Depression
34
Table 2. Classes of Anti-depressants with Potential Side Effects,
Advantages, and Additional Considerations
Class/Selected
Agents Adverse Effects Advantages
Additional
Considerations
SSRI: Selective
Serotonin Reuptake
Inhibitors ($)
Best safety profile:
• Citalopram
• Escitalopram
• Sertraline
Higher risk of drug
interactions with:
• Fluoxetine
• Paroxetine
• Fluvoxamine
Nausea, dry
mouth, insomnia,
somnolence,
agitation, diarrhea,
excessive sweating,
sexual dysfunction,
increased risk of
hyponatremia
from syndrome
of inappropriate
antidiuretic
hormone
(SIADH).
24
Lower
anticholinergic
effects than older
antidepressants
and well tolerated
by patients with
cardiovascular
disease.
Check sodium
levels 1 month aer
starting SSRIs.
Monitor for
symptoms of
hyponatremia
and/or GI Bleeds
(especially for those
with peptic ulcer
disease [PUD] or
on nonsteroidal
anti-inflammatory
drug [NSAIDs]).
24
SNRI: Serotonin
Norepinephrine
Reuptake
Inhibitors ($-$$)
• Venlafaxine
• Duloxetine
• Desvenlafaxine
Nausea, dry
mouth, insomnia,
somnolence,
agitation, diarrhea,
excessive sweating.
Sexual dysfunction.
Increased risk of
hyponatremia from
SIADH.
24
Venlafaxine can
raise BP especially
at higher doses (over
150–225 mg/d).
Dual action on
serotonin and
norepinephrine
access.
Duloxetine also has
FDA indication for
diabetic peripheral
neuropathic pain,
fibromyalgia,
and chronic
musculoskeletal
pain.
Lower
anticholinergic
effects than older
antidepressants
and well tolerated
by patients with
cardiovascular
disease.
25
Check sodium
levels 1 month aer
starting SNRIs.
Monitor for
symptoms of
hyponatremia such
as fatigue, malaise,
and delirium.
Dopamine
Norepinephrine
Reuptake
Inhibitors ($)
• Buproprion
Lowers seizure
threshold.
Agitation, dry
mouth, insomnia,
headache,
nausea, vomiting,
constipation.
No effect on weight.
May be activating.
Minimal interaction
with cytochrome
pathways.
Caution when
using for patients
with:
Seizures
Insomnia
