MAOIs (monoamine oxidase inhibitors)
MAIOs block the enzyme monoamine oxidase which leads to increased levels of key neurotransmitters: serotonin, norepinephrine & dopamine thought to play a role in mood. Drugs in this class were first used to treat depression in the early 1950s. MAOIs have shown to be effective in treating patients with depression but also have been associated with a long list of side-effects, food and drug-drug interactions. With the introduction of new classes of antidepressants with fewer side effects, MAOIs are now most often used when other medications fail.
SSRIs (selective serotonin re-uptake inhibitors)
Introduced in the 1980’s,SSRIs are considered to be 1st-line treatment for depression due to the safety and tolerability profile. SSRIs are better tolerated than MAOIs and TCAs.
SSRIs are thought to work by preventing serotonin from becoming reabsorbed in the pre-synaptic cell to allow the neurotransmitter to be available to the postsynaptic receptor. Drugs in this class do not boost serotonin levels, therefore it is important for the patient to incorporate lifestyle modifications known to increase serotonin.
Common side effects for this class of medications include: gastrointestinal distress (nausea, vomiting & diarrhea), sexual dysfunction and sleep disturbance.
- citalopram (CELEXA)
- escitalopram (LEXAPRO)
- fluoxetine (PROZAC)
- fluvoxamine (LUVOX)
- paroxetine (PAXIL)
- sertraline (ZOLOFT)
SNRIs (serotonin norepinephrine reuptake inhibitors)
SNRIs are thought to work by preventing both serotonin and norepinephrine from becoming reabsorbed in the pre-synaptic cell to allow the neurotransmitters to be available to the postsynaptic receptor. SNRIs have similar side effects to SSRIs (sexual dysfunction, Gl distress & sleep disturbance) as well as side-effects related to noradrenergic activity (increased pulse rate & blood pressure, dilated pupils, dry mouth, excessive sweating & constipation). Research suggests SNRIs may have a small advantage over SSRIs in regard to rates of remission.
TCAs (tricyclic antidepressants)
Like MAOIs, TCAs also date back to the 1950’s but have fewer side effects. TCAs are not optimal for patients with cardiovascular conditions, cardiac conduction defects, closed angle glaucoma, urinary retention, significant BPH, eating disorders with malnutrition or purging. TCAs may exacerbate hypotension and orthostasis leading to falls which can be a concern in elderly patients. Overdoses can be fatal.
- imipramine (TOFRANIL)
- amitriptyline (ELAVIL)
- desipramine (NORPRAMIN)
- doxepin (SILENOR)
- nortriptyline (PAMELOR)
- protriptyline (VIVACTIL)
- trimipramine (SURMONTIL)
NDRI (norepinephrine-dopamine reuptake inhibitor)
- buproprion (WELLBUTRIN)
Noradrenergic & specific serotonergic antidepressant
SARI (serotonin antagonist and reuptake inhibitor)
- trazodone oldest medication in this group that is still widely used. Mainly used at lower doses as a sedative hypnotic any antidepressant
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