Health.am| 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 |
* Medications that increase lithium levels: nonsteroidal anti-inflammatory drugs, diuretics (thiazides, ethacrynic acid, spironolactone, triamterene), angiotensinconverting enzyme inhibitors, metronidazole, tetracycline. Medications that decrease lithium levels: acetazolamide, theophylline, aminophylline, caffeine, osmotic diuretics.
ABBREVIATION: GABA = gamma-aminobutyric acid.