Antidepressant Tips (SSRIs and TCAs)

Carl Marci

SSRIs: Selective serotonin reuptake inhibitors

A. Common side-effects

· agitation, anxiety/ nervousness, insomnia; sedation

· headaches, nausea, diarrhea

· decreased sexual arousal, erectile dysfunction

B. Selected complications

· serotonin syndrome

· switch to mania

· withdrawal (flu-like syndrome) with shorter half-life agents

TCAs: Tricyclic antidepressants

A. General principles

· 3°amines block both NE and 5-HT; 2° amines more NE-selective

· if augmenting with SSRI, may need less TCA

· check ECG prior to starting

B. Common side-effects

· orthostatic hypotension

· anticholinergic: dry mouth, blurry vision, constip., urinary retention

· arrhythmias, reflex tachycardia (follow QRS and QT intervals)

· sedation, weight gain

C. Selected complications

· overdose >1g is toxic; prescribe small quantities, close f/u.

· switch to mania

· interactions: antiarrhythmics, antipsychotics, T3/T4, thiazides,

SSRI, OCP, steroids, stimulants

source: Hyman SE et al. (1995) Handbook of Psychiatric Drug Therapy, 3^rd ed. Little Brown