Antidepressants Note 1

Antidepressants

Possible Indications

  • Depression

  • Eating Disorder

  • Pain Disorder

  • Enuresis

  • Obsessive-Compulsive Disorder (OCD)

  • Generalized Anxiety Disorder (GAD)

  • Post-Traumatic Stress Disorder (PTSD)

  • Paraphilias

  • Premenstrual Syndrome (PMS)

  • Smoking Cessation

Therapeutic Effects

  • Mood:

    • Reduce sadness, irritability, and anhedonia.

  • Thoughts:

    • Reduce hopelessness, pessimism, guilt, and suicidal thoughts.

    • Improve concentration and memory.

  • Behavior:

    • Improve diminished libido.

    • Reduce somatic complaints.

    • Improve energy and appetite.

  • Sleep:

    • Improve sleep disturbances, including insomnia, early morning awakening, and hypersomnia.

Onset of Action

  • All antidepressants may take as long as 6 weeks to achieve therapeutic effect.

  • Maximum benefit may take longer than 6 weeks.

Monoamine Oxidase Inhibitors (MAOI)

Generic and Brand Names

  • Tranylcypromine - ParnateⓇ

  • Phenelzine - Nardil®

  • Isocarboxazid - Marplan®

  • Selegiline - EmsamⓇ (Transdermal System)

Dosage and Half-life

  • Tranylcypromine

    • Dose: 10-60 mg/d

    • Half-life: unknown

  • Phenelzine

    • Dose: 7.5-90 mg/d

    • Half-life: unknown

  • Isocarboxazid

    • Dose: 10-60 mg/d

    • Half-life: unknown

  • Selegiline

    • Dose: 6 mg to 9 mg/24 hr

    • Half-life: 16-69 hours

Tyramine

  • Definition: An amino acid released from proteins during aging, fermenting, pickling, smoking, and spoiling.

  • Mechanism: In the body, tyramine triggers the release of norepinephrine from adrenergic nerve endings. It is deactivated by monoamine oxidase (MAO) in the liver and intestine.

  • Implications for MAOI Patients:

    • With MAO inhibitors, tyramine levels may increase, leading to excessive norepinephrine release.

    • This may cause hypertensive reactions and intracranial bleeding.

Foods High in Tyramine

  • Aged Cheeses:

    • Blue

    • Camembert

    • Cheddar

    • Gouda

    • Parmesan

    • Provolone

    • Romano

    • Stilton

    • Swiss

  • Alcoholic Beverages:

    • Beer

    • Cognac

    • Liqueurs

    • Red Wine

    • Sherry

  • Fish:

    • Caviar

    • Shrimp paste

  • Fruits:

    • Bananas

    • Figs

  • Meats:

    • Beef or chicken liver

    • Corned beef

    • Smoked and processed meats (e.g., bologna, pepperoni, salami)

  • Vegetables:

    • Avocados

    • Chinese pea pods

    • Fava beans

    • Pickled vegetables (e.g., pickles, sauerkraut)

  • Other Sources:

    • Beverages containing caffeine

    • Cheese-filled desserts

    • Fermented bean curd

    • Olives

    • Flat Italian Beans

    • Monosodium Glutamate

    • Protein supplements

  • Medications:

    • Pseudoepherine

    • Dextromethorphan

Tricyclic Antidepressants (TCA)

Generic and Brand Names

  • Amitriptyline - Elavil®

  • Amoxapine - AsendinⓇ

  • Clomipramine - Anafranil®

  • Desipramine - NorpraminⓇ

  • Doxepine - SinequanⓇ

  • Imipramine - Tofranil®

  • Maprotiline - Ludiomil®

  • Nortriptyline - Pamelor®

  • Protriptyline - VivactilⓇ

Dosage and Half-life

  • Amitriptyline

    • Dose: 25-300 mg/d

    • Half-life: 31-46 hrs

  • Amoxapine

    • Dose: 25-600 mg/d

    • Half-life: 8 hrs

  • Clomipramine

    • Dose: 25-250 mg/d

    • Half-life: 19-37 hrs

  • Desipramine

    • Dose: 10-300 mg/d

    • Half-life: 12-27 hrs

  • Doxepine

    • Dose: 10-300 mg/d

    • Half-life: 6-8 hrs

  • Imipramine

    • Dose: 10-300 mg/d

    • Half-life: 11-25 hrs

  • Maprotiline

    • Dose: 25-225 mg/d

    • Half-life: 27-58 hrs

  • Nortriptyline

    • Dose: 50-150 mg/d

    • Half-life: 18-44 hrs

  • Protriptyline

    • Dose: 5-60 mg/d

    • Half-life: 67-89 hrs

Side Effects

  • Anticholinergic Effects:

    • Dry mouth

    • Dry eyes

    • Blurred vision

    • Constipation

  • Other Effects:

    • Sedation

    • Orthostatic hypotension

    • Weight gain

    • Arrhythmia