Various types of antidepressants are available:

A. Selective Serotonin Reuptake Inhibitors (SSRIs)

B. Serotonin norepinephrine reuptake inhibitors (SNRIs)
C. Monoamine oxidase inhibitors (MAOIs)
D. 5-HT2 Antagonists
E. Bupropion

A. SSRSIs
a. Agents: Fluoxetine (Prozac), paroxetine, sertraline, fluvoxamine,
Citalopram, & Escitalopram (s-citalopram)
b. Clinical uses:
i. Major Depression: the primary indication Obsessive-compulsive
disorder (OCD) (fluvoxamine, clomipramine)
ii. Panic disorder
iii. Generalized anxiety disorder
iv. Posttraumatic stress disorder (Sertraline and paroxetine)
v. Social anxiety disorder (SAD): fluvoxamine, venlafaxine
vi. Premenstrual dysphoric disorder (fluxetine & sertraline)
vii. Bulimia nervosa (only fluoxetine)
viii. Premature ejaculation
c. Repeated treatment leads to gradual down-regulation
d. no affinity for cholinergic, -adrenergic or histamine receptors and do
not interfere with cardiac conduction
e. adv. Effect:
i. GIT: nausea, GIT upset, diarrhea.
ii. Sexual dysfunction: loss of libido, delayed orgasm, or
diminished arousal.
iii. CNS: Sleep disturbances. For this reason, fluoxetine is usually
administered in the morning after breakfast
iv. Weight gain particularly paroxetine
v. SSRIs have also been associated with extrapyramidal side
effects, especially those with Parkinsons disease
B. SNRIs
a. Agents: venlafaxine, desvenlafaxine, and duloxetine & milnacipran*
b. All SNRIs bind the serotonin (SERT) and norepinephrine (NET)
transporters
c. At dosages <150 mg/day, venlafaxine is a potent inhibitor of serotonin
reuptake and, at medium to higher doses, is an inhibitor of
norepinephrine re-uptake
d. Duloxetine inhibits serotonin and norepinephrine reuptake at all doses
e. Clinical uses:
i. Depression: in patients in whom SSRIs are ineffective
ii. chronic joint and muscle pain: duloxetine
iii. Fibromyalgia: milnacipran

f.

SNRIs have many of the serotonergic adverse effects associated with

SSRIs
g. In addition, SNRIs may also have noradrenergic effects, including
increased blood pressure and heart rate, and CNS activation, such as
insomnia, anxiety, and agitation
C. TCA
a. The TCAs were the dominant class of antidepressants until the
introduction of SSRIs in the 1980s and 1990s
b. Agents: imipramine (the prototype drug), amitriptyline, clomipramine,
doxepin , trimipramine, desipramine, nortriptyline, and protriptyline
c. inhibition 5HT and NE reuptake
d. TCAs also block serotonergic, -adrenergic, histaminic, and muscarinic
receptors
e. Clinical uses:
i. Depression: that is unresponsive to more commonly used
antidepressants )SSRIs or SNRIs)
ii. Panic disorder
iii. Control bed-wetting in children (older than 6 years) by causing
contraction of the internal sphincter of the bladder (Imipramine) 1
iv. Treatment of migraine headache and chronic pain syndromes for
which the cause of the pain is unclear (Amitriptyline)
f. Adverse effects:
i. Antimuscarinic SEs: dry mouth ,constipation, urinary retention,
blurred vision, and confusion
ii. Life-threatening arrhythmias: The TCAs are class 1A
antiarrhythmic agents
iii. Sedation (H1 antagonism)
iv. weight gain
v. Sexual dysfunction
D. MAOIs
a. Agents: selegline, phenelzine, and tranylcypromine
b. Adverse effects:
i. Orthostatic hypotension, weight gain, edema, and sexual
dysfunction are common during MAOI therapy
ii. Sexual SEs: highest rates are associated with the irreversible
nonselective MAOIs (phenelzine and tranylcypromine)
iii. Hepatotoxicity is likely to occur with isocarboxazid or phenelzine
E. 5-HT2 Antagonist
a. Agents: Nefazodone, Trazodone, mirtazapine and mianserin (not
marketed in the U.S.)
b. Inhibition of 5-HT2A receptors in both animal and human studies is
associated with substantial antianxiety, antipsychotic, and
antidepressant effects
c. Clinical uses:
i. Depression: Mirtazapine can be advantagous in patients with
depression having sleep difficulties
d. Adverse effects:
i. Sedation (trazodone & mirtazapine)

ii. weight gain (mirtazapine)

iii. Nefazodone has been associated with hepatotoxicity, including
rare fatalities and cases of hepatic failure requiring
transplantation
F. Buproprion
a. It acts as a weak dopamine and norepinephrine reuptake inhibitor to
alleviate the symptoms of depression
b. Bupropion has virtually no direct effects on the serotonin system
c. Unlike the SSRIs, bupropion does not cause sexual side effects
d. It does not block muscarinic, histaminergic, or adrenergic receptors
e. Clinical uses:
i. Depression
f. Bupropion is approved as a treatment for smoking cessation
g. The mechanism by which bupropion is helpful in this application is
unknown, but the drug may mimic nicotine's effects on dopamine and
norepinephrine and may antagonize nicotinic receptors
h. Side Effects
i. Bupropion is occasionally associated with CNS stimulations
(agitation, insomnia, and anorexia)