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Depression: common affective disorder involving feelings of sadness that…

- - - - INDICATION: Inhibits presynaptic reuptake of 5HT (serotonin) and NE (norepinephrine) neurotransmitters, leading to accumulation of these in the synaptic cleft and increased stimulation of the postsynaptic receptors.
        
        CONTRAIND: in Pt's with allergies to drug, history of cardiac problems like Myocardial Infarctions, recent myelography, using MAOI drugs with TCAs, and pregnancy. Caution in Pt's with CV disorders: GI or GU surgery, angle-closure glaucoma, urinary retention, prostate hypertrophy. Also, caution with manic-depressive and suicidal pt's, a history of seizures, and presence of renal or hepatic disease.
        
        Adverse Effects:
        CNS and PNS systems = sedation, sleep disturbances, fatigue, hallucinations, disorientation, visual disturbances, concentration difficulty, weakness, ataxia (abnormal, uncontrolled muscular movement and coordination), and tremors.
        GI anticholinergic effects = dry mouth, constipation, nausea, vomiting, anorexia, increased saliva, cramps and diarrhea.
        GU effects = urinary retention and hesitancy, loss of libido, and changes in sexual functioning.
        CV = orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, and stroke.
        Other = alopecia, weight gain/loss, flushing, chills, and nasal congestion
        
        Drug-Drug Interactions:
        TCAs with cimetidine, fluoxetine, or ranitidine.
        TCAs and anticoagulants
        TCAs sympathomimetics or clonidine
        TCAs and MAOIs
        
        PROTOTYPE: imipramine (Tofranil)
        
        IND: Relief of depression symptoms; enuresis in children older than 6; off label consideration - control of chronic pain.
        
        ACTS: Inhibits presynaptic reuptake of 5HT and NE; anticholinergic at CNS and peripheral receptors; sedating.
        
        ARs: previously stated
  - - - IND: treatment of Pts with depression who do not respond to other antidepressive therapy or in whom other antidepressive therapy is contraindicated.
      - ACTS: Irreversibly inhibits enzyme MAO from recycling or restoring 5HT, NE, and dopamine...allowing these neurotransmitters to accumulate in the synaptic cleft; this is believed to cause the therapeutic effects of drug.
      - ARs: dizziness, vertigo, headache, over-activity, hyperreflexia, tremors, mania, weakness, drowsiness, fatigue, sweating, orthostatic hypotension, constipation, diarrhea, dry mouth, edema, anorexia, potential for fatal hypertensive crisis.
  - - - Previously listed Indications + off label uses for chronic pain, alcoholism, neuropathies, and obesity.
      - ACTS: Previously stated.
      - ARs: headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, sweating, rash, nausea, vomiting, diarrhea, dry mouth, anorexia, sexual dysfunction, upper respiratory infections, weight loss, fever.
    - - citalopram (Celexa)
        escitalopram (Lexapro)
        fluvoxamine (Luvox)
        paroxetine (Paxil)
        sertraline (Zoloft)
  - - - duloxetine (Cymbalta)
        venlafaxine (Effexor, Effexor XR)