Psychotropic Medications

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs, such as phenelzine (Nardil) and tranylcypromine (Parnate), were the first clinically effective antidepressants to be discovered (Stahl, 1996). Their popularity is limited due to dietary restrictions that prohibit patients from consuming tyramine-containing foods, such as wine and aged cheese. They can increase the level of tyramine in the brain and cause dangerously high blood pressure.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) comprise one of the next-oldest groups of antidepressants. Some of the commonly used tricyclics include imipramine (Trofranil), amitriptyline (Elavil, Endep, Tryptanol), and nortriptyline (Pamelor). TCAs are highly efficacious but have several unpleasant side effects, resulting in poor compliance. They include constipation, blurred vision, drowsiness, weight gain, dizziness, and decreased blood pressure. Their use is also limited in individuals who are suicidal, as an overdose can lead to fatal cardiac arrhythmias.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used first-line agents for depression. Some other disorders that are treated with SSRIs are panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social phobia, and posttraumatic stress disorder (PTSD). SSRIs inhibit the reuptake of the neurotransmitter serotonin in the brain. They are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). They have become popular because they are highly efficacious and relatively safe. Some of the side effects include headache, nausea, vomiting, weight gain, and sexual dysfunction. One caution with SSRIs is “serotonin syndrome,” which results from an increase in brain serotonin levels. This usually occurs when two medications that elevate serotonin are combined. The symptoms are tremor, hyperthermia, tachycardia, muscle rigidity, and agitation that can progress to hallucinations, seizures, and coma.

Other Antidepressants

Venlafaxine (Effexor) (SNRI) is a unique agent in that it inhibits the serotonin and norepinephrine (and to a lesser extent, dopamine) reuptake, like the tricyclic antidepressants (TCAs) without their major side effects. At higher doses, hypertension may occur.

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