T ANTIDEPRESSANTS SSRI Selective Serotonin Reuptake Inhibitors SNRI Serotonin Norepinephrine Reuptake Inhibitors 4-6 weeks to take effect → Fluoxetine (Prozac) → Sertraline (Zoloft) → Citalopram (Celexa) → Escitalopram (Lexapro) → Paroxetine (Paxil) -First line (especially in children, adolescents and elderly) -Dose in the 4-6 weeks to take effect → Venlafaxine (Effexor) → Desvenlafaxine (Pristiq) → Duloxetine (Cymbalta) → Levomilnacipran (Fetzima) morning Contraindications → Hypersensitivity → MAOI’s within 14 days Contraindications → MAOI’s within 14 days → SNRI’s are teratogenic → Pregnancy/Breastfeeding → Liver disease → Renal failure Patient teaching → Avoid the concurrent use of St. John’s Wort → Be aware that sexual dysfunction can occur → Observe for manifestations of serotonin syndrome Patient teaching → Avoid abrupt cessation of the medication → Take with food → Take medication on a daily basis to establish therapeutic use → Follow a healthy diet and exercise regimen because weight gain can occur Side effects → Nausea → Headache → Dry mouth → Insomnia Side effects → Nausea → Sweating → Sexual dysfunction → ↑ blood pressure Monoamine Oxidase Inhibitors MAOI → Phenelzine (Nardil) → Tranylcypromine (Parnate) → Isocarboxazid (Marplan) → Selegiline (Emsam) Contraindications → Food rich in tyramine: Aged cheese, cured meats, fermented foods, soy products → Concurrent use of other antidepressants → Liver Impairment → Patients with glaucoma Patient teaching → Do not use with any other antidepressants → Avoid tyramine foods → Understand the importance of medication adherence: Do not double up on missed doses Side effects → Dizziness → Insomnia → Weight gain → Sexual dysfunction → Orthostatic hypotension ↑ Tricyclic Antidepressants TCA → Amitriptyline (Elavil) → Nortriptyline (Pamelor) → Imipramine (Tofranil) → Desipramine (Norpramin) Contraindications → Hypersensitivity to TCA’s → Recent myocardial infarction → Arrhythmias or cardiovascular conditions → Angle closure glaucoma → Concurrent use of other antidepressants Patient teaching → Take at bedtime to reduce daytime drowsiness → Do not stop taking this drug class abruptly → Notify doctor if you are experiencing suicidal thoughts Side effects → Dry mouth → Constipation → Blurred vision → Urinary retention (Anticholinergic effects)