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SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; + = use of this medication could relieve the symptom; – = use of this medication may be a less appropriate choice.
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aIn general, TCAs and psychostimulants can cause and exacerbate cardiac
arrhythmia. SSRIs, bupropion, venlafaxine, and nefazodone are generally less
likely to cause cardiac problems. EKGs should be obtained before starting TCA
medication, and a cardiologist should be consulted if there is concern for
cardiac compromise.
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bThe shorter-acting SSRIs (sertraline and paroxetine) are less problematic
than fluoxetine in patients with hepatic dysfunction. There is less potential
for adverse drug interactions and fewer problems related to drug accumulation
due to a shorter half-life. Sertraline and nefazodone reportedly have less
effect on hepatic P450 enzyme activity.
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cClinicians should consider whether antidepressant doses and administration
schedules require modification for their patients with renal or hepatic
insufficiency.
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dThe TCAs are contraindicated in closed-angle glaucoma.
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