Antidepressant Drug Chart
| DRUG | MOA | SIDE EFFECTS | CI | EXTRA | |
|---|---|---|---|---|---|
| MAOI's | Phenelzine (Nardil) Tranylcypromine (Partite) Selegiline (Eldepryl & Emsam) *An MAOI approved by the FDA for treatment of Parkinson’s and major depression.* Emsam is supplied in patch form | MAO is an enzyme found in brain, gut, and liver. MAOIs Will ↑ norepi, serotonin, and dopamine within the neuron. | HA, Tachycardia, Nausea, HTN, cardiac arrhythmias, stroke, death—cheese effect Downiness, ortho hypotn, blurred vision, dry mouth, sleep disturbance, dysuria, and constipation | MAOIs and SSRI can cause serotonin syndrome Cocaine Sudafed Demerol (Meperdine | Cheese effect—foods that are fermented (cheese, wine, beer, ckn liver) can result in HTN ER Wash out period of 14-20dys before another drug started |
| TCA'S (Tricyclic Antidepressants) | Amitripyline (Elavil) Despiramine (Norpramin) Imipramine (Tofranil) Nortriptyline (Pamelor) Doxepin (Sinequan | Potent inhibitors of the neuronal re-uptake of norepinephrine and serotonin into presynaptic nerve terminals. Do not block dopamine transporters. Block serotonergic, α adrenergic, histaminic, and muscarinic receptors. | O-Orthostatic hypo TN T-Thrombocytopenia C-Cardiac arrhythmias (EKG) A-Anticholinergic SE (BPH/glaucoma) S-Sedation, seizure, sexual SE Weight gain | Caution in manic-dep pt can unmask manic behavior Narrow therapeutic index and have a narrow lethal dose (SUICIDE) | Depressed pt should only be given limited amt of drug and be monitored closely Monitor—CBC, leukocytes and diff, LFTs |
| SNRI'S (Serotonin Norepinephrine Reuptake Inhibitors) | Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Venlafaxine (Effexor, XR) | Tx of major dep with prominent pain complaints. {EFFEXOR} Similar to TCAs but not muscarinic, histaminic or α adrenergic receptors. {CYMBALTA} inhibitor or serotonin and norepinephrine reuptake and less potent inhibitor of dopamine | {EFFEXOR} N, Dizzy, Insomnia, sedation, constipation AT HIGH DOSES CAN CAUSE ↑BP, Sweating, nervous, agitation, lower SZ threshold {CYMBALTA} GI SE, N, dry mouth, constipation, sexual dysfxn | {EFFEXOR} Hyponatremia (SIADH), Mydriasis (↑ICP in glaucoma pt) {CYMBALTA} should not be given to pt with liver failure or end stage renal disease. Can cause HEPATOTOXICITY | {CYMBALTA} has been approved for the treatment of diabetic neuropathy and fibromyalgia. |
| SSRI'S (Selective Serotonin Reuptake Inhibitors) | Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine HCL (Paxil) Escitalopram (Lexapro) Citalpram (Celexa) Paroxetine mesylate (Pexeva) {PROZAC} Blocks reuptake of serotonin; Longest half-life and very stimulatory; Available in weekly time released form {PAXIL} Has some antihistamine actions and more likely to cause sedation and constipation {LEXAPRO} Is a metabolite of Citalpram (Celexa) {LUVOX} Major inhibitor of several CYP enzymes resulting in a lot of DDI {WELBUTRIN} Acts at an unidentified site to alleviate symptoms of depression Zyban—Nicotine sensation {REMERON} Blocks 5-HT2 and alpha 2 receptors, antihistaminic activity {DESYREL} block 5-HT1 presynaptic auto receptors and increase serotonin release | Block the reuptake of serotonin, leading to increased concentration of the neurotransmitters in the synaptic clefts Also plays a role in migraines and antiemetic | S-stimulatory, sedation, stomach Aches S- Serotonergic syndrome R-Reduced libido I-Insomnia, increased {PROZAC} ↓appetite and weight loss, ↓SZ threshold, ↓platelet aggregation (bleeding), Hyponatremia in elderly, Rash (dc if pt develops) {PAXIL} Greater Weight Gain, nervousness, sweating, irritation, jitteriness, ↑sexual SE and ↑ DC of symptoms than other SSRI; Sleep disturbance {CELEXA} High degree of QTc interval prolongation, HEPATOXICITY {LEXAPRO} Less side effects than Celexa {LUVOX} Tardive dyskinesia, CNS depression, psychotic symptoms; Weight Gain {WELLBUTRIN} Dry mouth, sweating, tremor, weight loss, HTN and ↓ SZ threshold {REMERON} Severe sedation, Increased appetite, Weight gain, dizzy, elevated cholesterol, ortho hypoTN; Agranulocytosis, cardiac, renal/hepatic {DESYREL} Sedation, Priapism, Cardiac disease, Ortho Hypotension {CELEXA} High degree of QTc interval prolongation, HEPATOXICITY {ZOLOFT} Causes most GI upset, most associated with N/V | MAOIs, antimicrobial agents (zyvox), other serotonergic drugs (dextromethorphan (Demerol), sumatriptan (Imitrax), tramadol, Zofran, St johns wart Abrupt withdrawal can lead to Flu-like sx –taper slow {PROZAC} Highest degree of DDI-inhibits the metabolism of other drugs-- P450 Renal/Hepatic pt {CELEXA} A lot of DDI {LUVOX} Alosetron (lotronex), pimozide (Orap), tizanidine (Zanaflex), thioridazine (Mellaril), mesoridazine (Serenity) {WELLBUTRIN} Sz disorders, bulimia or anorexia, withdrawal from ETOH/Drugs, MAOIs {ZOLOFT} Titrate dose carefully…a lot of DDI | Serotonergic syndrome Most commonly a result of an interaction with MAOIs; Life-threatening condition characterized by: Altered mental changes, Fever, tachycardia, hypertension, Agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, Seizure, Diaphoresis, shivering, GI symptoms {PROZAC} Monitor platelets; DOC for treatment of children and adolescents {ZOLOFT} When you think about Zoloft think about S for stomach {PAXIL} When you think about Paxil think of PACKING ON THE POUNDS {LEXAPRO} mg to mg Lexapro is more potent than Celexa {LUVOX} Rarely used {WELLBUTRIN} Better drug for depressed pt without severe anxiety who cannot tolerate sexual dysfxn, weight gain, and sedation of other drugs {REMERON} Useful when insomnia or agitation is prominent, and depressed pt with marked anorexia {DESYREL} Put a pt in a trance |