Name common TCAs
TCAs block neuronal reuptake of two monoamine transmitters: noreepinephrine and serotonin.
Long half life. Initial response takes 1-3 weeks, maximal response 1-2 months.
Most common side effects are orthostatic hypotension, sedation, and anticholinergic effects.
Cardiac toxicity is rare, but my cause conduction delays by decreasing vagal influence on the heart and acting directly on bundle of his.
EKG before and periodically during TX recommended.
Overdose can be life threatening
(Lethal dose only 8x daily dose)
Do not use concurrently with MAOI's - SEVERE hypotension.
- Common TCAs:
Describe MAOIs (monoamine oxidase inhibitors)?
- As effective as TCAs and SSRIs but more dangerous - use only for Atypical depression.
- May trigger hypertensive crisis by eating foods rich in tyramine.
Works to deactivate Monoamine oxidase from making norepinephrine and serotonin inactive.
Cause CNS excitement. Risk of orthostatic hypotension.
Must educate patients about foods high in tyramine: aged fish or meat, most cheeses, fermented sausages, yeast extracts, dried fruit, chocolate, bananas and rasberrries.
What are common SSRIs?
As effective as TCAs but do not cause the hypotension, sedation or anticholinergic effects of TCAs.
Produces CNS excitation vs TCA sedation.
Effects begin in 1-3 weeks.
Death from OD rare.
Causes sexual dysfunction in 70% of patients.
Weight gain common complaint.
- Abrupt discontinuation can cause withdrawl syndrome, dizziness, HA, neusea, sensory disturbances, tremor, anxiety, and dysphoria.
- Must taper down!
Produce selective inhibition of serotonin reuptake, intensifying transmission at serotonergic synapses.
May cause but rare: extrapyramidal effects, bruxism, and bleeding disorders, use with caution in Pt. with hx of GI bleed.
- Common SSRI's include:
- Prozac, Zoloft, Lexapro, Celexa, Luvox, Paxil