Antidepressants Overview

General Concepts

• Increased Risk of Suicide: All antidepressants may increase the risk of suicide as they boost energy levels, potentially enabling individuals to carry out pre-existing suicidal plans.
  • Monitor for suicidal thoughts and comments.
• Do Not Stop Abruptly: Antidepressants should be tapered off, not stopped suddenly.

Types of Antidepressants

SSRIs (Selective Serotonin Reuptake Inhibitors)

• Uses: Depression, anxiety, OCD, and eating disorders.
• Action: Inhibit serotonin reuptake, increasing serotonin levels.
• Common Medications: Recognizable by suffixes like -talopram, -oxetine, -zodone. S for Sertraline (an outlier) and SSRIs.
• Side Effects:
  • "S's of SSRIs": Sexual dysfunction, Stomach issues (GI upset), Swole (weight gain), Serotonin syndrome.
  • Serotonin Syndrome: Too much serotonin; symptoms include muscle rigidity, restlessness, high heart rate, and blood pressure.
• Patient Education:
  • Medications take 4-6 weeks to be effective.
  • Take in the morning (Memory trick: SSRIs, think Sunrise).
  • Do not combine with MAOIs or St. John's Wort to avoid serotonin syndrome.
  • Encourage a healthy diet and regular exercise.

TCAs (Tricyclic Antidepressants)

• Uses: Depressive episodes, bipolar disorder, OCD, neuropathy.
• Action: Block reuptake of serotonin and norepinephrine.
• Common Medications: Recognizable by suffixes like -tryptaline, -pramine.
• Side Effects:
  • Dizziness, orthostatic hypotension.
  • Anticholinergic effects: Can't pee (urinary retention), can't see (blurred vision), can't spit (dry mouth), can't poop (constipation).
• Patient Education:
  • Wait 14 days after MAOI use before starting TCAs (washout period).
  • Rise slowly from sitting/lying to avoid falls.
  • Combat dry mouth with fluids and sugar-free candies.
  • Combat constipation with increased fluids, fiber, and exercise.

MAOIs (Monoamine Oxidase Inhibitors)

• Uses: Depression.
• Action: Inhibit monoamine oxidase, increasing epinephrine, norepinephrine, dopamine, and serotonin.
• Common Medications: TIP - Tranylcypromine, Isocarboxazid, Phenelzine.
• Patient Education:
  • Require a 14-day washout period with SSRIs and TCAs.
  • Follow a tyramine-restricted diet to prevent hypertensive crisis.
  • Foods high in tyramine: Aged cheese, fermented meats/livers, overripe fruits, sour cream, yogurt.
  • Take in the morning (Memory trick: MAOIs, think Morning).
  • Takes 4 weeks for therapeutic effect (four letters in MAOI).

Additional Resources

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