Monoamine Oxidase Inhibitors

(MAOIs)

Mechanism of Action (MOA): Inhibits monoamine oxidase

SE: Dizziness, sedation, fatigue, constipation, weight gain, dry mouth, orthostatic hypotension, hepatotoxicity

Warnings/Precautions: Avoid tyramine containing foods, avoid OTC cold/cough and weight loss products, Cardio/Cerebrovascular disease, History of liver disease

Drug Interactions: Tramadol, SSRIs, Sympathomimetic agents, Meperidine, Dextromethorphan, Antidepressants, CNS depressants

Notes: Wash out period of atleast 2 weeks (14 days) before starting another antideprassant class, all are pregnancy code C

Phenelzine

Nardil®

Pregnancy: C 

MAOI

Tranylcypromine

Parnate®

Pregnancy: C

MAOI

Isocarboxazid

Marplan®

Pregnancy: C

MAOI

Selegeline

Emsam®

Only MAOI available as patch and ODT

Pregnancy: C

MAOI

Tricyclic Antidepressants

(TCAs)

MOA: Inhibits the reuptake of NE and 5HT

SE: Dry mouth, sedation, constipation, blurred vision, cognitive impairment, weight gain, dizziness, hypotension, cardiovascular dysfunction, seizures, sexual dysfunction, paralytic ileus (with other anticholinergics)

Warnings/Precautions: Suicidal ideations, cardiovascular conditions, closed angle glaucoma, urinary retention, severe prostate hypertrophy, seizures

DI: Tramadol, anticholinergics, CYP 450 inhibitors/inducers, Sympathomimetics agents, Kava Kava, St. John's Wort, SAMe, Valerian

Notes: Avoid in elderly due to cognitive impairing side effects, usually take 4-6 weeks for full effect

Amoxapine

Ascendin®

Pregnancy: C

TCA (Secondary Amine)

Nortriptyline

 Pamelor®

Pregnancy: D

Available as a solution

TCA (Secondary Amine)

Desipramine

Norpramin®

Pregnancy: C

TCA (Secondary Amine)

Protriptyline

Vivactil®

Pregnancy: C

TCA (Secondary Amine)

Amitriptyline

Elavil®

Pregnancy: C

TCA (Tertiary Amine)

Clomipramine

Anafranil®

Pregnancy: C

TCA (Tertiary Amine)

Doxepin

Sinequan®, Prudoxin®

Available as a solution

Pregnancy: C

TCA (Tertiary Amine)

Imipramine

Tofranil®

Pregnancy: D

TCA (Tertiary Amine)

Trimipramine

Surmontil®

Pregnancy: C

TCA (Tertiary Amine)

Selective Serotonin Reuptake Inhibitors

(SSRIs)

MOA: Inhibits the reuptake of serotonin, desensitizes 5HT autoreceptors

SE: Sexual dysfunction, gastrointestinal disturbances, insomnia, sedation, tremors, bruising, bleeding, SIADH (Syndrome of inadequate antidiuretic hormone)

Warnings/Precautions: History of serizures, initiation of other antidepressant therapy for 5 weeks after fluoxetine, elderly

DI: CYP 450 Inhibitors/Inducers, Tramadol, TCAs, MAOIs, Kava Kava, Warfarin, St. John's Wort, SAMe, Valerian

Notes: May be used for MDD in children

Fluoxetine

 Prozac®, Prozac® Weekly, Sarafem®

Pregnancy: C

Substrate of 2D6

SSRI

Paroxetine

 Paxil®, Paxil® CR

Most sedating of all SSRIs

Substrate of 2D6

Pregnancy: D

SSRI

Citalopram

 Celexa®

Substrate of 2D6

Pregnancy: C

SSRI

Escitalopram

Lexapro®

Pregnancy: C

SSRI

Fluvoxamine

 Luvox®

Substrate of 1A2, 2C19

Pregnancy: C

SSRI

Sertraline

 Zoloft®

Substrate of 3A4, 2D6

Pregnancy: C

SSRI

Serotonin-Norepinephrine Reuptake Inhibitors

(SNRIs)

MOA: Inhibits the reuptake of NE and 5HT, blocks monoamine transporters more selectively than TCAs

Venlafaxine

Effexor®, Effexor® XR

SE: Headache, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual dysfunction

Warnings/Precautions: History of heart disease or seizures, hypertension

DI: Tramadol, MAOIs, Linezolid (Zyvox®), 2D6/3A4 inhibitors/inducers, CNS depressants, Kava Kava, St. Johns Wort, SAMe, Valerian

Pregnancy: C

SNRI

Duloxetine

Cymbalta®

SE: Nausea, diarrhea, decreased appetite, sexual dusfunction, insomia, sedation, increased blood pressure, hepatotoxicity

Warnings/Precautions: History of seizures, substantial alcohol use, liver disease

DI: TCAs, MAOIs, 2D6/1A2 Inhibitors/Inducers, Linezolid (Zyvox®)

Pregnancy: C

SNRI

Desvenlafaxine

Pristiq®

SE: Constipation, abnormal dreams, sexual dysfunction, insomnia, increased blood pressure (Not as significant as Effexor)

Warnings/Precautions: History of heart disease/seizures

DI: Tramadol, MAOIs, Linezolid (Zyvox), 2D6/3A4 inhibitors/inducers, CNS depressants, Kava Kava, St. Johns Wort, SAMe, Valerian, Serotonin agonists

Pregnancy: C

SNRI

Trazodone

Desyrel®

MOA: Inhibits the reuptake of 5HT

SE: Dizziness, nausea, blurred vision, priapism (long, painful erection)

DI: 3A4 inhibitors/inducers

Notes: Inhibtits 2D6, Pregnancy: C

Miscellaneous Antidepressant

Nefazodone

Serzone®

MOA: Inhibits the reuptake of 5HT

SE: Hepatic failure (limits its use in clinical practice)

Pregnancy: C

Miscellaneous Antidepressant

Mirtazapine

Remeron®, Remeron® SolTab

MOA: Enhances the release of NE via blockade of alpha-2 receptors

SE: Antihistaminc activity, weight gain, abnormal dreams, hypotension, photosensitivity

Warnings/Precautions: History of seizures, avoid alcohol, may lower WBC

DI: Tramadol, MAOIs, 1A2/2D6/3A4 inhibitors/inducers, Kava Kava, St. Johns Wort, SAMe, Valerian

Pregnancy: C 

Miscellaneous Antidepressant

Burpropion

Wellbutrin®, Wellbutrin® XR, Wellbutrin® SR, Zyban®

MOA: Inhibits the reuptake of DA and NE

SE: dry mouth, constipation, nausea, weight loss, myalgias, insomnia, dizziness, anxiety, agitation, hypertension, seizures

Warnings/Precautions: Seizure disorders, eating disorders

DI: Tramadol, TCAs, MAOIs, Nicotine patches, Agents that lower seizure threshold

Pregnancy: C

Miscellaneous Antidepressant

Agents Used for Augmentation Therapy in Depression

1. Thyroid hormone

2. Buspirone (BuSpar®)

3. Stimulants (Modafinil (Provigil®))

4. Antipsychotics (Quetiapine (Seroquel®), Olanzapine (Zyprexa®), Aripiprazole (Abilify®), Olanzapine/Fluoxetine (Symbyax®))

5. Lithium (Lithobid®)