Tricyclic Antidepressants SSRI MOA Inhibitors NRIs SNRIs 2 Adrenergic

Antagonist
Mechanism of Action Reuptake Inhibition of NE and 5HT Selectively inhibit serotonin
Antagonizes other neurotransmitter w/o cholinergic, histamine,
receptors (muscarinic, Histaminergic, adrenergic receptor action
Alpha1 adrenergic)
Description 3 ring nucleus First line of Tx
First drug discovered
Very effective for severe depression
Efficacy/ 55-70 % response rate for acute treatment Rapidly absorbed
Pharmacokinetics Hepatic Metabolism
There is 10-20 delay in therapeutic effects
There is 10-20 delay in
Dose: 125-150 mg: relapse prevention therapeutic effects
Side Effects Lesser S/E
Significant S/E that affects
compliance: bloating and
ulcer-like symptoms
Sexual Dysfunction
Nausea/Vomiting
(postsynaptic 5-HT receptors)
Agitation/Akathisia
Sedation/Dizziness
Discontinuation syndrome
(related to short half-life)
Inhibits MAO A and B, increasing storage Inhibits NE reuptake Inhibits both 5HT Blocks presynaptic
and release of 5HT and NE No activity at the and NE REUPTAKE A2 receptors
cholinergic, adrenergic
MAO A: NE, 5HT, Tyramine or histaminergic NE and 5HT
MAO B:: DA, Tyramine, Phenylethylamine receptors specific
antidepressant,
5HT3
antihistaminic
Developed for the Tx of TB Alerting properties Dual action reuptake
Third line of Tx inhibitors
Low-Tyramine diet required Lacks the S/E of TCA
Rapidly absorbed Rapid onset and Increase NE
Half-life: 2 weeks enhanced efficacy in Activity by blocking
severe depressive negative feedback
disorder on presynaptic a2
receptors
Lower doses: 5HT
High Doses: NE
Cause severe
withdrawal
symptoms

Serotonin Syndrome: a
potentially life threatening
drug reaction that causes the
body to have too much
serotonin
Contraindications Heart block. Hypomania or mania, recent CVD, Stroke, Epilepsy, Hepatic Disease,
MI Pheocytochroma, Hyperthyroidism,
Children
Less Indicated: Elderly, Psychotic, Physically
ill, Suicidal, Bipolar
Indications Adults, agitation, retardation, severe Severe depression, Tx resistant
depression depression. Anxiety/OCD
Examples Nortriptyline Sertraline Reboxetine Venlafaxine Mirtazapine
Imipramine Paroxetine Atomaxetine Duloxetine
Clomipramine Fluvoxamine
Amitripyline Fluoxentine
Desipramine Escitatopram