1. SSRI: Fluoxetine 
-Perhaps more effective
-Worse for inducing mania

-One of the least selective SRI 

-4-7 day half life, no wean necessary
-More stimulating SSRI 

2. SSRI: Paroxetine 
-Most anticholinergic effects.
-Worst w/d 2/2 shortest half life.
-Increases risk of suicide in kids 

-Sedating
-Least likely to increase levels of carbamazepine 

3. SSRI: Sertraline: 

-Some dopamine effects?

-Doesn't have interactions, great for complex patients on a lot of meds. 

-Probably less effective. 

4. SSRI: Fluvoxamine 

-used less because it really hits cyp3A4, interacts with everything

5. SSRI: Escitalopram/Citalopram 

-Escitalopram: most selective SSRI 

-Citalopram: only 30% get better (STAR*D trial) 

6. SSRI side effects

-Sexual (impotence, low libido, anorgasmia)

-Diarrhea (initially only)

-Makes people tired

-Headaches 

-Constriction in range of emotion-- good for impulsive patients, less range of emotions so people seek out highs less

7. Serotonin syndrome:

-Autonomic changes

-Rigidity

-Diarrhea, flushing

-Myoclonic jerks (unique to SS, differs it from NMS)

8. TCA side effects:

-"HAM": antihistamine (sedating), anti-adrenergic (orthostatic hypotension- CI in people with bleeding risk), antimuscarinic (dry mouth, constipation, blurry vision) 

-Cardiotox: Inverts T waves, QRS widening (>100ms => TCA tox), can lead to torsades, can prolong QT

-Has all the side effects of SSRIs
-Weight gain
-nortriptyline has less orthostatic hypotension than some of the others.
-nortriptyline, desipramine act more on norepi
-imipramine, clomipramine act more on serotonin; (clomipramine has sexual side effects like an SSRI)
-amitriptyline is more balanced. 

9. TCA uses: 
-somatic pain, migraines, enuresis. OCD (clomipramine)
-not effective in treating depression in children, worse than placebo

10. MAOI 
-uses: better for atypical depression (i.e those who sleep and eat more, hypersensitive to rejection).
-orthostatic hypotension
-serotonin syndrome (combined with meperidine/demerol, linezolid)
-tyramine induced hypertensive crisis
-CI in pregnancy as it can worsen pregnancy-induced hypertension
-Need 2 week washout after d/c before starting another drug that increases serotonin levels to prevent serotonin syndrome