| Class |
Cardiovascular Side Effect |
Likely Mechanism of Side Effect |
Other Effect and Benefits |
| Tricyclic and related cyclic antidepressants |
Orthostatic hypotension |
Postsynaptic alpha1 receptor blockade |
|
| Nortriptyline (Pamelor) |
|
|
Nortriptyline with lowest incidence of orthostatic hypotension |
| Imipramine (Tofranil) |
|
|
|
| Amitriptyline (Elavil) |
|
|
|
| Desipramine (Norpramin) |
Tachycardia |
Secouadry to hypotension |
|
| Clomipramine (Anafranil) |
|
|
|
| Doxepin (Sinequan) |
Decreased heart rate variability |
Postsynaptic cholinergic receptor blockade |
Urinary retention, dry mouth, constipation, confusion, exacerbation of narrow-angle glaucoma |
| Trimipramine (Surmontil) |
|
|
|
| Protriptyline (Vivactil) |
Slowing of intraventricular conduction |
Quinidine-like effects |
Avoid in patients with bifascicular block, left bundle branch block, QTc > 44 ms, or QRS > 11 ms |
| Monoamine oxidase inhibitors |
Orthostatic hypotension |
Inhibition of metabolism of serotonin and catecholamines |
Fatal in overdose |
| Phenelzine (Nardil) |
Hypertensive crisis |
|
Requires adherence to tyramine-free diet, and avoidance of other antidepressants, and sympathomimetics |
| Tranylcypromine (Parnate) |
|
|
|
| Isocarboxazid (Marplan) |
|
|
|
| Selective serotonin reuptake inhibitors (SSRIs) |
|
Postsnaptic serotonin receptor blockade |
Fatal in overdose |
| |
|
|
Typical SSRI side effects: nausea, insomnia, sexual dysfunction, nervousness |
| Fluoxetine (Prozac) |
Sinus bradycadia |
Unknown |
Requires 8 weeks for complete washout |
| |
|
|
Inhibator of CYP450IID6 CYP450IIIA4 enzymes |
| |
|
|
Also FDA-approved for treatment of adult and pediatric obsessive compulsive disorder (OCD), bulimia, pediatric depression |
| Paroxetine (Paxil) |
Clinically insignificant decreases in heart rate |
Unknown |
Inhibitor of CYP450 IID6 enzyme |
| |
|
|
Also FDA-approved for treatment of social phobia, panic disorder, OCD, generalized anxiety disorder (GAD) |
| Sertraline (Zoloft) |
None known |
|
In high doses, inhibitor of CYP450 IID6 enzyme |
| |
|
|
Also FDA-approved for treatment of panic disorder, adult and pediatric OCD, post-traumatic stress disorder (PTSD) |
| Fluvoxamine (Luvox) |
None known |
|
Potent inhibitor of multiple CYP450 enzymes |
| |
|
|
Also FDA-approved for treatment of adult and pediatric OCD |
| Citalopram (Celexa) |
None known |
|
|
| Escitalopram (Lexapro) |
None known |
|
SSRI with most selective binding to serotonin transporter |
| Venlafaxine (Effexor) |
Arrhythmia or cardiac block in overdose |
Unknown |
No significant inhibition of CYP450 enzymes |
| |
Increased diastolic blood pressure in doses > 300 mg/d |
Presynaptic inhibition of norepinephrine reuptake |
Side-effect profile similar to SSRIs |
| Presynaptic alpha2-receptor antagonist |
|
|
|
| Mirtazapine (Remeron) |
None known |
Postsynaptic histamine1-receptor blockade |
Very sedating in low doses |
| |
|
|
Weight gain |
| |
|
|
Minimal sexual side effects |
| |
|
|
No significant inhibition of CYP450 enzymes |
| Dopamine and norepinephrine reuptake inhibitor |
|
|
|
| Bupropion (Wellbutrin; Zyban) |
Significant increases in blood pressure in patients with preexisting hypertension |
Presynaptic inhibition of norepinephrine reuptake |
No significant inhibition of CYP450 enzymes |
| |
|
|
Minimal sexual side effects |
| |
|
|
Not proven effective in the treatment of anxiety disorders |
| |
|
|
FDA-approved for treatment of nicotine dependence |
| Atypical serotonergic agents |
|
|
|
| Trazodone (Desyrel) |
Orthostatic hypotension |
Postsynaptic alpha1-receptor blockade |
Sedation, confusion, dizziness |
| |
Cardiac arrhythmias rare |
unknown |
Rare cases of priapism |
| Nefazodone (Serzone) |
Sinus bradycardia |
unknown |
Similar side-effect profile as trazodone (except without priapism) |
| |
|
|
Minimal sexual side effects |
| |
|
|
Potent inhibitor of multiple CYP450 enzymes |
| |
|
|
Liver failure rare |
| Psychostimulants |
|
|
|
| Dextroamphetamine (Dexedrine) |
Rarely increases blood pressure or induces tachycardia in therapeutic doses |
Release of dopamine and catecholamines |
Avoid in patients with hyperthyroidism, severe hypertension, severe angina, tachyarrthythmias |
| Methylphenidate (Ritalin) |
|
|
|
| Benzodiazepines |
|
Allosteric alteration of GABAA receptors |
Rapid relief of anxiety symptoms |
| Alprazolam (Xanax) |
|
|
|
| Clonazepam (Klonopin) |
|
|
|
| Lorazepam (Ativan) |
Hypotension |
Muscle relaxation of GABAA spinal cord receptors |
Can cause fatigue, ataxia, drowsiness, amnesia, and behavioral dyscontrol |
| Oxazepam (Serax) |
|
|
Relatively safe in overdose |
| Partial 5-HT1A-receptor agonist |
|
|
|
| Buspirone (BuSpar) |
None known |
|
FDA-approved for treatment of GAD |
| |
|
|
Nonaddictive |
| Omega1-receptor agonist |
|
|
|
| Zolpidem (Ambien) |
None known |
Potentiation of GABAA receptor |
Sedating
Nonaddictive |
| Zaleplon (Sonata) |
None known |
|
|
| Lithium |
Sinus node dysfunction
Sinoatrial block
T-wave inversion or flattening, particularly in patients >60 years of age
Arrhythmias and sudden death in patients with cardiac disease |
Unknown |
Narrow therapeutic index (.6-1.2 mmol/L)
Many medications alter lithium plasma levels*
Fatal in overdose
Mood stabilizer for patients with bipolar disorder
Yearly ECG in patients over 50 |
