Antidepressants are the most widely prescribed drugs in the United States, and the number of Americans taking antidepressants has doubled in a year. Yet the majority of people were not being treated for depression. Half were taking them for back pain, nerve pain, fatigue, sleep difficulties, IBS and other issues. They are used to treat a whole host of symptoms such as depression, anxiety disorders, eating disorders, obsessive compulsive disorder, ADHD, neuropathy, fibromyalgia, and other physical and mental issues.

An Antidepressant is a psychiatric medication used to alleviate depression and anxiety disorders. The most common include:

Monoamine Oxidase Inhibitors (MAOIs):
- Benmoxin (Nerusil, Neuralex)
- Iproclozide (Sursum)
- Iproniazid (Marsilid, - Irpozid, Ipronid, Rivivol, Propilniazida)
- Isocarboxazid (Marplan)
- Mebanazine (Actomol)
- Moclobemide (Aurorix, Manerix)
- Nialamide (Niamid)
- Octamoxin (Ximaol, Nimaol)
- Phenelzine (Nardil)
- Safrazine (Safra)
- Selegiline (Eldepryl, Emsam)
- Tranylcpromine (Parnate)

MAO stands for Monoamine Oxidase, which is an enzyme responsible for metabolizing neurotransmitters such as Serotonin and Norepinephrine.

MAO Inhibitors work by interfering with the MAO enzyme, therefore increasing the concentrations of various neurotransmitters, such as Serotonin, Epinephrine, Dopamine and Norepinephrine.  MAO Inhibitors are so effective at preventing the MAO enzymes from metabolizing neurotransmitters that they can have serious consequences when combined with various over-the-counter items and foods. Due to the potential for serious dietary and drug interactions, MAOIs are prescribed less frequently than other classes of antidepressant medication.

The list of interactions items with MAO Inhibitors is extensive.  The increase of Norepinephrine (a powerful blood vessel constrictor) can become dangerously high and prove fatal if MAOs are combined with the following: (list is not comprehensive, check with your pharmacist or medical professional for additional items to avoid)

Pseudoephedrine (nasal decongestant)
Amphetamine or Dextroamphetamine
Naphazoline or Oxymetazoline (in nasal sprays)
Isometheptene (in prescription drug Migranal)
Meperidine (ingredient in Demerol, for pain)
Eye drops with decongestants
Herbal products with stimulants

Monoamine Oxidase enzymes also exist in our intestinal tract and aid in the breakdown of tyramine. MAO Inhibitors allow large amounts of tyramine to enter the bloodstream where they can cause a hypertensive crisis (severe elevation of blood pressure). Therefore, anyone taking an MAO Inhibitor must eliminate high tyramine foods from their diet. This is a list of foods containing tyramine:

Aged cheese (including romani, asiago, cheddar and other strong-tasting hard cheeses)
Aged meats
Smoked meats or pickled meats
Processed foods (many contain high amounts of tyramine)
Yeast
Liver
Anchovies
Sauerkraut
Avocado
Bananas
Pepperoni
Salami
Caffeine
Soy (including tofu, miso, soy and teriyaki sauce)
Chocolate
Nuts (including brazil, peanuts)
Coconut
Beer, ale, wine and hard liquor
Liver
Figs, prunes, raisins, pineapple (primarily canned)
Vanilla

Note:  Patients must wait a minimum of 14 days following discontinuation of an MAO Inhibitor before they can safely consume any tyramine food item. Be sure to check with your healthcare practioner.

Side Effects May Include: Headache, dizziness, drowsiness, sleep disturbances, insomnia, fatigue, weakness, tremors, twitching, weight gain, edema, sexual disturbances, jitteriness, euphoria, urinary retention, skin rash, sweating, blurred vision, glaucoma, manic reaction, convulsions, gastrointestinal disturbances, lupus-like syndrome, fever, nausea, vomiting and malaise

Withdrawal Symptoms Include: aggression, anxiety, balance issues, blurred vision, brain zaps, concentration impairment, constipation, crying spells, depersonalization, diarrhea, dizziness. electric shock sensations, fatigue, flatulence, flu-like symptoms, hallucinations, hostility, highly emotional, indigestion, irritability, impaired speech, insomnia, jumpy nerves, lack of coordination, lethargy, migraine headaches / increased headaches, nausea, nervousness, over-reacting to situations, paranoia, repetitive thoughts or songs, sensory & sleep disturbances, severe internal restlessness (akathisia), stomach cramps, tremors, tinnitus (ear ringing or buzzing), tingling sensations, troubling thoughts, visual hallucinations / illusions, vivid dreams, speech visual changes, worsened depression  

Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs): - also see Tetracyclic Antidepressants (TeCAs)
- Amoxapine (Asendin)
- Maprotiline (Deprilept, Ludiomil, Psymion)
- Mianserin (Bolvidon, Norval, Tolvon)
- Mirtazapine (Remeron, Avanza, Zispin, Norset, Rexer, Remergil, Mirtabene, Remergon, Mirtazon, Axit, Mirtaz, Promyrtil, Noxibel, Mirzaten and Mizapin Sol)
- Setiptiline (Tecipul)

All NaSSAs are also classified as Tetracyclic Antidepressants (TeCAs) and instead of inhibiting the reabsorption of neurotransmitters like other antidepressants, NaSSAs prevent neurotransmitters from binding to nerve cell receptors called Alpha-2. This indirectly increases the levels of Norepinephrine and Serotonin in the brain.  As a stress hormone, Norepinephrine affects parts of the brain where attention and responding actions are controlled.  Norepinephrine, along with Epinephrine, underlies the ‘fight or flight’ response, directly increasing heart rate, triggering glucose release from energy stores and increasing blood flow to skeletal muscle.  Norepinephrine also has a neurotransmitter role in the brain as an anti-inflammatory agent.

The Alpha-2 receptors play a critical role in specific body functions including:

- The inhibition of insulin release in the Pancreas. 

- The release of glucagons (raises blood glucose levels) from the pancreas. 

- Contraction of sphincters (circular muscles) in the gastrointestinal tract.

Serotonin is a neurotransmitter involved in the transmission of nerve impulses. When the brain produces Serotonin, tension is eased. Dopamine and Norepinephrine cause us to act more quickly and heighten our alertness. Many foods have proteins that help us to create Serotonin, so diet is a contributing factor to depression. Complex carbohydrates have a calming effect while proteins including essential fatty acids increase cognitive function and alertness.

NaSSAs are a newer type of antidepressant but have side effects such as drowsiness. Therefore it is advised to only take NaSSAs at night since they can impair daytime function.

Side Effects May Include: Dry Mouth, Malaise, Hypertension, Face edema, Neck pain, Enlarged abdomen, Abdominal pain, Neck rigidity, Constipation, Increased salivation, Thirst or dehydration, Bladder problems, particular improper elimination of urine, Sexual problems, Blurred Vision, Dizziness, Sinusitis, Rash, Drowsiness, Increased heart rate, Urinary tract infections, Eye pain, Restlessness, Twitching, Agitation, Anxiety, Amnesia

Withdrawal Symptoms May Include: Nausea, Vomiting, Diarrhea, Tremors, Excessive sweating, Light-headedness, Muscle pains, Dizziness, Weakness, Insomnia, Anxiety

Norepinephrine (Noradrenaline) Reuptake Inhibitors (NRIs)
- Atomoxetine (Strattera)
- Mazindol (Mazanor, Sanorex)
- Reboxetine (Edronax, Vestra)

An NRI acts on Norepinephrine (Noradrenaline) and Epinephrine (Adrenaline) and tends to cause significant gastrointestinal side effects including nausea and diarrhea. The persistent gastrointestinal effects are considered to promote weight loss.

NRIs are used in the clinical treatment of attention-deficit hyperactivity disorder (ADHD); narcolepsy; to decrease fatigue or lethargy as stimulants; obesity or an appetite suppressant for weight loss; for mood disorders; depression; nasal or sinus congestion as a decongestant; bed-wetting; hypotension (low blood pressure); or to offset the side effects of other drugs that cause sexual dysfunction.NRIs increase Norepinephrine, both as a hormone and neurotransmitter. As a hormone secreted by the adrenal gland, it works alongside epinephrine (adrenaline) to give the body sudden energy in times of stress. This is known as the ‘fight or flight’ response. But it also regulates many body functions, including growth; digestion; internal fluid balance; increasing blood pressure; constricting blood vessels and increasing heart rate – all responses that occur when we feel stress.  As a neurotransmitter, Norepinephrine passes impulses from one nerve cell to the next and helps to regulate arousal, dreaming and moods.

Consistently raising Norepinephrine levels can cause Adrenal Fatigue, where over-stimulation of the Adrenal Glands leaves them unable to meet the body’s needs to control stress.

Symptoms of Adrenal Fatigue may include: (also see Adrenal Fatigue)
 
Excessive fatigue and exhaustion, Non-refreshing sleep , Unable to cope with stressors, Feeling rundown, Salt and sweet food cravings, Most energetic in the evening, Sleep disturbances, Low stamina, Slow to recover from injury, illness or stress, Difficulty concentrating, brain fog, Poor digestion, Poor immune function, Increase in allergies

NRI Side Effects May Include:
 Constipation, Insomnia, Fatigue, Weight loss, Chills, Tremor, Vomiting, Abdominal pain, Dry mouth, Nausea, Decreased appetite, Dizziness, Sleep disorders, Erectile dysfunction, Sinus headache, Severe sweating, Dehydration, Rash, Menstrual cramps, Problems passing urine, Mood swings, Stunting of growth in children

Norephinephrine Dopamine Reuptake Inhibitors (NDRIs)
- Amineptine (Survector, Maneon, Directin)
- Bupropion (Wellbutrin, Zyban)
- Dexmethylphenidate (Focalin)
- Fecamfamine(Altimina, Sicoclor)
- Methylphenidate (Ritalin, Concerta, Metadate, Methylin, Daytrana) - see also Stimulants
- Pipradrol (Meretran)

- Prolintane (Promotil, Katovit)

- Pyrovalerone (Centroton, Thymergix)
- Difemetorex

NDRIs act on the neurotransmitters Norepinephrine and Dopamine.  Norepinephrine is both a neurotransmitter and a hormone. As a hormone secreted by the adrenal gland it works in conjunction with epinephrine and adrenaline to give the body rapid energy in times of stress.  As a neurotransmitter, it passes nerve impulses from one cell in the nervous system to the next.  Dopamine, as a chemical messenger, is similar to adrenaline, and affects the processes in the brain that control movement, emotional responses and our ability to experience pleasure and pain.  Dopamine is often called the ‘reward chemical’ of the body. 

SNRIs increase Norepinephrine and Dopamine levels in the brain by preventing the absorption into the cells that released them. This process is called “reuptake inhibition”.

Buproprion was approved in 1985 and is the most common NDRI prescribed today. However, in May 2010 reports of a possible link between the antidepressant drug and cardiac birth defects surfaced. These reports appeared in the American Journal of Obstetrics and Gynecology and indicated 2 of every 1,000 women who took Buproprion during the first trimester of their pregnancy had an increased risk of heart birth defects. Additionally, the findings indicated that there is more than double the risk for specific heart defects as compared to babies whose mothers had not taken the drug.

Since the medication can increase blood pressure in some individuals, it’s important to monitor your levels on a regular basis. Anyone with a history of heart disease, seizure and eating disorders should alert their doctor prior to beginning an NDRI.

There are potentially dangerous drug interactions, so alert your doctor and pharmacist to all the over the counter (OTC), prescription medications, herbal and dietary supplements you are taking. Those with cirrhosis of the liver are not encouraged to take NDRIs because they can actually cause more liver problems.

NDRIs are often not used as the first choice for an antidepressant, but are instead used when other medications have been ineffective in relieving symptoms.

Unlike most antidepressants, NDRIs are generally considered stimulants and have a unique set of side effects.

NDRI Side Effects May Include:
 Loss of appetite, Weight loss, Headache, Dry mouth, Skin rash, Sweating, Ringing in the ears, Shakiness and nervousness,, Stomach pain, Agitation, Constipation, Anxiety, Dizziness, Trouble sleeping, Muscle pain, Nausea and vomiting, Fast heartbeat, Sore throat, More frequent urination

Selective Antagonist Reuptake Inhibitors (SARIs) also known as Serotonin modulator

- Nefazodone (Serzone, Nefadar) - discontinued

- Trazodone (Desyrel, Molipaxin, Trittico, Thombran, Trialodine)


SARIs are antidepressants that block the reuptake of Serotonin less potently than the Selective Serotonin Reuptake Inhibitors (SSRIs) or the Tricyclic Antidepressants (TCAs). They act on Serotonin Norepinephrine and Dopamine to a lesser extent.

SARIs have an antihistaminic component that is likely responsible for the strong sedative and hypnotic effects. This sedative effect renders SARIs an ineffective antidepressant, which is why they are used for sleep issues.

Serotonin 2 Antagonists have been associated with rare cases of priapism, a potentially painful and harmful medical condition in which the erect penis or clitoris does not return to its flaccid state. Priapism is considered a medical emergency, with 33% of the cases reported requiring surgical intervention. In a portion of these cases, permanent impairment of erectile function or impotence resulted.

A patient who abruptly stops an SARI, even in low doses may suffer adverse mental reactions such as emotional instability, depression and suicidal thoughts. This warning is generally included in printed materials supplied with the drug.

Side Effects May Include: Drowsiness, fatigue, lethargy, lightheadedness, dizziness, difficult concentrating, confusion, memory loss, uncontrollable laughter, change in libido, tremor, headache, migraine, akathisia, muscle stiffness, slurred speech, slowed speech, tinnitus, vertigo, tingling of extremities, paresthesia, weakness, seizure, muscle twitching, numbness, euphoria, tardive dyskinesia, dry or numb mouth, blurred vision, priapism, diplopia, nasal congestion, constipation, sweating, urinary retention, urinary frequency, incontinence, hypotension, tachycardia, palpitations, shortness of breath, apnea, atrial fibrillation, bradycardia, ventricular activity, myocardial infarction and cardiac arrest.

Selective Serotonin Reuptake Inhibitors (SSRIs)
- Citalopram (Celexa, Cipramil, Cipram, Dalsan, Recital, Emocal, Sepram, Seropram, Citox)
- Escitalopram (Lexapro, Cipralex, Esertia, Lexaprin, Lexamil, Sipralexa, Enact, Seroplex)
- Fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Ladose, Fluctin, Fluox, Depress, Lovan)
- Fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
- Paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Divarius, Rexetin, Xetanor, Paroxat, Loxamine)

- Vilazodone (Viibryd)

- Sertraline (Zoloft, Lustral, Serlain)

SSRIs mechanism of action is on Serotonin, a hormone also called 5-hydroxytryptamine, found in the pineal gland, blood platelets, digestive tract and the brain. Serotonin acts as both a chemical messenger that transmits nerve signals between nerve cells and causes the blood vessels to narrow.  Serotonin makes blood clots form and is a muscle as well as a vasoconstrictor, but it also plays an important role in sleep, appetite, memory, aggression, sexual behavior, cardiovascular activity, respiratory activity, motor output, neuroendocrine and sensory function, and perception. According to Dr. Ann Blake Tracy, an increase in Serotonin produces rushes of insulin that drops blood sugar levels and can create a chemically induced hypoglycemia (low blood sugar). Additionally, too much Serotonin damages blood vessels, particularly in the lungs and may adversely affect heart valves. This is because Serotonin is a powerful vasoconstrictor (narrows the blood vessels).

Consistently elevating Serotonin levels causes the stress hormones Cortisol and Adrenaline (Epinephrine) in the body and brain to be triggered by the adrenal glands. This natural reaction is the body’s way to combat the excessive Serotonin levels. This boost produces a euphoric state and can be viewed as a lessening of depression. However, prolonged increases in Serotonin can cause adrenal exhaustion, where the Adrenals lose their efficiency, causing adrenaline to fall while Cortisol rises. Ultimately the Cortisol levels fall and lead to fatigue. Many SSRI users report fatigue, and it can take time for the Adrenal Glands to restore normal adrenaline levels after stopping antidepressants.

The eyes have significant levels of Melatonin, and the precursor to Melatonin is Serotonin, which is derived from the amino acid tryptophan, which converts to 5-HTP first and then to Serotonin. Within the pineal gland, Serotonin is used to yield melatonin. Therefore, Serotonin also dramatically alters the sleep-wake cycle since Serotonin activity gradually decreases as one becomes drowsy and enters slow wave sleep (non-REM sleep). During REM sleep (Rapid Eye Movement), or dream sleep, Serotonin activity falls completely silent. It returns to its basic level several seconds prior to the end of REM sleep, which occurs in 90-100 minute cycles. REM alternates with Non-REM about 4-5 times during the night.  During non-REM sleep, there is a lot of movement, but during REM sleep, only the eye muscles move. This may explain why so many SSRI users report bizarre, vivid dreams.

It is estimated that 95% of our Serotonin is produced in the gut region, where it triggers digestion. Nerve cells in the gut also use Serotonin to signal back to the brain, where it trains us not to eat certain foods by communicating pain and gas. This second brain is an independent network of over 100 billion neurons that signals our bodies to stress, but can also cause illness if the stomach is unhealthy, since the majority of our immune cells line the gut walls. The high concentration of Serotonin in the stomach region is why antidepressants commonly have side effects that include nausea, weight gain and stomach upset.

Side Effects May Include:  Dry mouth, Chills, Suicide attempts, Heart Palpitations, Stomach Ulcer, Emotional liability, Larynx edema, Rash, Taste Perversion, Increased depression, Photosensitivity, Paranoia, Urinary Retention, Blurred Vision, Constipation, Sedation, Sleep disruption, Weight gain, Headache, Nausea, Gastrointestinal disturbance, diarrhea, Abdominal pain, Sexual dysfunction including loss of libido, Agitation, Anxiety

Double-blind controlled studies indicate that 35-78% of patients after five weeks or more of treatment who abruptly stop antidepressants or titrate in 10mg increments or more, will develop one of more of the discontinuation symptoms that can range from mild-moderate discomfort to extremely distressing.

The duration of symptoms can vary in time between individuals and can include the following symptoms: Dizziness, Vertigo, Lightheadedness, Difficulty walking, Nausea / vomiting, Fatigue, Headaches, Insomnia, Shock-like sensations, Parathesia (skin crawling, burning or prickling), Visual disturbances, Muscle pain, chills

Bicyclic Antidepressants:

Bicyclic antidepressants are usually categorized as Serotonin Norepinephrine Reuptake Inhibitors (SNRI) and are named after the drug’s molecular structure, which contains two rings of atoms compared to tetracyclics and tricyclics, which have 4 and 3 rings of atoms, respectively. Bicyclics inhibit the reabsorption of Serotonin, Norepinephrine and to a lesser extent Dopamine. Effexor, Fluoxetine are examples of Bicyclics. (see also SNRIs)

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):
- Emovit (Viloxazine)
- Desvenlafaxine (Pristiq – the active metabolite of Venlafaxine)
- Duloxetine (Cymbalta, Yentreve, Airclaim, Xeristar)
- Milnacipran (Dalcipran, Ixel, Savella)
- Levomilnacipran (under development)
- Sibutramine (under development for weight loss)
- Bicifadine (under development for pain)
- Venlafaxine (Effexor)
- Viloxazine (Emovit, Vivalan, Vicilan, Vivarin)

SNRIs are one of the newest classes of antidepressants, and their mechanism of action is on both Norepinephrine and Serotonin. Normally these neurotransmitters are released by a nerve cell, than reabsorbed back into the same cell for distribution throughout the body. SNRIs slow this reabsorption (reuptake), allowing higher amounts of both Norepinephrine and Serotonin to stay in the brain for longer periods of time.

Norepinephrine is both a hormone and a neurotransmitter, and as a hormone is secreted by the adrenal gland. It is almost identical in structure to epinephrine and works in conjunction with epinephrine and adrenaline to give the body the sudden energy it needs in times of stress. This is known as the “fight or flight” response. The sympathetic nervous system functions in response to short-term stress and both Norepinephrine and Epinephrine increase the heart rate as well as blood pressure. Other actions of Norepinephrine include the conversion of glycogen to glucose in the liver, the conversion of fats to fatty acids in the fat tissue, and relaxation of the bronchial muscle to open the air passages to the lungs. All of these actions represent the flight or fight response.

As a neurotransmitter, Norepinephrine passes nerve impulses from one nerve cell to the next and is important for attention, emotions, sleeping, dreaming and learning. Mild elevations in our Norepinephrine levels create heightened arousal, a state produced by stimulants. This increased sense of arousal is what links many substances to their potential for addiction. Some individuals using SNRIs develop a state of emotional elation (hypomania) and are cautioned to notify their treating physician/psychiatrist, as it is a sign of Norepinephrine levels increasing too high. But this condition is often mistaken as an easing of depression and goes unreported or addressed.

Moderately high levels of Norepinephrine create a sense of arousal that is uncomfortable and includes intensified worrying, anxiety, increased startle reflex, jumpiness, fear of crowds and tight places, impaired concentration, and restless sleep.  All these symptoms are also side effects of SNRIs as are rapid fatigue, muscle tension/cramps, irritability and a sense of being on edge.  SNRIs can cause blood pressure to increase, so it is recommended to carefully monitor while on the medication.

Serotonin contributes to various body functions, such as regulating body temperature, sleep, mood, appetite and pain. 95% of our Serotonin is located in the gut region where it regulates intestinal movements, while the vast majority of Serotonin is in the enteroendocrine (endocrine cells pertaining to hormones) of the gastrointestinal tract. If irritants (pesticides, preservatives, etc) are present, the stomach region releases more Serotonin to make the gut move faster, i.e., to cause diarrhea so the area is emptied of the noxious substance.  Antidepressants can cause both diarrhea and constipation, depending on the action of Serotonin in the gut region. Many antidepressants have shown to lower Serotonin levels below the baseline after chronic use, despite the initial increases. Therefore the benefit may decrease after long-term treatment.

The Serotonin eventually finds its way out of the tissues and into the blood where it is actively taken up by the blood platelets that store it until they bind to a clot. The platelets then release Serotonin, where it serves as a vasoconstrictor (narrowing of the blood vessels) and helps to regulate hemostatsis (prevents internal bleeding) and blood clotting. Serotonin is also synthesized in the central nervous system where it contributes to mood, appetite, sleep, muscle contractions and cognitive functions including memory and learning. 

Extremely high levels of Serotonin can cause Serotonin Syndrome, a toxic and potentially fatal condition. Serotonin Syndrome is generally a concern with a combination of Serotonergic agents, such as concurrent use of Antidepressants, or Antidepressants combined with herbs that increase Serotonin (St. John’s Wort, 5-HTP, Kava, etc). Mild forms of Serotonin Syndrome have been reported at even non-toxic levels of antidepressants.

The Symptoms of Serotonin Syndrome Include:  Agitation or restlessness, Confusion, Rapid heart rate, Dilated pupils, Loss of muscle coordination or twitching muscles, Heavy sweating, Diarrhea, Headache , Shivering, Goose bumps, High fever, Seizures, Irregular heartbeat

Side Effects May Include:  Abnormal dreams, Anxiety or nervousness, Body weakness, Chills, Cough, Difficulty sleeping, Dizziness, Drowsiness, fatigue or weakness, Dry mouth, Extreme elation or feeling of happiness that may alternate with a depressed or sad mood, Engaging in dangerous or unusual activities, Hallucinations, Headache, Heart Palpitations, High blood pressure (hypertension), Hostility or aggressiveness, Increased sweating, Loss of appetite or weight loss, Nausea, vomiting, indigestion, diarrhea or constipation, Restlessness or inability to sit still, Sexual problem, including decreased libido, Shakiness (tremor), Suicidal thoughts or behavior, Vision changes, Yawning

The following criteria define the SNRI withdrawal syndrome:
- A 4-week course or longer of treatment after which the SNRI is stopped or interrupted, or the dose is reduced
- Symptoms develop within 1-10 days
- The symptoms (increased side effects) cause significant distress or impairment
- The symptoms are not caused by a medical condition.

Tetracyclic Antidepressants (TeCAs) - also Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs):

- Amoxapine (Asendin)
- Maprotiline (Deprilept, Ludiomil, Psymion)
- Mianserin (Bolvidon, Norval, Tolvon)
- Mirtazapine (Remeron, Avanza, Zispin, Norset, Rexer, Remergil, Mirtabene, Remergon, Mirtazon, Axit, Mirtaz, Promyrtil, Noxibel, Mirzaten and Mizapin Sol)
- Setiptiline (Tecipul)

All TeCAs are also classified as Noradrenergic and Specific Serotonergic Antidepressant NaSSAs and instead of inhibiting the reabsorption of neurotransmitters like other antidepressantsc NaSSAs prevent neurotransmitters from binding to nerve cell receptors called Alpha-2. This indirectly increases the levels of Norepinephrine and Serotonin in the brain. Tetracyclic Antidepressants were first introduced in the 1970s and are named after their chemical structure, which contains four rings of atoms. They are closely related to Tricyclic Antidepressants, which contain three rings but prevent neurotransmitters from binding with nerve cells called the Alpha-2 receptor. The Alpha-2 receptors are located on liver cells, blood platelets and the smooth muscle of blood vessels. These antidepressants are usually not a first-choice for depression because of the numerous side effects. Tetracyclics can be deadly if taken in excessive doses. They are not usually given to older adults or people who have low blood pressure or certain heart problems.

A dangerous interaction can occur if a Tetracyclic antidepressant is combined with an MAO Inhibitor. Increased sedation and respiratory effects may occur if a TeCA is combined with a sedative, antihistamine or alcohol. A rare side effect of a Tetracyclic is a dangerous drop in white blood cell count (agranulocytosis). This condition can render an individual vulnerable to serious infection. Talk to your doctor if you have a sore throat, fever, inflammation of the mouth, flu-like symptoms or other signs of infection.

Side Effects May Include: Abdominal pain, Chills, Fever, Face Edema, Ulcer, Neck rigidity, Neck pain, Chest pain, Hypertension, Angina, Migraine, Goiter, Thirst or dehydration, Weight loss, Abnormal healing, Diabetes, Arthritis or bursitis, Anxiety, Agitation, Twitching, Hostility, Reflexes increased, Convulsions, Sinusitis, Cough increased, Rash, Acne, Urinary retention

Tricyclic Antidepressants (TCAs): The TCAs include the following agents which are predominantly serotonin and/or norepinephrine reuptake inhibitors:

- Amitriptyline (Elavil, Endep, Tryptizol, Laroxyl)
- Amitriptylinoxide (Amioxid, Ambinalon, Equilibrin)
- Butriptyline (Evadyne)
- Clomipramine (Anafranil)
- Demexiptiline (Deparon, Tinoran)
- Desipramine (Norpramin, Pertofrane)
- Dibenzepin (Noveril, Victoril)
- Dimetacrine (Istoril, Istonyl, Linostil, Miroistonil)
- Dosulepin (Dothiepin, Prothiaden, Dothep, Thaden, Dopress)
- Doxepin (Adapine, Aponal, Deptran, Sinquan, Sinequan, Silenor)
- Imipramine (Tofranil, Janimine, Praminil)
- Imipraminoxide (Imiprex, Elepsin)
- Lofepramine (Lomont, Gamanil, Tymelyt)
- Melitracen (Deanxit, Dixeran, Melixeran, Trausabun)
- Metapramine (Timaxel)
- Nitroxazepine (Sintamil)
- Nortriptline (Pamelor, Aventyl)
- Noxiptiline (Agedal, Elronon, Nogeda)
- Pipofezine (Azafen, Azaphen)
- Propizepine (Depressin, Vagran)
- Protriptyline (Vivactil)
- Quinupramine (Kevopril, Kinupril, Adeprim, Quinuprine)
- Trimipramine (Surmontil)
- Triavil (Etrafon)  

Tricyclic Antidepressants were discovered in the 1950s amid the birth of psychopharmacology, but not released for another decade. They are named for their chemical structure that contains three rings of atoms.

TCAs inhibit the reabsorption (reuptake) of Serotonin and Norepinephrine, and to a lesser extent Dopamine. This process increases the levels of neurotransmitters in the brain. Tricyclics also block transmission at cholinergic synapses, causing an anticholinergic effect, and accounts for the many side effects. This countering of Acetycholine can cause weak muscles, memory loss, constipation, dizziness, dry mouth, blurred vision and a slowing of urination.

Tricyclics can be dangerous when combined with other drugs. Abnormal heart rhythms can occur when combined with other Tetracyclics or Tetracyclics. Tricyclics can increase 2 to 10 fold when co-administered with an SSRI (the SSRI can also increase) and increase cardiac issues. The combination with Bupropion can increase the risk of seizures. Combining with MAO Inhibitors can increase the risk of Serotonin Syndrome (potentially fatal), low blood pressure or hypertensive reaction. Concurrent administration with insulin can cause a greater than expected drop in blood sugar.

Side Effects May Include: Dry Mouth, Constipation, Bladder problems; particular improper elimination of urine, Sexual problems, Blurred Vision, Dizziness, Drowsiness, Increased heart rate, Coma, Stroke, Arrhythmias, Hypotension, Seizures, Hallucinations, Abnormal involuntary movements, Excitement, Anxiety, Restlessness, Insomnia, Nightmares, Weakness, Fatigue, Tremors, Edema of the face and tongue, Bone marrow depression

Withdrawal Symptoms May Include: Nausea, Vomiting, Diarrhea, Tremors, Excessive sweating, Lightheadedness, Muscle pains, Dizziness, Weakness, Insomnia, Anxiety