These drugs operate by blocking the re-uptake of serotonin and norepinephrine, increasing their levels in the brain and thus affecting mood and emotion. Used for clients with major depressive disorder, type 2 bipolar disorder, or depression secondary to other disorders such as in OCD, panic attacks, phobias, etc. It is prescribed for adults and the elderly, used in children and adolescents, but not recommended for pregnant and lactating individuals.
Tricyclic Antidepressant Drugs (TCA)
These may take from 2 to 6 weeks to take effect.
- Sinequan (Doxepin)
- Anafranil (Clomiframin)
- Vivactil (Protriptylline)
- Elavil (Amitriptylline)
- Tofranil (Imipramine)
- Ascendin (Amoxapine)
- Norpramin (Despramine)
Monoamine Oxidase Inhibitor
These may take 2 to 4 weeks to take effect. Patients should be warned to avoid tyramine-rich food in order to avoid a hypertensive crisis.
- Marplan (Isocarboxazid)
- Nardil (Phenelzine)
- Parnate (Tranylcypromine)
Selective Serotonin Reuptake Inhibitor (SSRI)
These may take 2 to 3 weeks to take effect.
- Prozac (Fluoxetine)
- Paxil (Paroxetine)
- Zoloft (Sertraline)
- Luvox (Fluvoxamine)
Norepinephrine Reuptake Inhibitors (NRI)
AKA Noradrenaline Reuptake Inhibitors or Adrenergic Reuptake Inhibitors (ARI). These block norepinephrine and epinephrine re-uptake in the brain by blocking their transporters. This leads to increased extracellular concentration, increasing adrenergic neurotransmission.
- Dyserel (Trazadone)
- Effexor (Venlafaxine)
- Wellbutrin (Bupriopion)
- Strattera (Atomoxetine)
Contraindications
- Cardiovascular Disease
- Glaucoma
- Benign Prostatic Hypertrophy
- Liver and Renal Disease
Side Effects
Common:
- Anticholinergic Effects
- Photosensitivity
- CNS Effects (sedation and fatigue)
- Cardiovascular Effects
- GIT Effects (anorexia and nausea)
Serious:
- Agranulocytosis
- Serotonin Syndrome: Diaphoresis, Mental Status Changes (confusion, restlessness, agitation), Hypertension, Rigor, Acidosis, Respiratory Failure, Myoclonus (twitching), Tremors
- Treatment and Management: serotonin receptor antagonist; Sansert (Methysergide), Periactin (Cyproheptadine).
- Notify physician, withhold further medication, admit client to ICU, administer IVF and antiarrhythmic drugs, and hyperthermic measures.
- Treatment and Management: serotonin receptor antagonist; Sansert (Methysergide), Periactin (Cyproheptadine).
- TCA Overdose: sedation, stupor, convulsion, coma, agitation, ataxia, respiratory depression.
- Treatment and Management:
- Monitor Vital Signs and ECG Tracing
- Maintain a patent airway
- Catharsis or gastric lavage
- Cholinergic stimulants e.g. Antilirium (Physostigmine)
- Treatment and Management: