Table 13.6-4. Major adverse effects and interactions of different classes of antidepressant agents

Class

Examples

Major adverse effects

Selective serotonin reuptake inhibitors (SSRIs)

(considered second generation)

Citalopram

Escitalopram

Fluoxetine

Paroxetine

Sertraline

Suicidal ideation, CNS, GI upset, weight gain, sexual dysfunction, hyponatremia, serotonin syndrome, bleeding risk (especially when combined with NSAIDs)

Fluvoxamine

(considered second generation)

(belongs to SSRI class but is less commonly used for depression)

SSRI adverse effects ± palpitations, tachycardia, malaise, sedation

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

(considered second generation)

Desvenlafaxine

Duloxetine

Venlafaxine

GI, weight gain, CNS, sexual dysfunction, dermatologic

Noradrenergic and specific serotonergic antidepressants (NaSSAs)

(considered second generation)

Mirtazapine

Increased appetite, weight gain, postural hypotension, drowsiness

Bupropion

(considered second generation)

GI, CNS, dermatologic

Tricyclic antidepressants (TCAs)

(considered first generation)

Amitriptyline

Desipramine

Imipramine

Nortriptyline

Arrhythmias, CNS, sedation, anticholinergic, endocrine, hyponatremia, GI, weight gain; high lethality with overdose

Reversible inhibitors of monoamine oxidase A (RIMAs)

(considered second generation)

Moclobemide

Sleep disturbances, CNS, GI, dermatologic

Monoamine oxidase inhibitor (MAOI)

(considered first generation)

Phenelzine

Postural hypotension, sleep disturbances, CNS, GI, fetal malformations; can cause hypertensive crisis when combined with certain foods and medications, in particular other antidepressants (eg, during tapering course)

CNS, central nervous system; GI, gastrointestinal tract; NSAID, nonsteroidal anti-inflammatory drug.