SSRIs (Selective Serotonin Reuptake Inhibitors)
- Mechanism of Action: Inhibit reuptake of serotonin
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- Depression
- Anxiety disorders
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- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
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- GI upset (nausea, diarrhea)
- Weight gain
- Insomnia
- Sexual dysfunction
- Headache
- Increased bleeding risk
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- No MAOIs (Serotonin Syndrome)
- Caution in bipolar (risk of mania)
- Caution with bleeding disorders / anticoagulants
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SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
- Mechanism of Action: Inhibit reuptake of serotonin & norepinephrine
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- Depression
- Anxiety
- Fibromyalgia
- Neuropathic pain
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- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
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- GI upset
- Weight gain
- Insomnia
- Sexual dysfunction
- Sweating
- Headache
- Hypertension
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- No MAOIs
- Uncontrolled hypertension
- Caution in bipolar (mania risk)
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TCAs (Tricyclic Antidepressants)
- Mechanism of Action: Inhibit reuptake of serotonin/norepinephrine; anticholinergic
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- Depression
- Neuropathic pain
- Migraine prevention
- Fibromyalgia
- Insomnia (off-label)
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- Amitriptyline
- Nortriptyline
- Imipramine
- Clomipramine
- Doxepin
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- Anticholinergic (dry mouth, constipation, urinary retention, blurred vision)
- Sedation
- Orthostatic hypotension
- Weight gain
- Arrhythmias
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- No MAOIs
- Cardiac conduction issues (QT prolongation, heart block)
- Caution in elderly (falls, confusion)
- High overdose risk
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MAOIs (Monoamine Oxidase Inhibitors)
- Mechanism: Inhibit MAO → ↑ serotonin, norepinephrine, dopamine
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- Treatment-resistant depression
- Parkinson’s (selegiline)
- Panic disorder
- Social phobia
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- Phenelzine
- Tranylcypromine
- Selegiline
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- Hypertensive crisis (tyramine foods)
- Insomnia
- Sexual dysfunction
- Weight gain
- Serotonin syndrome
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- Avoid tyramine
- No SSRIs/SNRIs/TCAs
- 2-week washout period before switching antidepressants
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Atypical Antidepressants
- Mechanism: Varies by agent (dopamine, norepinephrine, serotonin…)
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- Depression
- Smoking cessation (bupropion)
- Seasonal affective disorder
- Insomnia adjunct (trazodone, mirtazapine)
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- Bupropion (Wellbutrin)
- Trazodone
- Mirtazapine
- Nefazodone
- Vilazodone
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- Sedation (trazodone, mirtazapine)
- Weight gain (mirtazapine)
- Weight loss (bupropion)
- Dry mouth
- Seizure risk (bupropion)
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- Avoid in seizure/eating disorders
- No MAOIs
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Typical Antipsychotics (1st Gen)
- Mechanism: Block D2 → decreased dopamine in certain pathways
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- Schizophrenia (positive sx)
- Psychosis
- Acute mania
- Agitation
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- Haloperidol
- Chlorpromazine
- Fluphenazine
- Thioridazine
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- EPS (dystonia, akathisia, parkinsonism)
- Tardive dyskinesia
- Neuroleptic Malignant Syndrome
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- Parkinson’s disease
- CNS depression
- QT prolongation
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Atypical Antipsychotics (2nd Gen)
- Mechanism: Block D2 & 5-HT2A → dopamine/serotonin balance
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- Schizophrenia (pos/neg sx)
- Bipolar disorder
- Psychosis
- Acute mania
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- Risperidone
- Olanzapine
- Quetiapine
- Aripiprazole
- Clozapine
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- Metabolic changes (weight gain, dyslipidemia, hyperglycemia)
- Sedation
- QT prolongation
- Agranulocytosis (clozapine) → WBC checks
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- Diabetes
- Seizure risk
- Monitor WBCs (clozapine)
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Mood Stabilizers
- Mechanism: Varies (e.g. Lithium alters intracellular signaling)
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- Bipolar disorder
- Schizoaffective disorder
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- Lithium
- Valproate
- Carbamazepine
- Lamotrigine
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- Tremor (Lithium)
- Weight gain
- Thyroid dysfunction
- Renal impairment
- GI upset
- Rash (lamotrigine) - SJS risk
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- Lithium: monitor kidneys, sodium/hydration
- Valproate: hepatotoxicity, pregnancy risk
- Carbamazepine: blood dyscrasias
- Lamotrigine: slow titration to avoid rash
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Benzodiazepines
- Mechanism: Enhance GABA-A → increased inhibitory effect
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- Anxiety
- Panic disorder
- Insomnia (short-term)
- Seizures / Status epilepticus
- Alcohol withdrawal
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- Alprazolam (Xanax)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
- Chlordiazepoxide (Librium)
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- Sedation
- Respiratory depression
- Amnesia
- Dependence / tolerance
- Withdrawal risk (seizures if abrupt stop)
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- High abuse potential
- Avoid in substance abuse history
- Caution in elderly (falls, confusion)
- Avoid in severe respiratory conditions
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Stimulants
- Mechanism: ↑ release / block reuptake of NE & dopamine
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- ADHD
- Narcolepsy
- Binge eating disorder
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- Methylphenidate (Ritalin)
- Dexmethylphenidate
- Amphetamine
- Lisdexamfetamine
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- Insomnia
- Decreased appetite → weight loss
- Anxiety
- Tachycardia
- Hypertension
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- Serious cardiac conditions
- Severe hypertension
- Substance abuse history
- Anxiety disorders
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