Classes of Antidepressants (4):
1. Tricyclic Antidepressants (TCA): Amitriptyline
2. Selective Serotonin Reuptake Inhibitors (SSRI): Fluoxetine, citalopram
3. Serotonin Norepinephrine Reuptake Inhibitors (SNRI): venlafaxine
4. Monoamine Oxidase Inhibitors (MAOI): tranylcypromine
Basic Information: All have black box warnings for suicidal ideation & don’t give any at the same time
as MAOIs, TAPER OFF
Serotonin Syndrome: caused by medications that build up high levels of serotonin in the body
(ANTIDEPRESSANTS). Serotonin is a chemical that the body produces naturally. It's needed for the
nerve cells and brain to function
- Symptoms include: change in mental status, tachycardia, labile BP, hyperthermia, hyperreflexia &
incoordination, GI symptoms
TCA’s Prototype: Amitriptyline
- Used to treat depression, neuropathic pain & insomnia
Administration Considerations:
- Administer at bedtime (sedative effect)
- Do not give with MAOI
- Geriatric patients sensitive to its anticholinergic effects
- Taper off drug–do NOT stop abruptly
- Monitor for orthostatic hypotension (fall risk precautions)
Adverse Effects:
- Report signs & symptoms of suicidal thoughts (BLACK BOX)
- Anticholinergic effects
- Hypotension
- Dysrhythmias (lengthens QT interval)
- Sedation
, - Sexual dysfunction
- Altered seizure threshold
SSRI Prototype: fluoxetine, citalopram
- ADVANTAGE: less side effects than TCA and MAOI
- Inhibits the reuptake of serotonin
Indications for Use:
- Depression
- OCD
- Bulimia
- Panic disorder/PTSD/anxiety
- PMS
- Migraine
Administration Considerations:
- BLACK BOX: Increase in suicidal thoughts
- Taper off–do NOT stop abruptly
- Use caution with liver dysfunction
- May take up to 12 weeks before achieving therapeutic effect
- Take in the morning
Adverse Effects (REPORT IMMEDIATELY):
- Increased suicidality
- Serotonin syndrome
- Rash, mania, seizures, decreased appetite/weight, increased bleeding, hyponatremia, anxiety,
insomnia
SNRI Prototype: Venlafaxine
- Inhibits reuptake of serotonin and norepinephrine, with weak inhibition of dopamine reuptake
- May take up to 8 weeks before achieving therapeutic effects
1. Tricyclic Antidepressants (TCA): Amitriptyline
2. Selective Serotonin Reuptake Inhibitors (SSRI): Fluoxetine, citalopram
3. Serotonin Norepinephrine Reuptake Inhibitors (SNRI): venlafaxine
4. Monoamine Oxidase Inhibitors (MAOI): tranylcypromine
Basic Information: All have black box warnings for suicidal ideation & don’t give any at the same time
as MAOIs, TAPER OFF
Serotonin Syndrome: caused by medications that build up high levels of serotonin in the body
(ANTIDEPRESSANTS). Serotonin is a chemical that the body produces naturally. It's needed for the
nerve cells and brain to function
- Symptoms include: change in mental status, tachycardia, labile BP, hyperthermia, hyperreflexia &
incoordination, GI symptoms
TCA’s Prototype: Amitriptyline
- Used to treat depression, neuropathic pain & insomnia
Administration Considerations:
- Administer at bedtime (sedative effect)
- Do not give with MAOI
- Geriatric patients sensitive to its anticholinergic effects
- Taper off drug–do NOT stop abruptly
- Monitor for orthostatic hypotension (fall risk precautions)
Adverse Effects:
- Report signs & symptoms of suicidal thoughts (BLACK BOX)
- Anticholinergic effects
- Hypotension
- Dysrhythmias (lengthens QT interval)
- Sedation
, - Sexual dysfunction
- Altered seizure threshold
SSRI Prototype: fluoxetine, citalopram
- ADVANTAGE: less side effects than TCA and MAOI
- Inhibits the reuptake of serotonin
Indications for Use:
- Depression
- OCD
- Bulimia
- Panic disorder/PTSD/anxiety
- PMS
- Migraine
Administration Considerations:
- BLACK BOX: Increase in suicidal thoughts
- Taper off–do NOT stop abruptly
- Use caution with liver dysfunction
- May take up to 12 weeks before achieving therapeutic effect
- Take in the morning
Adverse Effects (REPORT IMMEDIATELY):
- Increased suicidality
- Serotonin syndrome
- Rash, mania, seizures, decreased appetite/weight, increased bleeding, hyponatremia, anxiety,
insomnia
SNRI Prototype: Venlafaxine
- Inhibits reuptake of serotonin and norepinephrine, with weak inhibition of dopamine reuptake
- May take up to 8 weeks before achieving therapeutic effects
