Overdose Attempts Agitation Agitation Delirium Delirium Convulsions Convulsions Hyperactive deep tendon reflex's Hyperactive deep tendon reflex's Bowel and bladder paralysis Bowel and bladder paralysis Dysregulation of (BP) and temperature Dysregulation of (BP) and temperature Mydriasis Mydriasis Coma Coma Respiratory depression Respiratory depression Cardiac arrhythmias (3-4days) Cardiac arrhythmias (3-4days)
venlafexine, Effexor® 1st available as IR, not well tolerated Approval of XR resulted in better tolerance at higher doses better efficacy Available in 37.5-75-150mg caps Dose range 75-300 in XR form Half life 5 hours steady state in 3 days, longer with XR preparation Very effective with comorbid depression and anxiety, OCD, panic
Anti-anxiety effect present at higher doses >150mg QD No weight gain Rare sedation Dizziness, lightheaded, restless, disturbed sleep more common Sweating, headaches Side effects are usually transient at onset of treatment
Duloxitine, Cymbalta® Newest addition to SSRI/SNRI group Available 30-40-60mg caps Dose range 30-120mg QD Marketed as effective for patients with somatic/pain issues More efficacious SNRI mg for mg than venlafexine
Very useful in the elderly with chronic pain, discomfort Effective with FMS As effective as venlafexine in anxiety, panic Not as efficacious as venlafexine in OCD, by experience Well tolerated, no sedation, weight gain Dry mouth, headaches, restless, insomnia dose related
buproprion, Wellbutrin SR, XL® SNRI & dopamine reuptake inhibitor Available 100-150-200SR, 75-100-150IR, 100- 150-300XL, tabs Dosage range 75-450mg QD rarely exceeds 300mg QD Half life 20 hours, steady state 2-4 weeks Effective for depression with low mood, energy and motivation, (anhedonia)
Effective at addressing cognitive symptoms associated with mood disorders. Improves attention and concentration and mental energy. Well tolerated no sedation, weight gain, no sexual dysfunction Headaches, restless, rare agitation, insomnia
Venlafaxine Selective Serotonin and noradrenaline reuptake inhibitor – like amitryptyline. Few other effects – unlike amitryptyline. 75-150mg / day minimum Dry mouth, somnolence, high BP, nausea, headache and dizziness.
The old ones block peripheral MAOI ( B ) and central MAOI (A) so a low tyramine diet is needed. ? Obsolete. Moclobemide. Only MAOI-A. ? Role. ? Special place in anxiety disorder. 300-600mg / day.