Atypical Antidepressants Mirtazapine makes you sleepy MoA: selective alpha2-adrenergic antagonists -> increase serotonin & NE release 5-HT2 & 5-HT3 receptor antagonist -> increase effect of serotonin on free 5-HT, -R H1 antagonist - likely cause of antidepressant effect Indications: MDD esp. in pts who are underweight &lor have insomnia Side effects: appetite & weight gain -> may be desired sedation (due to H1 antagonism) increase cholesterol & triglyceride levels minimal sexual side effects dry mouth Drug Interactions: risk of serotonin syndrome if used concomitantly with other serotonergic drugs Bupropion MoA: ? dop & NE reuptake inhibitor -> increase dopamine & NE Indications: smoking cessation -> used in conjunction with counselling & nicotine replacement MDD NO WEIGHT GAIN, WEIGHT LOSS Side effects: stimulant effect THR weight loss neuropsychiatric symptoms: insomnia, agitation, headache dry mouth no sexual side effects decrease in seizure threshold (contraindicated in pts @ risk of seizures, epilepsy, th, anorexia/bulimia, alcohol or benzodiazepine withdrawal) Drug Interactions: Risk of serotonin syndrome if used concomitantly with other serotonergic drugs Vilazodone MoA: serotonin reuptake in synaptic cleft -> increase serotonin levels 5-HT1A receptor partial agonist Indications: MDD Side Effects: Headaches Nausea Diarrhea Sleep disturbances sexual dysfunction Anti-cholinergic effect (e.g. dry mouth) Drug Interactions: Serotonin syndrome if used concomitantly with other serotonergic drugs Other Info: Rare cases of pancreatitis have been reported Buspirone MoA: 5-HT-R Needs consistent daily intake for at least 2 wks due to having a delayed onset of action Indication: Anxiety Disorders Side Effects: Headaches Dizziness Nausea Seizure due to chronic use Additional Info: Not sedative No risk of addiction or tolerance No interaction with alcohol as opposed to barbiturates & benzodiazepines Vortioxeline MoA: serotonin reuptake in the synaptic cleft -> increase serotonin levels 5-HT1A-R agonist 5-HT3-R antagonist Indications: MDD Drug Interactions: Risk of serotonin syndrome if used concomitantly with other serotonergic drugs Side Effects: Sexual dysfunction Nausea Abnormal dreams Sleep disturbances Anti-cholinergic effects e.g. dry mouth Varenicline MoA: nicotinic Ach-R partial agonists decrease dop. -> decrease nicotine craving & withdrawal Indications: Smoking cessation Varenicline makes you Very Clean from Nicotine Side Effects: Sleep disturbances Seizures