Antidepressant Medications

Side effects of SSRI’s

Nausea, GI disturbances

Restlessness, jitteriness

Sleep disturbance

Sexual dysfunction

Bruxism

Serotonin syndrome

Mental confusion, anxiety, agitation,

tremors, hyperreflexia, incoordination,

abdominal pain, diarrhea, fever,

diaphoresis

SSRI

Fluoxetine (Prozac) (PROTOTYPE) - most commonly used

SSRI

Citalopram (Celexa)

SSRI

Eescitalopram (Lexapro)

SSRI

Paroxetine (Paxil

SSRI

Sertraline (Zoloft)

SSRI

Vilazodone (Viibryd)

SSRI

Fluvoxamine (Luvox)

SSRI Mechanism of Action

Inhibit reuptake of serotonin at the presynaptic membrane

increased serotonin in synapseincreased serotonin in synapse

SSRI Uses

Depression, anxiety disorders, bulimia nervosa, premenstrual

dysphoric disorder, bipolar disorderdysphoric disorder, bipolar dis

Antidepressant Drugs

Enhance serotonin and norepinephrine

Block reuptake at the presynaptic neuron

Inhibit metabolism and deactivation

Increase release

 May increase neurotrophic factors

 Indicated for depressive and anxiety

disorders

Anti Depressant drugs

Take 2-4 weeks to see therapeutic effect

 Med should be continued for 6-9 months

after symptoms subside

 Given once per day

 Taper to discontinue

 Can trigger manic episode in patients with

bipolar disorder or psychosis in patients with

schizophrenia

SNRI Mechanism of Action

Inhibit reuptake of serotonin and norepinephrine

Uses of SNRI

Depressive and anxiety disorders, neuropathic

pain

Side Effects

Headache

 Nausea

 Sexual dysfunction

 Agitation, anxiety

 Dry mouth

 Sleep disturbance

 Can increase BP

SNRI

Duloxetine (Cymbalta)

SNRI

Venlafaxine (Effexor)

SNRI

Desvenlafaxine (Pristiq)

SNRI

Milnacipran (Savella)

SNRI

Levomilnacipran (Fetzima)

Atypical Antidepressant

Bupropion (Wellbutrin) (PROTOTYPE)

Bupropion (Wellbutrin) MOA

Blocks reuptake of dopamine and NE and inhibits

nicotinic acetylcholine receptors

Bupropion (Wellbutrin) Uses

Depression, seasonal depression, with SSRIs for

sexual SE, smoking cessation, and adult ADHD

Bupropion (Wellbutrin) Side Effects

Headache, decreased appetite & weight loss,

restlessness, tremor, insomnia, decreased seizure

threshold

 Less sexual side effects

Atypical Antidepressant

Mirtazepine (Remeron)

Mirtazepine (Remeron)

Increases release of serotonin and NE

Mirtazepine (Remeron) Side Effects

Sedation, increased appetite and weight gain, less sexual

and GI side effects than SSRI’s

Atypical Antidepressant

Trazodone (Desyrel)

Trazodone (Desyrel)

Serotonin antagonist and reuptake inhibitor

Trazodone (Desyrel) Side Effects

Sedation, orthostatic hypotension, priapism

Atypical Antidepressant

Vortioxetine (Trintellix)

Vortioxetine (Trintellix)

Serotonin modulator and stimulator

Vortioxetine (Trintellix) Side Effects

Nausea, constipation, vomiting, less sexual side effects

Newer antidepressant

Esketamine

Esketamine

NMDA receptor antagonist

 FDA approved for tx resistant depression

 Blocks glutamate from binding to NMDA receptors

 Spravato nasal spray with other antidepressants

 Potential for abuse

 Side effects

Elevated BP, dissociation, numbness, dizziness,

vertigo, sedation, anxiety, feeling drunk

Tricyclic Antidepressants

(TCA’s) MOA

Block reuptake of serotonin and norepinephrine

Tricyclic Antidepressants

(TCA’s) Uses

Depression, anxiety disorders, neuropathic pain,

fibromyalgia, insomnia, bipolar disorder

Side effects of TCA

Cardiac dysrhythmias

 Contraindicated for CAD

 EKG

 Lethal in overdose

 Suicide assessment

 Sedation

 Anticholinergic effects

 Orthostatic hypotension

 Increased appetite

 Excessive sweating

 Decreased seizure threshold

TCA

Amitriptyline (Elavil) (PROTOTYPE)

TCA

Nortriptyline (Pamelor, Aventyl)

TCA

Doxepin (Sinequan)

TCA

Impramine (Tofranil )

TCA

Amoxapine (Asendin)

TCA

Trimipramine (Surmontil)

Monamine Oxidase Inhibitors

(MAO-I’s) MOA

Block MAO

Results in increased serotonin, norepinephrine,

and dopamine

Monamine Oxidase Inhibitors

(MAO-I’s) Uses

Depression, bulimia nervosa, atypical depression

Monamine Oxidase Inhibitors

(MAO-I’s) side effects

Anxiety, agitation, orthostatic hypotension,

drowsiness, anticholinergic effects

Monamine Oxidase Inhibitors

(MAO-I’s) Food/Drug Interactions

Avoid foods high in tyramine

 Aged cheese, pickled & smoked fish, wine, beer,

fermented foods, smoked and cured meats,

overripe fruits

 Avoid norepinephrine agonists

 Ephedrine (cold & allergy meds) and stimulants

 Avoid antidepressants, buspirone,

meperedine

MAO-I’s

Phenelzine (Nardil) (PROTOTYPE

MAO-I’s

Isocarboxazid (Marplan)

MAO-I’s

Tranylcypromine (Parnate)

MAO-I’s

Selegiline (Emsam)

Selegiline (Emsam)

Transdermal patch

 Bypasses digestive system = less food restriction

 Drug interactions still problematic

ST John’s Wort

Effective for mild to moderate depression

 Increases serotonin, norepinephrine, and

dopamine

 Not regulated by FDA

 Potential drug interactions/serotonin

syndrome