Antidepressants

Three classes of antidepressants are generally distinguished, on the basis of chemical structure or presumed pharmacological mechanism of action: the tricyclics (structure of three rings), the selective serotonin reuptake inhibitors (SSRIs), and the monoamine oxidase inhibitors (MAOIs). However, certain antidepressants cannot be fitted neatly into this somewhat arbitrary classification. Some features of these three classes are given in the table:

Class

Example

Characteristics

Tricyclics

Trimipramine

The most effective antidepressants in severe

(Surmontil)

depressive states Anxiolytic, analgesic, and hypnotic properties, which are predictable, dose-related, and helpful Wide dose range

MAOIs

Phenelzine

Grossly underused due to fears of 'cheese

(Parnate)

reaction' and consequent dietary restriction; effective in atypical and refractory depression

SSRIs

Fluoxetine

Widely prescribed by GPs for emotional

(Prozac)

problems, often effectively as a placebo Frequently but unpredictably cause agitation, gastrointestinal upset, and sexual dysfunction Less effective for severe cases Limited dose range

Reports of suicidality and withdrawal symptoms

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