Updated: 11/30/2019

Atypical Antidepressants

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Snapshot
  • A 32-year-old male presents to clinic for management of his depression.  He has stopped taking his fluoxetine because it has affected his sexual performance.  He is looking for an alternative medication.  Additionally, he is interested in smoking cessation as a loved one recently died from lung cancer.
Overview
  • Buproprion
    • mechanism
      • ↑ NE and dopamine via unknown mechanism
    • other uses
      • smoking cessation
    • toxicity
      • stimulant effects (tachycardia and insomnia)
      • headache
      • lowers seizure threshhold (for Step exams)
        • particularly in bulimic/anorexic patients
      • no sexual side effects
      • no weight gain 
Snapshot
  • A 17-year-old female is brought to your clinic by her parents.  They are concerned about her continued weight loss.  She runs 11 miles per day and has severely restricted her diet. She is very concerned with her appearance and states that she still has fat in some areas she would like to lose.  Her BMI is 14 kg/m2 and she seems visibly fatigued.  Her last menstrual period was 1 year ago.  On exam you see a very thin, young female with thin hair, and fine lanugo over her body.
Overview
  • Mirtazapine
    • mechanism
      • α2 receptor antagonist
        • ↑ release of NE and 5-HT
      • 5-HT2 and 5-HT3 receptor antagonist
    • other uses
      • depression + anorexia nervosa
        • due to weight gain side effect
    • toxicity
      • sedation, ↑ appetite, weight gain, and dry mouth
Snapshot
  • A 19-year-old male presents to student health.  He was seen last week for management of his insomnia, but this week he comes complaining of feeling light-headed when he stands up quickly.  At the end of the interview, he states that he has had erections for extended periods of time that can be quite painful.
Overview
  • Trazodone
    • mechanism
      • primarily inhibits serotonin reuptake
    • other uses
      • causes sedation
        • therefore used for insomnia
      • high doses are needed for antidepressant effects
    • toxicity
      • sedation, nausea, orthostatic hypotension
      • priapism in adolescent boys
        • "trazoBONE"
Other Atypical Antidepressants
  • Amoxapine
    • mechanism
      • antagonism of dopamine receptor
      • member of TCA class
    • toxicity
      • EPS, seizures, cardiotoxicity
  • Maprotiline
    • mechanism
      • blocks NE reuptake
    • toxicity
      • sedation, orthostatic hypotension, seizures, cardiotoxicity

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