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Table 2. Classes of Anti-depressants with Potential Side Effects,
Advantages, and Additional Considerations
Class/Selected
Agents Adverse Effects Advantages
Additional
Considerations
Tetracyclic
Antidepressant ($)
• Mirtazepine
Sedating.
May cause weight
gain.
Consider for
patient with
insomnia and poor
appetite.
More sedating at
lower doses.
Administer at hour
of sleep.
Available in
dissolving solutab.
Caution when
using in patients
with diabetes.
Serotonin
Modulator ($)
• Trazodone
Sedating, priapism
(rare), postural
hypotension (at high
doses)
Oen sedating when
used at higher doses.
Cautions:
• Cardiac
arrhythmias
and conduction
problems.
• Serotonin
syndrome when
used with SSRI/
SNRI.
Tricyclic
antidepressants
(TCAs) ($)
• Nortriptyline
(Secondary
amine)
• Amitriptyline
(Tertiary amine)
Anticholinergic
side effects: dry
mouth, blurred
vision, constipation,
urinary retention,
inhibition of
sweating, cognitive
dysfunction,
arrhythmia,
orthostatic
hypotension,
delirium.
Of the TCAs,
nortriptyline is oen
preferred because
it is less likely to
cause postural
hypotension.
Caution if history of:
• BPH
• Cardiac
arrhythmias
and conduction
problems
• Constipation
• Dementia
• Glaucoma
• Orthostatic
hypotension
• Falls
Psychostimulants
($$)
• Methylphenidate
• Modafinil
Anxiety, arrhythmia,
insomnia, anorexia,
weight loss, elevated
blood pressure
Quick response
(hours or days) for
those who respond
Can cause:
• Cardiovascular
disease
• Priapism
• Abuse potential
Use of antidepressants carries a black box warning concerning increased risk of suicidal
thoughts and behaviors in pediatric and young adults/adolescents.
