Anti-Depressants Medication

Tricyclic Antidepressants

• Amitriptyline

• Nortriptyline

MOA of Tricyclic Antidepressants

• Blocks the uptake of neurotransmitters norepinephrine and serotonin in brain

• Significant anticholinergic properties

Indication of Tricyclic Antidepressants

• Major depression

• Agitated Depression

Contrainidcation of Tricyclic Antidepressants

• Use with MAIOs Within 14 days pregnancy

• Not recommended for patient’s with chornic cardiac problems or seizure disorders

Side effects of Tricyclic Antidepressants

• Suicidal Thoughts

• Sedation

• Anticholinergic effects

• Dizziness

• Orthostatic Hypotension

• Arrhythmias

• Weight gain

• Sexual dysfunction

• GI distress

• Blood Dycrasias

Interactions of Tricyclic Antidepressants (

• Increased CNS effects with alcohol and other CNS depressants

• DO NOT take concurrently with MAIOs due to leading cardiotoxicity (stop 14 days before MAIOs and vice versa)

• Increased Sedation and anticholinergic effects with phenothiazines and haloperidol

Non-selective MAO-A and MAO-B

• Tranylcypromine sulfate

• Phenelzine Sulfate

Selective MAO-B

• Selegiline; Transdermal patch used for depression

MOA of Monoamine Oxidase Inhibitors

• Blocks the action of monoamine oxidase enzyme which is what inactivates norepinephrine, dopamine, epinephrine and serotonin increasing the neurotransmitter levels in brain

Indication of Monoamine Oxidase Inhibitors

• Depression that is not contyrolled with TCAs and second generation anti-depressants

Side effects of Monoamine Oxidase Inhibitors

• Agitation

• Restlessness

• Insomnia

• Anticholinergic effects

• Orthostatic Hypotension

• Hypertensie crisis due to fatal tyramine interaction

Drug interaction of Monoamine Oxidase Inhibitors

• Phenylephrine and speudoepinephrine canc ause hypertensive crisis when taken with MAOI

• Must be off TCA, SSRI and SNRI 14 days before starting MAOIs

Food interactions of Monoamine Oxidase Inhibitors

• Banana

• Aged meats

• Soy sauce

• Aged cheese

• Avocados

• Chocolate

• Ales

• Beer and Wine

Selective Serotonin Reuptake iNhibitors (SSRIs)

• Fluvoxamine, Fluxetine, Sertraline, Paroxetine, Citalopram, Escitalopram

MOA of SSRIs

• Blocks uptake of serotonin neurotransmitter

Indications of SSRIs

• Major depression

• Anxiety disorders

• Obssessive-Compulsive Disorder

• Panic Phobias

• Prevention of Migraine headaches

Side Effects of SSRIs

• Headache

• Nervousness and Restlessness

• Insomnia

• Tremors and seizures

• GI distress

• Sexual Dysfunction

• Suicidal dieation

• Side effects over 2 to 4 weeks

Interactions of SSRIs

• Increased CNS effects with alcohol and other CNS depressants

• St. John’s Wort increases chance of serotonin syndorme

• Toxicity occurs with grapefruit juice

• Concomitant use of MAOIs and SSRIs is contraindicated

Therapeutic Effects of SSRIs

• It takes 3 to 4 weeks for SSRIs to achieve full therapeutic effects

Signs and Symptoms Serotonin syndrome

• Agitations

• Hallucinations

• Coma

• Tachycardia

• Labile BP

• Hyperthermia

• Hyperreflexia

• Incoordination

• Nasuea, vomiting, Diarrhea

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

• Venlafaxine, Duloxetine, Desvenlafaxine

MOA of SNRIs

• Inhibit the reuptake of serotonin and norepinephrine increasing substances in nerve fibers

Indications of SNRIs

• Major depression

• Anxiety Disorders

• Adjuvant treatment for chronic pain

Side effects of SNRIs

• Drowsiness and dizziness

• Fatigue and Insomnia

• Headache

• Euphoria

• Anticholinergic effects
  GI Distress

• Sexual Dysfunction

• Hypertension

• Blood dyscrasias

• Suicidal ideation

• Stevens-Johnson Syndrome

• Seizures

Interactions of SNRIs

• St johns Wort may increase the risk for serotonin Syndrome

• Concomitant use of MAOI with SNRIs is contraindicated