Isahel N. Alfonso, R.N

 Selective Serotonin Reuptake Inhibitor (SSRI) Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram  Tricyclic Compound (TCA) Impiramine Despiramine Amitriptyline nortriptyline

 Doxepine  Trimipramine  Protriptyline  Maprotiline  Mirtrazapine  Amoxapine  Clomipramine  Monoamine Oxidase Inhibitors (MAOI) Phenelzine Tranylcypromine Isocarboxazid

 Indication: Treatment of major depressive disorder, anxiety disorder, depressed phase of bipolar disorder and psychotic depression. Off-label uses: Treatment of chronic pain, migraine, peripheral and diabetic neurophaties, sleep apnea, certain dermatologic disorders, panic disorder and eating disorder.  Mechanism of Action Interacts with norepinephrine and serotonin that are responsible for arousal, attention, mood and appetite. SSRI’s block serotonin uptake Cyclic antidepressants and venlafaxine primarily blocks norepinephrine and to some extent serotonin. MAOI’s interfere with enzyme metabolism. Antidepressants take effect in: SSRI- 2-3 weeks, Cyclic-4-6 weeks, MAOI- 2-3 weeks

 SSRI: Anxiety, agitation, akathisia, nausea, insomnia, Sexual dysfunction, diminish sexual drive, difficulty achieving orgasm, erection, weight gain, sedation, sweating, hand tremors, headache and diarrhea.  TCA: Dry mouth, Constipation, urinary hesitency/retention, Dry nasal passages, Blurred vision, Agitation, Delirium, Orthostatic hypotension, Sedation, Weight gain, Tachycardia, Sexual dysfunction  MAOI: Daytime sedation, Insomnia, Weight gain, Dry mouth, othostatic hypotension, Sexual dysfunction, hypertensive crisis.

 Lithium, Carbamazipine, Valproic, Gabapentin, Topiramate, Oxcarbazepine, Lamotigrine.  Indication: Treatment of bipolar disorders and acute episode of mania  Mechanism of Action: Lithium normalizes reuptake of serotonin, norepinephrine, acetylcholine and dopamine. Valproic acid and Topiramate increases GABA level.

 Lithium: Nausea, Diarrhea, Anorexia, Fine hand tremor, Polydipsia, Polyuria, Metallic taste in mouth, fatigue, Lethargy and weight gain. Therapeutic serum level: mEq/L Mild to moderate toxic reactions: mEq/L Moderate to severe toxic reactions: 2-3 mEq/L Toxic effect: Severe diarrhea, vomiting, drowsiness, muscle weakness and lack of coordination, coma and death if serum level is >3 mEq/L  Carbamazepine and Valproic Acid: Drowsiness, sedation, dry mouth, blurred vision, othostatic hypotension, weight gain, alopecia and tremor

 Carbamazepine and Valproic Acid: Drowsiness, sedation, dry mouth, blurred vision, orthostatic hypotension, alopecia, weight gain, tremor  Toparimate: Dizziness, sedation, weight loss, increased incidence of renal calculi

 Benzodiazepinez  Alprazolam  Chlordiazepam  Clonazepam  Chlorazepate  Diazepam  Flurazepam  Lorazepam  Oxazepam  Temazepam  Triazolam  Non-benzodiazepines  Buspirone

 Indication Use to treat anxiety and anxiety disorders, insomnia, obsessive compulsive disorders, depression, post traumatic stress disorder and alcohol withdrawal  Mechanism of Action Benzodiazepines mediate the actions of the amino acid GABA Buspirone acts as a partial agonist at serotonin receptors which decreases serotonin turnover.  Side Effects Can cause physical dependency, drowsiness, sedation, poor coordination, impaired memory and clouded sensation

 Methylphenidate  Dextroamphetamine  Amphetamine  Pemoline  Selective Norepenephrine Reuptake inhibitor Atomoxetine

 Indication For treatment of attention deficit hyperactive disorder and narcolepsy.  Mechanism of action Acts as cortical and RAS stimulants by increasing the release of norepinephrine, dopamine and serotonin from the presynaptic neurons and block their reuptake. Paradoxical effect of calming hyperexcitability through CNS stimulation is related to increase stimulation of an immature RAS (Receptor alpha stimulants).  Adverse Reactions: Nervousness, Insomnia, Dizziness and headache, blurred vision, Nausea, vomiting, hypertension, arrhythmia and angina  Side Effects: Anorexia, weight loss, nausea, irritability, growth and weight suppression