Antidepressant Fact files

Question 1

TCA

Answer 1

Sedating: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Mianserin, Trimipramine
Non-Sedating: Lofepramine, Imipramine, Nortriptyline

Indication: Depression, neuropathic pain, phobic/obsessive disorders (clomipramine)
MOA: Block reuptake of serotonin & noradrenaline
Contraindications: Mania, recent MI, heart block, arrhythmia, children
Interactions: MAOIs (HTN crisis), anticholinergics, antipsychotics, alcohol
Side Effects: Antimuscarinic effects, cardiotoxicity (especially in overdose)
Notes: Lofepramine = safer; Sedating TCAs = good for anxious; Non-sedating = apathetic; Dangerous in overdose, long half-life allows once-daily dosing

Question 2

MOAI

Answer 2

Reversible: Moclobemide
Irreversible: Isocarboxazid, Phenelzine, Tranylcypromine

Indication: Atypical/hypochondriacal/hysterical depression, 2nd line (moclobemide)
MOA: Inhibits monoamine degradation → ↑ serotonin, NA, dopamine
Contraindications: CVD, CVA, uncontrolled hypertension, tyramine-rich food
Interactions: Other antidepressants (require washout), tyramine foods, alcohol
Side Effects: Hypertensive crisis, serotonin syndrome, postural hypotension
Notes: Requires dietary restrictions, long washout; Tranylcypromine = most risky

Question 3

SARI

Answer 3

🟨 SARI: Trazodone
Indication: Depression with insomnia or anxiety
MOA: 5HT reuptake inhibitor + blocks histamine & α1-adrenergic receptors
Contraindications: Heart block, post-MI, mania, CVD, diabetes, epilepsy
Interactions: Bupropion
Side Effects: Sedation, arrhythmia, hypotension, blurred vision, agranulocytosis,
Notes: Titrate slowly, useful for sedative properties, avoid 1st trimester

Question 4

SSRI

Answer 4

🟧 SSRIs: Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine
Indication: Depression, anxiety, OCD, PTSD, menopause symptoms
MOA: Inhibit serotonin reuptake
Contraindications: Mania, poorly controlled epilepsy, diabetes, hx of bleeding
Interactions: NSAIDs, aspirin, other antidepressants, lithium
Side Effects: GI upset, headache, agitation, sexual dysfunction, QT prolongation, hyponatraemia
Notes: Fluoxetine = long t½ (needs 5-week washout before MAOI); Sertraline = post-MI; Paroxetine = short t½. Fluoxetine preferred for under 18 if over then sertraline

Question 5

SNRI

Answer 5

🟥 SNRIs: Venlafaxine, Duloxetine
Indication: Depression, anxiety, diabetic neuropathy (duloxetine), menopausal symptoms
MOA: Inhibit serotonin & noradrenaline reuptake
Caution: Cardiac disease, uncontrolled hypertension, arrhythmia, hx of mania
Interactions: NSAIDs, warfarin, aspirin, bupropion
Side Effects: HTN (esp. venlafaxine), sexual dysfunction, GI upset, QT prolongation (venlafaxine), hyponatraemia
Notes: Venlafaxine = monitor BP/ECG; Duloxetine = lower dose for depression (60mg) anxiety (120mg)

Question 6

Noradrenergic + specific serotonergic

Answer 6

🟪 NaSSA: Mirtazapine
Indication: Depression (esp. with poor sleep or appetite)
MOA: Alpha2-adrenergic antagonist → ↑ NA & serotonin
Caution: Mania, seizures, CVD, diab, urinary retention
Interactions: Can be cautiously combined with SSRIs/SNRIs
Side Effects: Sedation, weight gain, dizziness, blood dyscrasias
Notes: Good for elderly if insomnia or underweight; max dose 45mg

Question 7

Melatonin receptor agonist

Answer 7

🟫 Melatonin Receptor Agonist: Agomelatine
Indication: Depression
MOA: Melatonin receptor agonist + serotonin receptor antagonist
Caution: Age >75, liver disease, bipolar disorder, diabetes, mania
Interactions: Smoking (↓ effect), alcohol
Side Effects: Hepatotoxicity, GI issues, insomnia, suicidal ideation
Notes: Requires LFT monitoring (baseline, 3, 6, 12, 24 weeks). Avoid in pregnancy and BF