Antidepressants
Drug Class | Specific Medication | Selected Precautions* |
|---|---|---|
Selective Serotonin Reuptake Inhibitors (SSRIs) | ||
Lower potential for drug interactions because it has less effect on CYP450 isoenzymes Risk of QT-interval prolongation that limits doses to ≤ 40 mg/day | ||
Lower potential for drug interactions because it has less effect on CYP450 isoenzymes | ||
Has very long half-life Less likely to cause discontinuation symptoms† The only antidepressant proven effective in children | ||
Of SSRIs, may cause the most weight gain | ||
Of SSRIs, has highest incidence of loose stools | ||
Should not be stopped abruptly; reduce dose gradually | ||
Serotonin modulators (5-HT2 blockers) | Cause discontinuation symptoms† if stopped abruptly | |
Causes weight gain and sedation Has fewer sexual adverse effects than SSRIs and SNRIs | ||
May cause priapism and sedation May cause orthostatic hypotension | ||
Serotonin-norepinephrine reuptake inhibitors (SNRIs) | — | |
— | May increase BP or HR (control BP before initiating the medication and monitor BP and HR while patients are on it) | |
Modest dose-dependent increase in systolic and diastolic BP May cause mild urinary hesitancy in males Less potential for drug interactions because it has less effect on CYP450 isoenzymes | ||
May increase BP or HR (control BP before initiating the medication and monitor BP and HR while patients are on it) Can affect urinary hesitation or retention (caution required in patients with obstructive urinary disorders; stop it if symptoms develop) | ||
Modest dose-dependent increase in diastolic BP Dual norepinephrine and 5-HT reuptake effect at about 150 mg Rarely, increase in systolic BP (not dose-dependent) If stopped, should be tapered slowly Less potential for drug interactions because it has less effect on CYP450 isoenzymes | ||
Norepinephrine-dopamine reuptake inhibitor | — | |
Contraindicated in patients who have bulimia or who are seizure-prone May interact with HCAs, increasing the risk of seizures May cause dose-dependent recent memory loss | ||
Heterocyclics | Contraindicated in patients with coronary artery disease, certain arrhythmias, angle-closure glaucoma, benign prostatic hyperplasia, or esophageal hiatus hernia Can cause orthostatic hypotension leading to falls and fractures, potentiate the effect of alcohol, and raise the blood level of antipsychotics Cause discontinuation symptoms† if stopped abruptly With significant overdose, potentially lethal | |
Causes weight gain | ||
Can have extrapyramidal adverse effects | ||
Lowers seizure threshold at doses of > 250 mg/day | ||
Metabolized only via CYP2D6 isoenzyme: Medications that inhibit this enzyme markedly increase plasma levels | ||
Causes weight gain | ||
May cause excessive sweating and nightmares | ||
Increased risk of seizures with rapid dose escalation at high doses | ||
Has long half-life (74 hours) | ||
Has long half-life (74 hours) | ||
Causes weight gain | ||
Monoamine Oxidase (MAO) Inhibitors | Serotonin syndrome possible when taken with an SSRI Hypertensive crisis possible when taken with other antidepressants, sympathomimetic or other selected medications, or certain foods and beverages With significant overdose, potentially lethal | |
Causes orthostatic hypotension | ||
Causes orthostatic hypotension | ||
Can cause application site reactions and insomnia | ||
Causes orthostatic hypotension | ||
Melatonergic antidepressant | ||
Agomelatine (5-HT2C receptor antagonist) | Should be stopped immediately if symptoms or signs of potential liver injury develop or if serum aminotransferases increase to> 3 times the upper limit of normal | |
* Antidepressant use may increase the risk of suicidal thinking and behavior in pediatric and young adult patients with major depressive disorder and other psychiatric disorders. Refer to a drug information resource for more detailed information regarding dosing, adverse reactions, and other safety considerations. † Discontinuation symptoms include nausea, chills, muscle aches, dizziness, anxiety, irritability, insomnia, and fatigue. BP = blood pressure; CYP = cytochrome P450 system; HCAs = heterocyclic antidepressants; HR = heart rate; 5-HT = 5-hydroxytryptamine (serotonin); NSAID = nonsteroidal anti-inflammatory. | ||