SSRIs (Selective Serotonin Reuptake Inhibitors)
- Mechanism of Action: Inhibit reuptake of serotonin, increasing serotonin levels
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- Depression
- Anxiety disorders (GAD, panic, OCD, PTSD, social anxiety)
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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 (risk of Serotonin Syndrome)
- Caution in bipolar (mania risk)
- Caution with bleeding disorders / anticoagulants
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SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
- Mechanism of Action: Inhibit reuptake of serotonin and norepinephrine, increasing their levels
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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 and norepinephrine; also block some receptors (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 effects (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 (fall risk, confusion)
- High overdose risk
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MAOIs (Monoamine Oxidase Inhibitors)
- Mechanism of Action: Inhibit monoamine oxidase → increased serotonin, norepinephrine, and dopamine
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- Treatment-resistant depression
- Parkinson’s disease (selegiline)
- Panic disorder
- Social phobia
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- Phenelzine
- Tranylcypromine
- Selegiline
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- Hypertensive crisis (tyramine foods: cheese, wine, aged meats)
- 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 of Action: Varies (e.g., affects dopamine, norepinephrine, and/or serotonin depending on agent)
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- Depression
- Smoking cessation (bupropion)
- Seasonal affective disorder
- Adjunct for insomnia (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)
- Increased appetite (mirtazapine)
- Dry mouth
- Seizure risk (bupropion)
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- Avoid in seizure disorders and eating disorders (bulimia, anorexia)
- No MAOIs
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Typical Antipsychotics (First-Generation)
- Mechanism of Action: Primarily block D2 receptors, reducing dopamine in certain pathways
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- Schizophrenia (positive symptoms: hallucinations, delusions)
- Psychosis
- Acute mania
- Agitation
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- Haloperidol
- Chlorpromazine
- Fluphenazine
- Thioridazine
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- Extrapyramidal symptoms (EPS): dystonia, akathisia, parkinsonism
- Tardive dyskinesia
- Neuroleptic Malignant Syndrome (fever, rigidity, autonomic instability)
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- Parkinson’s disease
- CNS depression (coma, sedation)
- QT prolongation
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Atypical Antipsychotics (Second-Generation)
- Mechanism of Action: Block D2 receptors and serotonin (5-HT2A) receptors, affecting dopamine/serotonin balance
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- Schizophrenia (positive & negative symptoms)
- Bipolar disorder
- Psychosis
- Acute mania
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- Risperidone
- Olanzapine
- Quetiapine
- Aripiprazole
- Clozapine
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- Metabolic changes (weight gain, dyslipidemia, hyperglycemia/diabetes)
- Sedation
- QT prolongation
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Agranulocytosis (clozapine) → monitor WBCs
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- Diabetes
- Seizure risk
- Monitor WBCs (clozapine - agranulocytosis)
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Mood Stabilizers
- Mechanism of Action: Varies (e.g., Lithium alters intracellular signaling, others affect ion channels)
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- Bipolar disorder (acute mania, maintenance)
- Schizoaffective disorder
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- Lithium
- Valproate (Valproic Acid)
- Carbamazepine
- Lamotrigine
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- Tremor (lithium)
- Weight gain
- Thyroid dysfunction
- Renal impairment
- GI upset
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Rash (lamotrigine) - risk of Stevens-Johnson Syndrome
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- Lithium: monitor kidney function, hydration, sodium levels
- Valproate: hepatotoxicity, pregnancy risk
- Carbamazepine: blood dyscrasias
- Lamotrigine: slow titration to prevent rash
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Benzodiazepines
- Mechanism of Action: Enhance GABA-A receptor activity → 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 (fall risk, confusion)
- Avoid in severe respiratory conditions (COPD, sleep apnea)
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Stimulants
- Mechanism of Action: Increase release/block reuptake of norepinephrine and dopamine
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- ADHD
- Narcolepsy
- Binge eating disorder (lisdexamfetamine)
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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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