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Mandatory hepatic monitoring is unique among antidepressants — ensure patient understands and complies with LFT schedule; document informed consent re...
1. Not firstline for depression: Due to sideeffect burden and lethality in overdose, TCAs are generally reserved for treatmentresistant depression or ...
1. Unique among TCAs — Amoxapine possesses mild antipsychotic activity due to dopamine D2 receptor blockade, making it potentially useful in depressio...
Sexual dysfunction advantage: Bupropion has minimal sexual side effects compared to SSRIs — consider as firstline when sexual dysfunction is a signifi...
OCD gold standard: Clomipramine remains the most effective single medication for OCD; consider when SSRIs (fluvoxamine, fluoxetine, sertraline) at ade...
1. Differentiate from venlafaxine: Desvenlafaxine is the active metabolite of venlafaxine with more predictable pharmacokinetics and fewer CYP450 inte...
1. Sedation as advantage: Strong sedative effect makes dothiepin suitable for anxious/agitated depression with insomnia — administer entire dose at be...
1. Dual benefit: One of few SNRIs effective for both mood disorders and neuropathic/chronic pain — useful when depression coexists with pain condition...
Escitalopram is the Senantiomer of citalopram — approximately twice as potent; do not substitute 1:1 with citalopram (10 mg escitalopram ≈ 20 mg cital...
1. Morning dosing preferred: Administer in the morning to minimise sleep disturbance; evening dosing may worsen insomnia 2. Long halflife advantage: ...
OCD preference: Fluvoxamine is one of the most wellstudied SSRIs for OCD and may be preferred firstline for this indication; higher doses often needed...
1. ECG is essential: Obtain baseline ECG in all adults >40 years or with any cardiac risk factor before initiating therapy; repeat if dose exceeds 150...
Lofepramine is a prodrug metabolised to desipramine — onset of action may be slightly delayed Better cardiac safety profile compared to older TCAs (...
1. Seizure threshold: Maprotiline has higher seizure risk than most antidepressants — keep dose ≤150 mg/day in outpatients and titrate slowly 2. Seda...
1. Dosedependent sedation paradox: Lower doses (7.5–15 mg) are more sedating than higher doses (30–45 mg) — at higher doses, noradrenergic activation ...
1. Dietary flexibility: Moclobemide has significantly lower tyramine dietary restrictions compared to classical irreversible MAOIs (phenelzine, tranyl...
1. Preferred TCA in elderly: Nortriptyline has lower anticholinergic burden and less sedation compared to amitriptyline, making it the preferred TCA c...
Discontinuation syndrome: Paroxetine has the highest risk of SSRI discontinuation syndrome due to its short halflife and potent serotonin reuptake inh...
Selective noradrenergic mechanism — useful when SSRIs cause sedation, sexual dysfunction, or weight gain Activating profile — beneficial for depress...
CLINICAL PEARLS 1. Sertraline is preferred SSRI for cardiac patients Lower risk of QT prolongation compared to citalopram/escitalopram Can be...
Paradoxically, lower doses (25–50 mg) are often more sedating than higher doses — this makes lowdose trazodone ideal for insomnia but inadequate for a...
Strong sedative profile — particularly useful in depressed patients with prominent insomnia Unlike most TCAs, trimipramine has minimal REM sleep sup...
1. Prefer ER formulation: Better tolerated, oncedaily dosing improves adherence, fewer GI side effects compared to IR 2. Taper gradually: Never stop ...