,240,325 which was published on July 11, 1998. Such methods couple frontal affinity chromatography with mass spectroscopy to determine both the structure and relative binding affinities of candidate multibinding compounds to transporters. The process set forth above for dimeric candidate multibinding compounds can, of course, be extended to trimeric candidate compounds and higher analogs thereof. Follow-up synthesis and analysis of additional array(s) Based on the information obtained through analysis of the initial library, an optional component of the process is to ascertain one or more promising multibinding "lead" compounds as defined by particular relative ligand orientations, linker lengths, linker geometries, etc. Additional libraries can then be generated around these leads to provide for further information regarding structure to activity relationships. These arrays typically bear more focused variations in linker structure to further optimize target affinity and/or activity at the target (antagonism, partial agonism, etc.), and/or alter physical properties. By iterative redesign/analysis using the novel principles of multibinding design along with classical medicinal chemistry, biochemistry, and pharmacology approaches, one is able to prepare and identify optimal multibinding compounds that exhibit biological advantage towards their targets and as therapeutic agents. To further elaborate upon this procedure, suitable divalent linkers include, by way of example only, those derived from dicarboxylic acids, disulfonylhalides, dialdehydes, dipseudohalides, diketones, dihalides, diisocyanates, diamines, diols, diboronates, mixtures of carboxylic acids, sulfonylhalides, aldehydes, ketones, halides, psuedohalides, isocyanates, boronates, amines and alcohols. In each case, the carboxylic acid, sulfonylhalide, aldehyde, ketone, halide, psuedohalide, isocyanate, boronate, amine and alcohol functional group is reacted with a complementary functionality on the ligand to form a covalent linkage. Such complementary functionality is well known in the art as illustrated in the following table, which is exemplary only: COMPLEMENTARY BINDING CHEMISTRIES First Reactive Group Second Reactive Group Linkage hydroxyl isocyanate urethane amine epoxide β-hydroxyamine sulfonyl halide amine sulfonamide carboxyl acid amine amide hydroxyl alkyl/aryl halide ether aldehyde amine/NaCNBH 3 amine ketone amine/NaCNBH 3 amine amine isocyanate urea Exemplary linkers include the following linkers identified as X-l through X-418 as set forth below in Table 1: Representative ligands for use in this invention include, by way of example, L-1 through L-13 as identified above, their derivatives and analogs thereof. Combinations of ligands (L) and linkers (X) per this invention include, by way example only, homo- and hetero-dimers wherein a first ligand is selected from L-1 through L-13 above and the second ligand and linker is selected from the following, with the proviso that when one ligand is selected from serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof: L-l/X-1- L-l/X-2- L-l/X-3- L-l/X-4- L-l/X-5- L-l/X-6- L-l/X-7- L-l/X-8- L-l/X-9- L-l/X-10- L-l/X-11- L-l/X-12- L-l/X-13- L-l/X-14- L-l/X-15- L-l/X-16- L-l/X-17- L-l/X-18- L-l/X-19- L-l/X-20- L-l/X-21- L-l/X-22- L-l/X-23- L-l/X-24- L-l/X-25- L-l/X-26- L-l/X-27- L-l/X-28- L-l/X-29- L-l/X-30- L-l/X-31- L-l/X-32- L-l/X-33- L-l/X-34- L-l/X-35- L-l/X-36- L-l/X-37- L-l/X-38- L-l/X-39- L-l/X-40- L-l/X-41- L-l/X-42- L-l/X-43- L-l/X-44- L-l/X-45- L-l/X-46- L-l/X-47- L-l/X-48- L-l/X-49- L-l/X-50- L-l/X-51- L-l/X-52- L-l/X-53- L-l/X-54- L-l/X-55- L-l/X-56- L-l/X-57- L-l/X-58- L-l/X-59- L-l/X-60- L-l/X-61- L-l/X-62- L-l/X-63- L-l/X-64- L-l/X-65- L-l/X-66- L-l/X-67- L-l/X-68- L-l/X-69- L-l/X-70- L-l/X-71- L-l/X-72- L-l/X-73- L-l/X-74- L-l/X-75- L-l/X-76- L-l/X-77- L-l/X-78- L-l/X-79- L-l/X-80- L-l/X-81- L-l/X-82- L-l/X-83- L-l/X-84- L-l/X-85- L-l/X-86- L-l/X-87- L-l/X-88- L-l/X-89- L-l/X-90- L-l/X-91- L-l/X-92- L-l/X-93- L-l/X-94- L-l/X-95- L-l/X-96- L-l/X-97- L-l/X-98- L-l/X-99- L-l/X-100- L-l/X-101- L-l/X-102- L-l/X-103- L-l/X-104- L-l/X-105- L-l/X-106- L-l/X-107- L-l/X-108- L-l/X-109- L-l/X-110- L-l/X-111- L-l/X-112- L-l/X-113- L-l/X-114- L-l/X-115- L-l/X-116- L-l/X-117- L-l/X-118- L-l/X-119- L-l/X-120- L-l/X-121- L-l/X-122- L-l/X-123- L-l/X-124- L-l/X-125- L-l/X-126- L-l/X-127- L-l/X-128- L-l/X-129- L-l/X-130- L-l/X-131- L-l/X-132- L-l/X-133- L-l/X-134- L-l/X-135- L-l/X-136- L-l/X-137- L-l/X-138- L-l/X-139- L-l/X-140- L-l/X-141- L-l/X-142- L-l/X-143- L-l/X-144- L-l/X-145- L-l/X-146- L-l/X-147- L-l/X-148- L-l/X-149- L-l/X-150- L-l/X-151- L-l/X-152- L-l/X-153- L-l/X-154- L-l/X-155- L-l/X-156- L-l/X-157- L-l/X-158- L-l/X-159- L-l/X-160- L-l/X-161- L-l/X-162- L-l/X-163- L-l/X-164- L-l/X-165- L-l/X-166- L-l/X-167- L-l/X-168- L-l/X-169- L-l/X-170- L-l/X-171- L-l/X-172- L-l/X-173- L-l/X-174- L-l/X-175- L-l/X-176- L-l/X-177- L-l/X-178- L-l/X-179- L-l/X-180- L-l/X-181- L-l/X-182- L-l/X-183- L-l/X-184- L-l/X-185- L-l/X-186- L-l/X-187- L-l/X-188- L-l/X-189- L-l/X-190- L-l/X-191- L-l/X-192- L-l/X-193- L-l/X-194- L-l/X-195- L-l/X-196- L-l/X-197- L-l/X-198- L-l/X-199- L-l/X-200- L-l/X-201- L-l/X-202- L-l/X-203- L-l/X-204- L-l/X-205- L-l/X-206- L-l/X-207- L-l/X-208- L-l/X-209- L-l/X-210- L-l/X-211- L-l/X-212- L-l/X-213- L-l/X-214- L-l/X-215- L-l/X-216- L-l/X-217- L-l/X-218- L-l/X-219- L-l/X-220- L-l/X-221- L-l/X-222- L-l/X-223- L-l/X-224- L-l/X-225- L-l/X-226- L-l/X-227- L-l/X-228- L-l/X-229- L-l/X-230- L-l/X-231- L-l/X-232- L-l/X-233- L-l/X-234- L-l/X-235- L-l/X-236- L-l/X-237- L-l/X-238- L-l/X-239- L-l/X-240- L-l/X-241- L-l/X-242- L-l/X-243- L-l/X-244- L-l/X-245- L-l/X-246- L-l/X-247- L-l/X-248- L-l/X-249- L-l/X-250- L-l/X-251- L-l/X-252- L-l/X-253- L-l/X-254- L-l/X-255- L-l/X-256- L-l/X-257- L-l/X-258- L-l/X-259- L-l/X-260- L-l/X-261- L-l/X-262- L-l/X-263- L-l/X-264- L-l/X-265- L-l/X-266- L-l/X-267- L-l/X-268- L-l/X-269- L-l/X-270- L-l/X-271- L-l/X-272- L-l/X-273- L-l/X-274- L-l/X-275- L-l/X-276- L-l/X-277- L-l/X-278- L-l/X-279- L-l/X-280- L-l/X-281- L-l/X-282- L-l/X-283- L-l/X-284- L-l/X-285- L-l/X-286- L-l/X-287- L-l/X-288- L-l/X-289- L-l/X-290- L-l/X-291- L-l/X-292- L-l/X-293- L-l/X-294- L-l/X-295- L-l/X-296- L-l/X-297- L-l/X-298- L-l/X-299- L-l/X-300- L-l/X-301- L-l/X-302- L-l/X-303- L-l/X-304- L-l/X-305- L-l/X-306- L-l/X-307- L-l/X-308- L-l/X-309- L-l/X-310- L-l/X-311- L-l/X-312- L-l/X-313- L-l/X-314- L-l/X-315- L-l/X-316- L-l/X-317- L-l/X-318- L-l/X-319- L-l/X-320- L-l/X-321- L-l/X-322- L-l/X-323- L-l/X-324- L-l/X-325- L-l/X-326- L-l/X-327- L-l/X-328- L-l/X-329- L-l/X-330- L-l/X-331- L-l/X-332- L-l/X-333- L-l/X-334- L-l/X-335- L-l/X-336- L-l/X-337- L-l/X-338- L-l/X-339- L-l/X-340- L-l/X-341- L-l/X-342- L-l/X-343- L-l/X-344- L-l/X-345- L-l/X-346- L-l/X-347- L-l/X-348- L-l/X-349- L-l/X-350- L-l/X-351- L-l/X-352- L-l/X-353- L-l/X-354- L-l/X-355- L-l/X-356- L-l/X-357- L-l/X-358- L-l/X-359- L-l/X-360- L-l/X-361- L-l/X-362- L-l/X-363- L-l/X-364- L-l/X-365- L-l/X-366- L-l/X-367- L-l/X-368- L-l/X-369- L-l/X-370- L-l/X-371- L-l/X-372- L-l/X-373- L-l/X-374- L-l/X-375- L-l/X-376- L-l/X-377- L-l/X-378- L-l/X-379- L-l/X-380- L-l/X-381- L-l/X-382- L-l/X-383- L-l/X-384- L-l/X-385- L-l/X-386- L-l/X-387- L-l/X-388- L-l/X-389- L-l/X-390- L-l/X-391- L-l/X-392- L-l/X-393- L-l/X-394- L-l/X-395- L-l/X-396- L-l/X-397- L-l/X-398- L-l/X-399- L-l/X-400- L-l/X-401- L-l/X-402- L-l/X-403- L-l/X-404- L-l/X-405- L-l/X-406- L-l/X-407- L-l/X-408- L-l/X-409- L-l/X-410- L-l/X-411- L-l/X-412- L-l/X-413- L-l/X-414- L-l/X-415- L-l/X-416- L-l/X-417- L-l/X-418- L-2/X-1- L-2/X-2- L-2/X-3- L-2/X-4- L-2/X-5- L-2/X-6- L-2/X-7- L-2/X-8- L-2/X-9- L-2/X-10- L-2/X-11- L-2/X-12- L-2/X-13- L-2/X-14- L-2/X-15- L-2/X-16- L-2/X-17- L-2/X-18- L-2/X-19- L-2/X-20- L-2/X-21- L-2/X-22- L-2/X-23- L-2/X-24- L-2/X-25- L-2/X-26- L-2/X-27- L-2/X-28- L-2/X-29- L-2/X-30- L-2/X-31- L-2/X-32- L-2/X-33- L-2/X-34- L-2/X-35- L-2/X-36- L-2/X-37- L-2/X-38- L-2/X-39- L-2/X-40- L-2/X-41- L-2/X-42- L-2/X-43- L-2/X-44- L-2/X-45- L-2/X-46- L-2/X-47- L-2/X-48- L-2/X-49- L-2/X-50- L-2/X-51- L-2/X-52- L-2/X-53- L-2/X-54- L-2/X-55- L-2/X-56- L-2/X-57- L-2/X-58- L-2/X-59- L-2/X-60- L-2/X-61- L-2/X-62- L-2/X-63- L-2/X-64- L-2/X-65- L-2/X-66- L-2/X-67- L-2/X-68- L-2/X-69- L-2/X-70- L-2/X-71- L-2/X-72- L-2/X-73- L-2/X-74- L-2/X-75- L-2/X-76- L-2/X-77- L-2/X-78- L-2/X-79- L-2/X-80- L-2/X-81- L-2/X-82- L-2/X-83- L-2/X-84- L-2/X-85- L-2/X-86- L-2/X-87- L-2/X-88- L-2/X-89- L-2/X-90- L-2/X-91- L-2/X-92- L-2/X-93- L-2/X-94- L-2/X-95- L-2/X-96- L-2/X-97- L-2/X-98- L-2/X-99- L-2/X-100- L-2/X-101- L-2/X-102- L-2/X-103- L-2/X-104- L-2/X-105- L-2/X-106- L-2/X-107- L-2/X-108- L-2/X-109- L-2/X-110- L-2/X-111- L-2/X-112- L-2/X-113- L-2/X-114- L-2/X-115- L-2/X-116- L-2/X-117- L-2/X-118- L-2/X-119- L-2/X-120- L-2/X-121- L-2/X-122- L-2/X-123- L-2/X-124- L-2/X-125- L-2/X-126- L-2/X-127- L-2/X-128- L-2/X-129- L-2/X-130- L-2/X-131- L-2/X-132- L-2/X-133- L-2/X-134- L-2/X-135- L-2/X-136- L-2/X-137- L-2/X-138- L-2/X-139- L-2/X-140- L-2/X-141- L-2/X-142- L-2/X-143- L-2/X-144- L-2/X-145- L-2/X-146- L-2/X-147- L-2/X-148- L-2/X-149- L-2/X-150- L-2/X-151- L-2/X-152- L-2/X-153- L-2/X-154- L-2/X-155- L-2/X-156- L-2/X-157- L-2/X-158- L-2/X-159- L-2/X-160- L-2/X-161- L-2/X-162- L-2/X-163- L-2/X-164- L-2/X-165- L-2/X-166- L-2/X-167- L-2/X-168- L-2/X-169- L-2/X-170- L-2/X-171- L-2/X-172- L-2/X-173- L-2/X-174- L-2/X-175- L-2/X-176- L-2/X-177- L-2/X-178- L-2/X-179- L-2/X-180- L-2/X-181- L-2/X-182- L-2/X-183- L-2/X-184- L-2/X-185- L-2/X-186- L-2/X-187- L-2/X-188- L-2/X-189- L-2/X-190- L-2/X-191- L-2/X-192- L-2/X-193- L-2/X-194- L-2/X-195- L-2/X-196- L-2/X-197- L-2/X-198- L-2/X-199- L-2/X-200- L-2/X-201- L-2/X-202- L-2/X-203- L-2/X-204- L-2/X-205- L-2/X-206- L-2/X-207- L-2/X-208- L-2/X-209- L-2/X-210- L-2/X-211- L-2/X-212- L-2/X-213- L-2/X-214- L-2/X-215- L-2/X-216- L-2/X-217- L-2/X-218- L-2/X-219- L-2/X-220- L-2/X-221- L-2/X-222- L-2/X-223- L-2/X-224- L-2/X-225- L-2/X-226- L-2/X-227- L-2/X-228- L-2/X-229- L-2/X-230- L-2/X-231- L-2/X-232- L-2/X-233- L-2/X-234- L-2/X-235- L-2/X-236- L-2/X-237- L-2/X-238- L-2/X-239- L-2/X-240- L-2/X-241- L-2/X-242- L-2/X-243- L-2/X-244- L-2/X-245- L-2/X-246- L-2/X-247- L-2/X-248- L-2/X-249- L-2/X-250- L-2/X-251- L-2/X-252- L-2/X-253- L-2/X-254- L-2/X-255- L-2/X-256- L-2/X-257- L-2/X-258- L-2/X-259- L-2/X-260- L-2/X-261- L-2/X-262- L-2/X-263- L-2/X-264- L-2/X-265- L-2/X-266- L-2/X-267- L-2/X-268- L-2/X-269- L-2/X-270- L-2/X-271- L-2/X-272- L-2/X-273- L-2/X-274- L-2/X-275- L-2/X-276- L-2/X-277- L-2/X-278- L-2/X-279- L-2/X-280- L-2/X-281- L-2/X-282- L-2/X-283- L-2/X-284- L-2/X-285- L-2/X-286- L-2/X-287- L-2/X-288- L-2/X-289- 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L-12/X-363- L-12/X-364- L-12/X-365- L-12/X-366- L-12/X-367- L-12/X-368- L-12/X-369- L-12/X-370- L-12/X-371- L-12/X-372- L-12/X-373- L-12/X-374- L-12/X-375- L-12/X-376- L-12/X-377- L-12/X-378- L-12/X-379- L-12/X-380- L-12/X-381- L-12/X-382- L-12/X-383- L-12/X-384- L-12/X-385- L-12/X-386- L-12/X-387- L-12/X-388- L-12/X-389- L-12/X-390- L-12/X-391- L-12/X-392- L-12/X-393- L-12/X-394- L-12/X-395- L-12/X-396- L-12/X-397- L-12/X-398- L-12/X-399- L-12/X-400- L-12/X-401- L-12/X-402- L-12/X-403- L-12/X-404- L-12/X-405- L-12/X-406- L-12/X-407- L-12/X-408- L-12/X-409- L-12/X-410- L-12/X-411- L-12/X-412- L-12/X-413- L-12/X-414- L-12/X-415- L-12/X-416- L-12/X-417- L-12/X-418- L-13/X-1- L-13/X-2- L-13/X-3- L-13/X-4- L-13/X-5- L-13/X-6- L-13/X-7- L-13/X-8- L-13/X-9- L-13/X-10- L-13/X-11- L-13/X-12- L-13/X-13- L-13/X-14- L-13/X-15- L-13/X-16- L-13/X-17- L-13/X-18- L-13/X-19- L-13/X-20- L-13/X-21- L-13/X-22- L-13/X-23- L-13/X-24- L-13/X-25- L-13/X-26- L-13/X-27- L-13/X-28- L-13/X-29- L-13/X-30- L-13/X-31- L-13/X-32- L-13/X-33- L-13/X-34- L-13/X-35- L-13/X-36- L-13/X-37- L-13/X-38- L-13/X-39- L-13/X-40- L-13/X-41- L-13/X-42- L-13/X-43- L-13/X-44- L-13/X-45- L-13/X-46- L-13/X-47- L-13/X-48- L-13/X-49- L-13/X-50- L-13/X-51- L-13/X-52- L-13/X-53- L-13/X-54- L-13/X-55- L-13/X-56- L-13/X-57- L-13/X-58- L-13/X-59- L-13/X-60- L-13/X-61- L-13/X-62- L-13/X-63- L-13/X-64- L-13/X-65- L-13/X-66- L-13/X-67- L-13/X-68- L-13/X-69- L-13/X-70- L-13/X-71- L-13/X-72- L-13/X-73- L-13/X-74- L-13/X-75- L-13/X-76- L-13/X-77- L-13/X-78- L-13/X-79- L-13/X-80- L-13/X-81- L-13/X-82- L-13/X-83- L-13/X-84- L-13/X-85- L-13/X-86- L-13/X-87- L-13/X-88- L-13/X-89- L-13/X-90- L-13/X-91- L-13/X-92- L-13/X-93- L-13/X-94- L-13/X-95- L-13/X-96- L-13/X-97- L-13/X-98- L-13/X-99- L-13/X-100- L-13/X-101- L-13/X-102- L-13/X-103- L-13/X-104- L-13/X-105- L-13/X-106- L-13/X-107- L-13/X-108- L-13/X-109- L-13/X-110- L-13/X-111- L-13/X-112- L-13/X-113- L-13/X-114- L-13/X-115- L-13/X-116- L-13/X-117- L-13/X-118- L-13/X-119- L-13/X-120- L-13/X-121- L-13/X-122- L-13/X-123- L-13/X-124- L-13/X-125- L-13/X-126- L-13/X-127- L-13/X-128- L-13/X-129- L-13/X-130- L-13/X-131- L-13/X-132- L-13/X-133- L-13/X-134- L-13/X-135- L-13/X-136- L-13/X-137- L-13/X-138- L-13/X-139- L-13/X-140- L-13/X-141- L-13/X-142- L-13/X-143- L-13/X-144- L-13/X-145- L-13/X-146- L-13/X-147- L-13/X-148- L-13/X-149- L-13/X-150- L-13/X-151- L-13/X-152- L-13/X-153- L-13/X-154- L-13/X-155- L-13/X-156- L-13/X-157- L-13/X-158- L-13/X-159- L-13/X-160- L-13/X-161- L-13/X-162- L-13/X-163- L-13/X-164- L-13/X-165- L-13/X-166- L-13/X-167- L-13/X-168- L-13/X-169- L-13/X-170- L-13/X-171- L-13/X-172- L-13/X-173- L-13/X-174- L-13/X-175- L-13/X-176- L-13/X-177- L-13/X-178- L-13/X-179- L-13/X-180- L-13/X-181- L-13/X-182- L-13/X-183- L-13/X-184- L-13/X-185- L-13/X-186- L-13/X-187- L-13/X-188- L-13/X-189- L-13/X-190- L-13/X-191- L-13/X-192- L-13/X-193- L-13/X-194- L-13/X-195- L-13/X-196- L-13/X-197- L-13/X-198- L-13/X-199- L-13/X-200- L-13/X-201- L-13/X-202- L-13/X-203- L-13/X-204- L-13/X-205- L-13/X-206- L-13/X-207- L-13/X-208- L-13/X-209- L-13/X-210- L-13/X-211- L-13/X-212- L-13/X-213- L-13/X-214- L-13/X-215- L-13/X-216- L-13/X-217- L-13/X-218- L-13/X-219- L-13/X-220- L-13/X-221- L-13/X-222- L-13/X-223- L-13/X-224- L-13/X-225- L-13/X-226- L-13/X-227- L-13/X-228- L-13/X-229- L-13/X-230- L-13/X-231- L-13/X-232- L-13/X-233- L-13/X-234- L-13/X-235- L-13/X-236- L-13/X-237- L-13/X-238- L-13/X-239- L-13/X-240- L-13/X-241- L-13/X-242- L-13/X-243- L-13/X-244- L-13/X-245- L-13/X-246- L-13/X-247- L-13/X-248- L-13/X-249- L-13/X-250- L-13/X-251- L-13/X-252- L-13/X-253- L-13/X-254- L-13/X-255- L-13/X-256- L-13/X-257- L-13/X-258- L-13/X-259- L-13/X-260- L-13/X-261- L-13/X-262- L-13/X-263- L-13/X-264- L-13/X-265- L-13/X-266- L-13/X-267- L-13/X-268- L-13/X-269- L-13/X-270- L-13/X-271- L-13/X-272- L-13/X-273- L-13/X-274- L-13/X-275- L-13/X-276- L-13/X-277- L-13/X-278- L-13/X-279- L-13/X-280- L-13/X-281- L-13/X-282- L-13/X-283- L-13/X-284- L-13/X-285- L-13/X-286- L-13/X-287- L-13/X-288- L-13/X-289- L-13/X-290- L-13/X-291- L-13/X-292- L-13/X-293- L-13/X-294- L-13/X-295- L-13/X-296- L-13/X-297- L-13/X-298- L-13/X-299- L-13/X-300- L-13/X-301- L-13/X-302- L-13/X-303- L-13/X-304- L-13/X-305- L-13/X-306- L-13/X-307- L-13/X-308- L-13/X-309- L-13/X-310- L-13/X-311- L-13/X-312- L-13/X-313- L-13/X-314- L-13/X-315- L-13/X-316- L-13/X-317- L-13/X-318- L-13/X-319- L-13/X-320- L-13/X-321- L-13/X-322- L-13/X-323- L-13/X-324- L-13/X-325- L-13/X-326- L-13/X-327- L-13/X-328- L-13/X-329- L-13/X-330- L-13/X-331- L-13/X-332- L-13/X-333- L-13/X-334- L-13/X-335- L-13/X-336- L-13/X-337- L-13/X-338- L-13/X-339- L-13/X-340- L-13/X-341- L-13/X-342- L-13/X-343- L-13/X-344- L-13/X-345- L-13/X-346- L-13/X-347- L-13/X-348- L-13/X-349- L-13/X-350- L-13/X-351- L-13/X-352- L-13/X-353- L-13/X-354- L-13/X-355- L-13/X-356- L-13/X-357- L-13/X-358- L-13/X-359- L-13/X-360- L-13/X-361- L-13/X-362- L-13/X-363- L-13/X-364- L-13/X-365- L-13/X-366- L-13/X-367- L-13/X-368- L-13/X-369- L-13/X-370- L-13/X-371- L-13/X-372- L-13/X-373- L-13/X-374- L-13/X-375- L-13/X-376- L-13/X-377- L-13/X-378- L-13/X-379- L-13/X-380- L-13/X-381- L-13/X-382- L-13/X-383- L-13/X-384- L-13/X-385- L-13/X-386- L-13/X-387- L-13/X-388- L-13/X-389- L-13/X-390- L-13/X-391- L-13/X-392- L-13/X-393- L-13/X-394- L-13/X-395- L-13/X-396- L-13/X-397- L-13/X-398- L-13/X-399- L-13/X-400- L-13/X-401- L-13/X-402- L-13/X-403- L-13/X-404- L-13/X-405- L-13/X-406- L-13/X-407- L-13/X-408- L-13/X-409- L-13/X-410- L-13/X-411- L-13/X-412- L-13/X-413- L-13/X-414- L-13/X-415- L-13/X-416- L-13/X-417- L-13/X-418- Pharmaceutical Formulations When employed as pharmaceuticals, the compounds of the invention are usually administered in the form of pharmaceutical compositions. These compounds can be administered by a variety of routes including oral, rectal, transdermal, subcutaneous, intravenous, intramuscular, and intranasal. These compounds are effective as both injectable and oral compositions. Such compositions are prepared in a manner well known in the pharmaceutical art and comprise at least one active compound. This invention also includes pharmaceutical compositions which contain, as the active ingredient, one or more of the compounds of the invention associated with pharmaceutically acceptable carriers. In making the compositions of this invention, the active ingredient is usually mixed with an excipient, diluted by an excipient or enclosed within such a carrier which can be in the form of a capsule, sachet, paper or other container. When the excipient serves as a diluent, it can be a solid, semi-solid, or liquid material, which acts as a vehicle, carrier or medium for the active ingredient. Thus, the compositions can be in the form of tablets, pills, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments containing, for example, up to 10% by weight of the active compound, soft and hard gelatin capsules, suppositories, sterile injectable solutions, and sterile packaged powders. In preparing a formulation, it may be necessary to mill the active compound to provide the appropriate particle size prior to combining with the other ingredients. If the active compound is substantially insoluble, it ordinarily is milled to a particle size of less than 200 mesh. If the active compound is substantially water soluble, the particle size is normally adjusted by milling to provide a substantially uniform distribution in the formulation, e.g. about 40 mesh. Some examples of suitable excipients include lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum acacia, calcium phosphate, alginates, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, sterile water, syrup, and methyl cellulose. The formulations can additionally include: lubricating agents such as talc, magnesium stearate, and mineral oil; wetting agents; emulsifying and suspending agents; preserving agents such as methyl- and propylhydroxy-benzoates; sweetening agents; and flavoring agents. The compositions of the invention can be formulated so as to provide quick, sustained or delayed release of the active ingredient after administration to the patient by employing procedures known in the art. The compositions are preferably formulated in a unit dosage form, each dosage containing from about 5 to about 100 mg, more usually about 10 to about 30 mg, of the active ingredient. The term "unit dosage forms" refers to physically discrete units suitable as unitary dosages for human subjects and other mammals, each unit containing a predetermined quantity of active material calculated to produce the desired therapeutic effect, in association with a suitable pharmaceutical excipient. Preferably, the compound of the invention is employed at no more than about 20 weight percent of the pharmaceutical composition, more preferably no more than about 15 weight percent, with the balance being pharmaceutically inert carrier(s). The active compound is effective over a wide dosage range and is generally admimstered in a pharmaceutically effective amount. It, will be understood, however, that the amount of the compound acmally administered will be determined by a physician or veterinarian, in the light of the relevant circumstances, including the condition to be treated, the chosen route of administration, the actual compound administered and its relative activity, the age, weight, and response of the individual patient, the severity of the patient's symptoms, and the like. For preparing solid compositions such as tablets, the principal active ingredient is mixed with a pharmaceutical excipient to form a solid preformulation composition containing a homogeneous mixmre of a compound of the present invention. When referring to these preformulation compositions as homogeneous, it is meant that the active ingredient is dispersed evenly throughout the composition so that the composition may be readily subdivided into equally effective unit dosage forms such as tablets, pills and capsules. This solid preformulation is then subdivided into unit dosage forms of the type described above containing from, for example, 0.1 to about 500 mg of the active ingredient of the present invention. The tablets or pills of the present invention may be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action. For example, the tablet or pill can comprise an inner dosage and an outer dosage component, the latter being in the form of an envelope over the former. The two components can be separated by an enteric layer which serves to resist disintegration in the stomach and permit the inner component to pass intact into the duodenum or to be delayed in release. A variety of materials can be used for such enteric layers or coatings, such materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol, and cellulose acetate. The liquid forms in which the novel compositions of the present invention may be incorporated for administration orally or by injection include aqueous solutions, suitably flavored syrups, aqueous or oil suspensions, and flavored emulsions with edible oils such as corn oil, cottonseed oil, sesame oil, coconut oil, or peanut oil, as well as elixirs and similar pharmaceutical vehicles. Compositions for inhalation or insufflation include solutions and suspensions in pharmaceutically acceptable, aqueous or organic solvents, or mixtures thereof, and powders. The liquid or solid compositions may contain suitable pharmaceutically acceptable excipients as described supra. Preferably the compositions are administered by the oral or nasal respiratory route for local or systemic effect. Compositions in preferably pharmaceutically acceptable solvents may be nebulized by use of inert gases. Nebulized solutions may be inhaled directly from the nebulizing device or the nebulizing device may be attached to a face mask tent, or intermittent positive pressure breathing machine. Solution, suspension, or powder compositions may be administered, preferably orally or nasally, from devices which deliver the formulation in an appropriate manner. The following formulation examples illustrate representative pharmaceutical compositions of the present invention. Formulation Example 1 Hard gelatin capsules containing the following ingredients are prepared: Quantity Ingredient Cmg/capsule') Active Ingredient 30.0 Starch 305.0 Magnesium stearate 5.0 The above ingredients are mixed and filled into hard gelatin capsules in 340 mg quantities. Formulation Example 2 A tablet formula is prepared using the ingredients below: Quantity Ingredient (mg/tablef) Active Ingredient 25.0 Cellulose, microcrystalline 200.0 Colloidal silicon dioxide 10.0 Stearic acid 5.0 The components are blended and compressed to form tablets, each weighing 240 mg. Formulation Example 3 A dry powder inhaler formulation is prepared containing the following components: Ingredient Weight % Active Ingredient 5 Lactose 95 The active ingredient is mixed with the lactose and the mixmre is added to a dry powder inhaling appliance. Formulation Example 4 Tablets, each containing 30 mg of active ingredient, are prepared as follows: Quantity Ingredient (mg/tablet) Active Ingredient 30.0 mg Starch 45.0 mg Microcrystalline cellulose 35.0 mg Polyvinylpyrrolidone (as 10% solution in sterile water) 4.0 mg Sodium carboxymethyl starch 4.5 mg Magnesium stearate 0.5 mg Talc 1.0 mg Total 120 mg The active ingredient, starch and cellulose are passed through a No. 20 mesh U.S. sieve and mixed thoroughly. The solution of polyvinylpyrrolidone is mixed with the resultant powders, which are then passed through a 16 mesh U.S. sieve. The granules so produced are dried at 50° to 60 °C and passed through a 16 mesh U.S. sieve. The sodium carboxymethyl starch, magnesium stearate, and talc, previously passed through a No. 30 mesh U.S. sieve, are then added to the granules which, after mixing, are compressed on a tablet machine to yield tablets each weighing 120 mg. Formulation Example 5 Capsules, each containing 40 mg of medicament are made as follows: Quantity Ingredient (mg/capsule) Active Ingredient 40.0 mg Starch 109.0 mg Magnesium stearate 1.0 mg Total 150.0 mg The active ingredient, starch, and magnesium stearate are blended, passed through a No. 20 mesh U.S. sieve, and filled into hard gelatin capsules in 150 mg quantities. Formulation Example 6 Suppositories, each containing 25 mg of active ingredient are made as follows: Ingredient Amount Active Ingredient 25 mg Saturated fatty acid glycerides to 2,000 mg The active ingredient is passed through a No. 60 mesh U.S. sieve and suspended in the saturated fatty acid glycerides previously melted using the minimum heat necessary. The mixture is then poured into a suppository mold of nominal 2.0 g capacity and allowed to cool. Formulation Example 7 Suspensions, each containing 50 mg of medicament per 5.0 mL dose are made as follows: Ingredient Amount Active Ingredient 50.0 mg Xanthan gum 4.0 mg Sodium carboxymethyl cellulose (11 %) Microcrystalline cellulose (89%) 50.0 mg Sucrose 1.75 g Sodium benzoate 10.0 mg Flavor and Color q.v. Purified water to 5.0 mL The active ingredient, sucrose and xanthan gum are blended, passed through a No. 10 mesh U.S. sieve, and then mixed with a previously made solution of the microcrystalline cellulose and sodium carboxymethyl cellulose in water. The sodium benzoate, flavor, and color are diluted with some of the water and added with stirring. Sufficient water is then added to produce the required volume. Formulation Example 8 Quantity Ingredient (mg/capsule Active Ingredient 15.0 mg Starch 407.0 mg Magnesium stearate 3.0 mg Total 425.0 mg The active ingredient, starch, and magnesium stearate are blended, passed through a No. 20 mesh U.S. sieve, and filled into hard gelatin capsules in 425.0 mg quantities. Formulation Example 9 A formulation may be prepared as follows: Ingredient Quantity Active Ingredient 5.0 mg Corn Oil 1.0 mL Formulation Example 10 A topical formulation may be prepared as follows: Ingredient Quantity Active Ingredient 1-10 g Emulsifying Wax 30 g Liquid Paraffin 20 g White Soft Paraffin to 100 g The white soft paraffin is heated until molten. The liquid paraffin and emulsifying wax are incoφorated and stirred until dissolved. The active ingredient is added and stirring is continued until dispersed. The mixture is then cooled until solid. Another preferred formulation employed in the methods of the present invention employs transdermal delivery devices ("patches"). Such transdermal patches may be used to provide continuous or discontinuous infusion of the compounds of the present invention in controlled amounts. The construction and use of transdermal patches for the delivery of pharmaceutical agents is well known in the art. See, e.g.. U.S. Patent 5,023,252, issued June 11, 1991, herein incorporated by reference. Such patches may be constructed for continuous, pulsatile, or on demand delivery of pharmaceutical agents. Frequently, it will be desirable or necessary to introduce the pharmaceutical composition to the brain, either directly or indirectly. Direct techniques usually involve placement of a drug delivery catheter into the host's ventricular system to bypass the blood-brain barrier. One such implantable delivery system used for the transport of biological factors to specific anatomical regions of the body is described in U.S. Patent 5,011,472, which is herein incorporated by reference. Indirect techniques, which are generally preferred, usually involve formulating the compositions to provide for drug latentiation by the conversion of hydrophilic drugs into lipid-soluble drugs. Latentiation is generally achieved through blocking of the hydroxy, carbonyl, sulfate, and primary amine groups present on the drug to render the drug more lipid soluble and amenable to transportation across the blood-brain barrier. Alternatively, the delivery of hydrophilic drugs may be enhanced by intra-arterial infusion of hypertonic solutions which can transiently open the blood-brain barrier. Other suitable formulations for use in the present invention can be found in Remington's Pharmaceutical Sciences, Mace Publishing Company, Philadelphia, PA, 17 th Ed (1985). The effectiveness or activity of the 5-HT transporter multimeric compounds proposed herein for alleviating or moderating depression can be tested by any of several methods known in the art. For example, the in vitro potency can be evaluated by measuring the inhibition of [3H]-serotonin uptake in rat brain synaptosomes or cloned transporters. (See Blakely, et al. (1991) Nature 354: 66- 70; Fuller, et al. (1990) Ann NY Acad Sci 600: 68-80; Gershon, et al. (1979) Br J Pharmacol 66:7-9; Hoffman, et al. (1991) Science 254: 579-580; and Horn, A.S. (1973) J Neurochem 21: 883-888.) A number of different in vivo animal assays can also be used to identify compounds which inhibit serotonin reuptake. Animals exposed to inescapable and unavoidable electric shocks in one simation later fail to escape shock in a different situation when escape is possible. A treatment is considered to be effective if the learned helplessness is reduced and the number of failures to escape is decreased. (See Curzon. et al. (1992) Br J Psychiatry 160 (Suppl 15): 51-55; Maier, et al. (1976) J Exp Psychol 105: 3-46; and Sherman, et al. (1979) Neuropharmacology 18: 891-893.) Similarly, the "tail suspension test" wherein clinically-effective antidepressants reduce the immobility that mice display after unsuccessful attempts to escape when suspended by the tail has been described as a means of evaluating potential antidepressants. (See Steru, et al. (1985) Psychopharmacology 85:367- 370.) A like test may also be performed using mice or rats forced to swim in a restricted space from which they cannot escape. (See Borsini, et al. (1988) Psycho-pharmacology 94: 147 160; Porsolt, et al. (1978) Eur J Pharmacol 47: 379-391; Porsolt, et al. (1977) Arch Int Pharmacodyn 229:327-336; Porsolt, et al. (1977) Nαtwre 266: 730-732.) Utility The multibinding agents of the present invention are useful for modulating activity of the 5-HT transporter. The modulation of the transporter preferably inhibits or decreases serotonin uptake. These effects are useful in treating mammalian conditions modulated by the 5-HT transporter, including depression, anxiety, alcoholism, chronic pain, emesis and eating disorders such as obesity and bulimia. In order to further illustrate the present invention and advantages thereof, the following specific examples are given but are not meant to limit the scope of the claims in any way. EXAMPLES In the Examples below, all temperamres are in degrees Celsius (unless otherwise indicated) and all percentages are weight percentages (also unless otherwise indicated). In the Examples, the following abbreviations have the following meanings. If an abbreviation is not defined, it has its generally accepted meaning. A Angstroms cm centimeter DIC 2-dimethylaminoisopropyl chloride hydrochloride DCC N, N-dicy clohexy lcarbodiimide DCM dichloromethane DIPEA diisopropylethylamine DMA N,N-dimethylacetamide DMAP 4-N, N-dimethy laminopy ridine DMF N, N-dimethy If ormamide DMSO dimethylsulfoxide DPPA diphenylphosphoryl azide g gram HBTU 1 -hydroxybenzotrizole HPLC high performance liquid chromatography mg milligram min minute mL milliliter mm millimeter mmol millimol N normal PyBOP pyridine benzotriazol-1-yloxy- tris(dimethyl-amino)phosphonium hexafluorophosphate t-BOC tert-butyloxycarbonyl TBAF tetrabutyl ammonium fluoride TFA trifluoroacetic acid THF tetrahydrofuran TLC thin layer chromatography μ microliters Example 1: Preparation of (102), a compound of Formula I. (102) A solution of 20 mmols of fluoxetine (100) in DMF with 10 mmols of 1,6- dibromohexane (101) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title structure. Compound (100) is described in US 4018895. Example 2: Preparation of (105), a compound of Formula I. A solution of nor-fluoxetine (103) (2 mmols) and benzene- 1,4-bisacetic acid (104) (lmmol) in methylene chloride is prepared under argon in a flask equipped with magnetic stirrer and drying tube. To this solution is added dicyclohexylcarbodiimide (solid, 2.1 mmols) while stirring at room temperature. The course of the reaction is followed by thin layer chromatography. When reaction has occurred, the reaction solution is diluted with ethyl acetate and washed with water and with aqueous Na 2 CO 3 . The organic layer is dried (Na 2 SO 4 ), filtered and concentrated under reduced pressure to give the crude product. The desired compound is obtained by purification of the crude product by use of HPLC. Lithium aluminum hydride (LAH) (63.3 mmol) is dissolved in THF in an ice bath under nitrogen atmosphere. The above product (12.7 mmol) is dissolved in THF and added dropwise to the LAH/THF solution. The reaction is stirred with cooling, then warmed to room temperamre, placed in an oil bath and the temperamre is raised by increments of 10 °C to 85 °C over a 30 minute period. The mixmre is stirred at reflux for 18 hours, then cooled to room temperamre and placed in an ice bath. Sodium sulfate decahydrate is slowly added to quench the excess LAH. The solids are removed by filtration and rinsing with THF. The filtrate is concentrated to a thick syrup and excess solvent is removed under vacuum to afford the title product. Compound (103) is described in US 4018895. Example 3: Preparation of (108), a compound of Formula I. 4-Hydroxy -fluoxetine (106) (34.0 mmol) is dissolved in dichloromethane under a nitrogen atmosphere. Di-tert-butyl dicarbonate (Boc^O) (119.12 mmol) dissolved in dichloromethane is added dropwise to the stirred solution. The course of the reaction is followed by TLC and stirring is continued at room temperature until the reaction is judged complete. The reaction mixmre is evaporated giving a precipitate that is collected by filtration. The precipitate is rinsed with ether to afford the desired product. A solution of 20 mmols of the above product, N-Boc- 4-hydroxyfluoxetine, in DMF with 10 mmols of 1 ,4-dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product. The product (1 mmol) is dissolved in CH 2 CI2. A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title product. The preparation of compound (106) is described in Example 5. Example 4: Preparation of (110), a compound of Formula I. 4-Hydroxy-fluoxetine (106) (34.0 mmol) is dissolved in dichloromethane under a nitrogen atmosphere. Di-tert-butyl dicarbonate (Bo ^O) (119.12 mmol) dissolved in dichloromethane is added dropwise to the stirred solution. The course of the reaction is followed by TLC and stirring is continued at room temperamre until the reaction is judged complete. The reaction mixmre is evaporated giving a precipitate that is collected by filtration. The precipitate is rinsed with ether to afford the desired product. A solution of 20 mmols of the above product, N-Boc- 4-hydroxy-fluoxetine, in DMF with 20 mmols of 1 ,6-dibromohexane (101) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (109). A solution of 20 mmols of fluoxetine (100) in DMF with 20 mmols of the above product (109) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title strucmre. The product (1 mmol) is dissolved in CH 2 C1 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title product. The preparation of compound (106) is described in Example 5. Compound (100) is described in US 4018895. Example 5: Preparation of (106). 4-Benzyloxyphenol (0.290 mmol) is added in portions to a solution of (111) (0.29 mmol) and triphenylphosphine (0.290 mmol) in anhydrous THF at 0 °C. The mixture is cooled to -20 °C and diethyl azodicarboxylate (DEAD) (0.330 mmol) is added dropwise over 30 min. During this time, the temperamre of the mixture is not allowed to rise above -10 °C. When the addition is complete, the mixmre is allowed to warm to room temperamre and stirred for 16 h. The mixmre is concentrated in vacuo and the resulting residue is purified by chromatography to afford the title product. A solution of (112) (11.7 mmol) in methanol is hydrogenated overnight at 35 psi, in the presence of 10% Pd/C and 1 ml of cone. HCl. The reaction mixture is filtered and the filtrate is concentrated to dryness. The resulting residue is taken into dichloromethane and washed with saturated NaHCO 3 solution, dried over MgSO 4 and concentrated. The crude product is purified by chromatography over silica gel to afford the title product. Compound (111) is described in Tetrahedron Lett. 1991, 32, 1901-1904. Various fluoxetine analogs can be made using the procedure set forth in Tetrahedron Lett. 1991, 32, 1901-1904, and varying the reactants such as phenol. Example 6: Preparation of (121), a compound of Formula I. A solution of 20 mmols of nor-citalopram (120) in DMF with 10 mmols of \ ,6- dibromohexane (101) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title structure. Compound (120) is described in Eur. J. Med. Chem. 1977, 12, 289-95. Example 7: Preparation of (124), a compound of Formula I. (122) (124) A solution of 5-carboxycitalopram (122) (2 mmol) and 1 ,4-diaminobutane (123) (1 mmol) in methylene chloride is prepared under argon in a flask equipped with a magnetic stirrer and drying tube. To this solution is added dicyclohexylcarbodiimide (2.1 mmol) while stirring at room temperamre. The course of the reaction is followed by TLC. When judged complete, the reaction solution is diluted with ethyl acetate and washed with water and with aqueous Na 2 CO 3 . The organic layer is dried Na^O^ filtered and concentrated under reduced pressure to give the crude product. The desired compound is obtained by purification of the crude product by use of HPLC. The preparation of compound (122) is described in Example 7a. Example 7a: Preparation of (122). (125) (122) A solution of citalopram (125) in 85% H 2 SO 4 is heated to 80 °C. The course of the reaction is followed by TLC. The reaction is poured onto ice and the solution is neutralized to pH 7 and extracted with chloroform. The residue is purified by chromatography to afford the title product. Compound (125) is described in DE 02657013. Example 8: Preparation of (128), a compound of Formula I. A solution of 20 mmols of nor-citalopram (120) in DMF with 20 mmols of N-Boc- 4-bromobutylamine (126) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (127). Compound (127) (1 mmol) is dissolved in CH 2 C1 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the desired product. The above product (1 mmol) is carefully dried and placed in a solution in dry DMF with 5-carboxycitalopram (122) (1 mmol) and 1-hydroxybenzotriazole (1.4 mmols) under an inert atmosphere. The solution is stirred, cooled in an ice-water bath and protected from the atmosphere with a drying mbe. To the stirred solution is added 1-ethoxy- 3-[3-(dimethylamino)propyl]carbodiimide hydrochloride (1.1 mmol). The course of the reaction is followed by TLC. The cooling bath is removed and when reaction has occurred, the reaction mixmre is partitioned between methylene chloride and saturated aqueous NaHCO 3 . The organic layer is washed with water and brine, dried and concentrated under reduced pressure. The desired product is obtained by purification of the crude product by use of HPLC. Compound (120) is described in Eur. J. Med. Chem. 1977, 12, 289-95. The preparation of compound (122) is described in Example 7a. Example 9: Preparation of (131), a compound of Formula I. A solution of 20 mmols of sertraline (130) in DMF with 10 mmols of 1 ,6- dibromohexane (101) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title structure. Compound (130) is described in EP 00768083. Example 10: Preparation of (133), a compound of Formula I. 4-fluoro-3-hydroxy-sertraline (132) (34.0 mmol) is dissolved in dichloromethane under a nitrogen atmosphere. Di-tert-butyl dicarbonate (Boc^O) (119.12 mmol) dissolved in dichloromethane is added dropwise to the stirred solution. The course of the reaction is followed by TLC and stirring is continued at room temperamre until the reaction is judged complete. The reaction mixture is evaporated giving a precipitate that is collected by filtration. The precipitate is rinsed with ether to afford the desired product. A solution of 20 mmols of the above product, N-Boc- 4-fluoro-3-hydroxysertraline, in DMF with 10 mmols of 1 ,4-dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product. The product (1 mmol) is dissolved in CH 2 C1 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title product. The preparation of compound (132) is described in Example 12. Example 11: Preparation of (134), a compound of Formula I. 4-fluoro-3-hydroxy-sertraline (132) (34.0 mmol) is dissolved in dichloromethane under a nitrogen atmosphere. Di-tert-butyl dicarbonate (B0C 2 O) (119.12 mmol) dissolved in dichloromethane is added dropwise to the stirred solution. The course of the reaction is followed by TLC and stirring is continued at room temperature until the reaction is judged complete. The reaction mixmre is evaporated giving a precipitate that is collected by filtration. The precipitate is rinsed with ether to afford the desired product. A solution of 20 mmols of the above product, N-Boc- 4-fluoro-3-hydroxy-sertraline, in DMF with 20 mmols of 1 ,4-dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and ' the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (133) . A solution of 20 mmols of sertraline (130) in DMF with 20 mmols of the above product (133) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title strucmre. The product (1 mmol) is dissolved in CH 2 C1 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperature. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title product. The preparation of compound (132) is described in Example 12. Compound (130) is described in EP 00768083. Example 12 : Preparation of (132) . 1. MeNH ? ,TiC__4 2. Resolution A solution of (135) (134 mmol) in THF is prepared. Magnesium (123 mmol) is treated with a small portion of this solution and heated until a reaction starts (55 °C). The remainder of the solution is added dropwise, and after the addition is complete, the mixmre is stirred for 2 hours at 55 °C. The reaction mixture is then cooled to room temperamre and a solution of 1-tetralone (136) (123 mmol) in THF is slowly added. Stirring is continued at room temperamre for 16 hours after the addition was complete. Ether and water are then added to the reaction mixture, followed by 10% aqueous ammonium chloride solution. The ether layer is separated, dried over MgSo , filtered, and evaporated under vacuum to afford the desired product (137). Compound (137) (47 mmol) is dissolved in a solution of potassium permanganate (36.7 g) in acetone (1.6 L) and water, and the resulting solution is stirred at reflux for 16 h. The reaction mixture is then filtered, treated again with potassium permanganate (36.7 g), and stirred at reflux for another 16 h. This process is continued through three reaction period cycles. The reaction mixmre is then filtered, treated with activated charcoal, filtered, and evaporated under vacuum to a residue. The residue is taken up in ethyl acetate, and the ethyl acetate solution is washed twice with saturated aqueous sodium chloride solution, dried over MgSo 4 , and evaporated under vacuum to yield a solid, which is recrystallized from a mixmre of ethyl acetate and hexane to afford the desired product (138). A solution of (138) (13.8 mmol) in THF is cooled to 0 C and treated with methyl amine (13.8 mmol), followed by dropwise addition of titanium tetrachloride (1 ml). The resulting mixmre is stirred for 16 hours at room temperature, filtered, and evaporated under vacuum to an oil, which is dissolved in absolute ethanol. The ethanol solution is treated with sodium borohydride (26.4 mmol) and stirred for 1 hour at room temperamre. The reaction mixmre is then evaporated under vacuum to a residue, which is taken up in ethyl acetate. The ethyl acetate solution is washed with water and with saturated aqueous sodium chloride solution, dried over MgSo 4 , and evaporated under vacuum. The residue is purified by chromatography and the stereoisomers separated by known technique to afford (139). A solution of (139) (11.7 mmol) in methanol is hydrogenated overnight at 35 psi, in the presence of 10% Pd/C and 1 ml of cone. HCl. The reaction mixmre is filtered and the filtrate is concentrated to dryness. The resulting residue is taken into dichloromethane and washed with saturated NaHCO 3 solution, dried over MgSO 4 and concentrated. The crude product is purified by chromatography over silica gel to afford the title product. Example 13: Preparation of (141), a compound of Formula I. A solution of 20 mmols of paroxetine (140) in DMF with 10 mmols of 1,6- dibromohexane (101) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title strucmre. Compound (140): CAS 61869-08-7 Example 14: Preparation of (152), a compound of Formula I. (150) 3. NaOH A solution of 20 mmols of milnacipran (150) in THF with 80 mmols of triethylamine is treated at room temperamre with 40 mmols of trifluoroacetic anhydride. After 1 hour, a solution of 10 mmols of ,α' -dibromo-p-xylene (151) is added and the reaction followed by TLC. When judged complete, the mixmre is concentrated and the residue partitioned between ethyl acetate and water. After washing with water and sat. sodium carbonate and deprotection with NaOH, the organic phase is dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title strucmre. Compound (150): CAS 92623-85-3 Example 15: Preparation of (161), a compound of Formula I. A solution of 20 mmols of nor-citalopram (120) in DMF with 20 mmols of 1 ,4- dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (160). A solution of 20 mmols of (160) in DMF with 20 mmols of paroxetine (140) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title product. Compound (120) is described in Eur. J. Med. Chem. 1977, 12, 289-95. Compound (140): CAS 61869-08-7 Example 16: Preparation of (165), a compound of Formula I. Nor-sertraline (162) (100 mmol) is dissolved in pyridine and p-toluenesulfonyl chloride (105 mmol) is added. The mixmre is stirred and the progress of the reaction is monitored by TLC. When judged complete, the mixture is added to water and extracted with EtOAc. The extract is washed with dilute HCl, then dried and evaporated to afford the toluenesulfonate compound (163). A solution of 20 mmols of (163) in DMF with 20 mmols of 1 ,4-dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (164). A solution of 20 mmols of (164) in DMF with 20 mmols of fluoxetine (100) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product. A solution of the above product (10 mmol) and phenol (20 mL) in 48% aqueous hydrobromic acid (240 mL) is heated under reflux for 2 h. The mixmre is cooled to 0 °C in an ice bath and made basic (pH 12) by the slow addition of 50% aqueous sodium hydroxide. Methanol is added and the mixmre is stirred for 15 minutes and then diluted with water. The mixmre is extracted with dichloromethane, the combined extracts are dried over MgSO and concentrated in vacuo. The resulting residue is dissolved in hexane/toluene and washed with 0.5 M hydrochloric acid. The aqueous extracts are made basic (pH 12) by the addition of aqueous sodium hydroxide and the mixmre is extracted with dichloromethane. The combined dichloromethane extracts are dried over MgSO 4 and concentrated in vacuo. The resulting residue is purified by column chromatography to afford the title strucmre. Compound (162) is described in US 4536518. Compound (100) is described in US 4018895. Example 17: Preparation of (171), a compound of Formula I. (170) 4-Hydroxy-fluoxetine (106) (34.0 mmol) is dissolved in dichloromethane under a nitrogen atmosphere. Di-tert-butyl dicarbonate (B0C2O) (119.12 mmol) dissolved in dichloromethane is added dropwise to the stirred solution. The course of the reaction is followed by TLC and stirring is continued at room temperature until the reaction is judged complete. The reaction mixmre is evaporated giving a precipitate that is collected by filtration. The precipitate is rinsed with ether to afford the desired product. A solution of 20 mmols of the above product, N-Boc- 4-hydroxyfluoxetine, in DMF with 20 mmols of 1 ,4-dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (170). A solution of 20 mmols of (170) in DMF with 20 mmols of paroxetine (140) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product. The above product (1 mmol) is dissolved in CH 2 θ 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title strucmre. The preparation of compound (106) is described in Example 5. Compound (140): CAS 61869-08-7 Example 18: Preparation of (175), a compound of Formula I. (174) 3) TFA ("5) 1-Carboxy-milnacipran (172) (34.0 mmol) is dissolved in dichloromethane under a nitrogen atmosphere. Di-tert-butyl dicarbonate (BocpO) (119.12 mmol) dissolved in dichloromethane is added dropwise to the stirred solution. The course of the reaction is followed by TLC and stirring is continued at room temperamre until the reaction is judged complete. The reaction mixmre is evaporated giving a precipitate that is collected by filtration. The precipitate is rinsed with ether to afford the desired product. The above product (1 mmol) is carefully dried and placed in a solution in dry DMF with 4-amino-l-butanol (173) (1 mmol) and 1- hydroxybenzotriazole (1.4 mmols) under an inert atmosphere. The solution is stirred, cooled in an ice-water bath and protected from the atmosphere with a drying tube. To the stirred solution is added l-ethoxy-3-[3- (dimethylamino)propyl]carbodiimide hydrochloride (1.1 mmol). The course of the reaction is followed by TLC. The cooling bath is removed and when reaction has occurred, the reaction mixmre is partitioned between methylene chloride and saturated aqueous NaHCO 3 . The organic layer is washed with water and brine, dried and concentrated under reduced pressure. Purification of the crude product by use of HPLC affords the desired product (174). Compound (174) (100 mmol) is dissolved in pyridine and p-toluenesulfonyl chloride (105 mmol) is added. The mixmre is stirred and the progress of the reaction is monitored by TLC. When judged complete, the mixture is added to water and extracted with EtOAc. The extract is washed with dilute HCl, then dried and evaporated to afford the desired toluenesulfonate compound. A solution of 20 mmols of the above product in DMF with 20 mmols of paroxetine (140) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product. The product (1 mmol) is dissolved in CH j C^. A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title product. Compound (172): CAS 69160-57-2. Compound (140): CAS 61869-08-7 Example 19: Preparation of (181). a compound of Formula I. A solution of 20 mmols of tryptamine (180) in DMF with 20 mmols of (109), which is prepared according to example 3, and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography. The product (1 mmol) is dissolved in CH 2 C1 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixmre using HPLC to afford the title product. The preparation of compound (109) is described in Example 3. Example 20: Preparation of (183), a compound of Formula I. A solution of 20 mmols of fluoxetine (100) in DMF with 20 mmols of 1 ,6- dibromohexane (101) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (182). A solution of 20 mmols of (182) in DMF with 20 mmols of tryptamine (180) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the title product. Compound (100) is described in US 4018895. This reaction can be performed in a one-pot procedure followed by separation of the resulting homodimers. Example 21: Preparation of (186), a compound of Formula I. (184) (18S) (186) A solution of 20 mmols of (184), which is prepared from standard protection of 5- hydroxy tryptamine, in DMF with 20 mmols of 1,6-dibromobutane (107) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixture is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography to afford the desired product (185). A solution of 20 mmols of the above product (185) in DMF with 20 mmols of nor- fluoxetine (103) and 20 mmols of potassium carbonate is heated as necessary and the reaction followed by TLC. When judged complete, the mixmre is partitioned between ethyl acetate and water and the organic phase is washed with water, dried over sodium sulfate and the solvent is removed in vacuo. The residue is purified by chromatography. The product (1 mmol) is dissolved in CH 2 C1 2 . A solution of 10% trifluoroacetic acid in CH 2 C1 2 is added and the reaction is stirred for 1 hour at room temperamre. The solvent is then removed in vacuo to provide the desired material as the TFA salt. The desired material is then purified from this mixture using HPLC to afford the title product. Compound (103) is described in US 4018895. The above examples are illustrative only and are not meant to be representative of the scope of the invention, which is set forth in the claims below.

Claims: WHAT IS CLAIMED IS: 1. A multibinding compound comprising 2 to 10 ligands which may be the same or different and which are covalently attached to a linker or linkers which may be the same or different, each of said ligands comprising a ligand domain capable of binding to a 5-HT cell membrane transporter, with the following proviso: where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof. 2. A multibinding compound represented by Formula I: ( ) p (X) q (I) and pharmaceutically acceptable salts thereof; wherein: each L is a ligand that may be the same or different at each occurrence; each X is a linker that may be the same or different at each occurrence; p is an integer of from 2 to 10; and q is an integer of from 1 to 20; wherein each of said ligands comprises a ligand domain capable of binding to a 5-HT transporter, and where q is less than/?, with the proviso that where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof. 3. The multibinding compound of claim 2, wherein each of said ligands is capable of modulating serotonin levels in a mammal. 4. The multibinding compound of claim 3, wherein the ligand capable of binding to a 5-HT transporter independently comprises a group consisting of citalopram, dapoxetine, duloxetine, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, tianeptine, tramadol, venlafaxine, serotonin, tryptamine, and derivatives thereof. 5. The multibinding compound of claim 3, wherein each divalent linker X is independently selected from a strucmre of Table 1. 6. The multibinding compound of claim 5, wherein p is an integer of from 2 to 4, and q is less than/?. 7. A pharmaceutical composition comprising a pharmaceutically acceptable excipient and a therapeutically effective amount of one or more multibinding compounds, or pharmaceutically acceptable salts thereof, comprising 2 to 10 ligands which may be the same or different and which are covalently attached to a linker or linkers which may be the same or different, each of said ligands comprising a ligand domain capable of binding to a 5-HT cell membrane transporter of a cell mediating mammalian diseases or conditions, thereby modulating the diseases or conditions, with the following proviso: where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof. 8. A pharmaceutical composition comprising a pharmaceutically acceptable excipient and a therapeutically effective amount of one or more multibinding compounds represented by Formula I, (L) p (X) q (I) and pharmaceutically acceptable salts thereof; wherein: each L is a ligand that may be the same or different at each occurrence; each X is a linker that may be the same or different at each occurrence; p is an integer of from 2 to 10; and q is an integer of from 1 to 20; wherein each of said ligands comprises a ligand domain capable of binding to a 5-HT transporter, and where q is less than/?, with the proviso that where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof. 9. The pharmaceutical composition of claim 8, wherein said multibinding compound or compounds is capable of modulating serotonin levels in a mammal. 10. The pharmaceutical composition of claim 9, wherein each of said ligands are independently selected from a group consisting of citalopram, dapoxetine, duloxetine, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, tianeptine, tramadol, venlafaxine, serotonin, tryptamine, and derivatives thereof. 11. The pharmaceutical composition of claim 9, wherein each linker X is independently selected from a strucmre of Table 1. 12. The pharmaceutical composition of claim 11, wherein p is an integer of from 2 to 4, and q is less than p. 13. A method of preparing a multibinding compound represented by formula I: (L) p (X) q (I) wherein each L is a ligand that may be the same or different at each occurrence; X is a linker that may be the same or different at each occurrence; p is an integer of from 2 to 10; and q is an integer of from 1 to 20; wherein each of said ligands comprises a ligand domain capable of binding to a 5-HT transporter, and where q is less thanp, with the proviso that where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof, said method comprising: (a) providing at least/? equivalents of a ligand L or precursors thereof and at least q equivalents of linker or linkers X; and (b) covalently attaching said ligands to said linkers to produce a multibinding compound; or (b') covalently attaching said ligand precursors to said linkers and completing the synthesis of said ligands thereupon, thereby to produce a multibinding compound. 14. The method of claim 13, wherein p is an integer of from 2 to 4, and q is less than/?. 15. A method for modulating the activity of a 5-HT cell membrane transporter in a biological tissue, which method comprises contacting a tissue having the 5-HT cell membrane transporter with a multibinding compound, or a pharmaceutically acceptable salt thereof, under conditions sufficient to produce a change in transporter activity in said tissue, wherein the multibinding compound comprises 2 to 10 ligands which may be the same or different and which are covalently attached to a linker or linkers which may be the same or different, each of said ligands comprising a ligand domain capable of binding to a 5-HT cell membrane transporter, with the following proviso: where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof. 16. A method for treating depression in a mammal, which method comprises administering to a mammal in need of such treatment a therapeutically effective amount of a pharmaceutical composition comprising a pharmaceutically acceptable excipient and one or more multibinding compounds represented by formula I, (L) p (X) q (I) and pharmaceutically acceptable salts thereof, wherein each L is a ligand that may be the same or different at each occurrence; X is a linker that may be the same or different at each occurrence; p is an integer of from 2 to 10; and q is an integer of from 1 to 20; wherein each of said ligands comprises a ligand domain capable of binding to a 5-HT transporter, and where q is less than/?, with the proviso that where one ligand is serotonin, tryptamine or a derivative thereof, at least one other ligand is not serotonin, tryptamine or a derivative thereof. 17. The method of claim 16, wherein/? is an integer of from 2 to 4 and q is less than/?. 18. A method for identifying multimeric ligand compounds possessing multibinding properties which method comprises: (a) identifying a ligand or a mixmre of ligands wherein each ligand contains at least one reactive functionality and has a ligand binding domain capable of binding to a 5-HT transporter; (b) identifying a library of linkers wherein each linker in said library comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the ligand or mixture of ligands identified in (a) with the library of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands; and (d) assaying the multimeric ligand compounds produced in the library prepared in (c) above to identify multimeric ligand compounds possessing multibinding properties. 19. A method for identifying multimeric ligand compounds possessing multibinding properties which method comprises: (a) identifying a library of ligands wherein each ligand contains at least one reactive functionality and has a ligand binding domain capable of binding to a 5-HT transporter; (b) identifying a linker or mixmre of linkers wherein each linker comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the library of ligands identified in (a) with the linker or mixmre of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands; and (d) assaying the multimeric ligand compounds produced in the library prepared in (c) above to identify multimeric ligand compounds possessing multibinding properties. 20. The method according to Claim 18 or 19 wherein the preparation of the multimeric ligand compound library is achieved by either the sequential or concurrent combination of the two or more stoichiometric equivalents of the ligands identified in (a) with the linkers identified in (b). 21. The method according to Claim 20 wherein the multimeric ligand compounds comprising the multimeric ligand compound library are dimeric. 22. The method according to Claim 21 wherein the dimeric ligand compounds comprising the dimeric ligand compound library are heterodimeric. 23. The method according to Claim 22 wherein the heterodimeric ligand compound library is prepared by sequential addition of a first and second ligand. 24. The method according to Claim 18 or 19 wherein, prior to procedure (d), each member of the multimeric ligand compound library is isolated from the library. 25. The method according to Claim 24 wherein each member of the library is isolated by preparative liquid chromatography mass spectrometry (LCMS). 26. The method according to Claim 18 or Claim 19 wherein the linker or linkers employed are selected from the group comprising flexible linkers, rigid linkers, hydrophobic linkers, hydrophilic linkers, linkers of different geometry, acidic linkers, basic linkers, linkers of different polarization and/or polarizabihty and amphiphilic linkers. 27. The method according to Claim 26 wherein the linkers comprise linkers of different chain length and/or having different complementary reactive groups. 28. The method according to Claim 27 wherein the linkers are selected to have different linker lengths ranging from about 2 to 100A. 29. The method according to Claim 18 or 19 wherein the ligand or mixmre of ligands is selected to have reactive functionality at different sites on said ligands. 30. The method according to Claim 29 wherein said reactive functionality is selected from the group consisting of carboxylic acids, carboxylic acid halides, carboxyl esters, amines, halides, pseudohalides, isocyanates, vinyl unsaturation, ketones, aldehydes, thiols, alcohols, anhydrides, boronates, and precursors thereof wherein the reactive functionality on the ligand is selected to be complementary to at least one of the reactive groups on the linker so that a covalent linkage can be formed between the linker and the ligand. 31. The method according to Claim 18 or Claim 19 wherein the multimeric ligand compound library comprises homomeric ligand compounds except for homomeric ligand compounds of tryptamine or serotonin. 32. The method according to Claim 18 or Claim 19 wherein the multimeric ligand compound library comprises heteromeric ligand compounds except for heteromeric ligand compounds of tryptamine and serotonin. 33. A library of multimeric ligand compounds which may possess multivalent properties which library is prepared by the method comprising: (a) identifying a ligand or a mixture of ligands wherein each ligand contains at least one reactive functionality and has a ligand binding domain capable of binding to a 5-HT transporter; (b) identifying a library of linkers wherein each linker in said library comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; and (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the ligand or mixture of ligands identified in (a) with the library of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands. 34. A library of multimeric ligand compounds which may possess multivalent properties which library is prepared by the method comprising: (a) identifying a library of ligands wherein each ligand contains at least one reactive functionality and has a ligand binding domain capable of binding to a 5-HT transporter; (b) identifying a linker or mixmre of linkers wherein each linker comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand; and (c) preparing a multimeric ligand compound library by combining at least two stoichiometric equivalents of the library of ligands identified in (a) with the linker or mixmre of linkers identified in (b) under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands. 35. The library according to Claim 33 or Claim 34 wherein the linker or linkers employed are selected from the group comprising flexible linkers, rigid linkers, hydrophobic linkers, hydrophilic linkers, linkers of different geometry, acidic linkers, basic linkers, linkers of different polarization and/or polarizability and amphiphilic linkers. 36. The library according to Claim 35 wherein the linkers comprise linkers of different chain length and/or having different complementary reactive groups. 37. The library according to Claim 36 wherein the linkers are selected to have different linker lengths ranging from about 2 to lOOA. 38. The library according to Claim 33 or 34 wherein the ligand or mixture of ligands is selected to have reactive functionality at different sites on said ligands. 39. The library according to Claim 38 wherein said reactive functionality is selected from the group consisting of carboxylic acids, carboxylic acid halides, carboxyl esters, amines, halides, pseudohalides, isocyanates, vinyl unsaturation, ketones, aldehydes, thiols, alcohols, anhydrides, boronates, and precursors thereof wherein the reactive functionality on the ligand is selected to be complementary to at least one of the reactive groups on the linker so that a covalent linkage can be formed between the linker and the ligand. 40. The library according to Claim 33 or Claim 34 wherein the multimeric ligand compound library comprises homomeric ligand compounds except for homomeric ligand compounds of tryptamine or serotonin. 41. The library according to Claim 33 or Claim 34 wherein the multimeric ligand compound library comprises heteromeric ligand compounds except for heteromeric ligand compounds of tryptamine and serotonin. 42. An iterative method for identifying multimeric ligand compounds possessing multibinding properties which method comprises: (a) preparing a first collection or iteration of multimeric compounds which is prepared by contacting at least two stoichiometric equivalents of the ligand or mixture of ligands which target a transporter with a linker or mixture of linkers wherein said ligand or mixmre of ligands comprises at least one reactive functionality and has a ligand binding domain capable of binding to a 5-HT transporter, and said linker or mixmre of linkers comprises at least two functional groups having complementary reactivity to at least one of the reactive functional groups of the ligand wherein said contacting is conducted under conditions wherein the complementary functional groups react to form a covalent linkage between said linker and at least two of said ligands; (b) assaying said first collection or iteration of multimeric compounds to assess which if any of said multimeric compounds possess multibinding properties; (c) repeating the process of (a) and (b) above until at least one multimeric compound is found to possess multibinding properties; (d) evaluating what molecular constraints imparted or are consistent with imparting multibinding properties to the multimeric compound or compounds found in the first iteration recited in (a)-(c) above; (e) creating a second collection or iteration of multimeric compounds which elaborates upon the particular molecular constraints imparting multibinding properties to the multimeric compound or compounds found in said first iteration; (f) evaluating what molecular constraints imparted or are consistent with imparting enhanced multibinding properties to the multimeric compound or compounds found in the second collection or iteration recited in (e) above; (g) optionally repeating steps (e) and (f) to further elaborate upon said molecular constraints. 43. The method according to Claim 42 wherein steps (e) and (f) are repeated from 2-50 times. 44. The method according to Claim 42 wherein steps (e) and (f) are repeated from 5-50 times.

Inventors: AGGEN JAMES, BEATTIE DAVID T, GRIFFIN JOHN H, AGGEN, JAMES, BEATTIE, DAVID, T., GRIFFIN, JOHN, H.
Applicants: ADVANCED MEDICINE INC, AGGEN JAMES, BEATTIE DAVID T, GRIFFIN JOHN H, ADVANCED MEDICINE, INC., AGGEN, JAMES, BEATTIE, DAVID, T., GRIFFIN, JOHN, H.
Application year: 1999
Main classification: A61K
IPC codes: A61K45, A61K47, A61P43, C07B61, C07C217, C07K2, C40B20, C40B40, C40B50, G01N33