→ -Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine,
histamine, and acetylcholine receptors
→ -Examples: amitriptyline, clomipramine, desipramine, doxepin
→ -Common Side Effects:
→ • dry mouth
→ • constipation
→ • blurred vision
→ • urinary retention
→ • sedation
→ • weight gain
→ • hypotension
→ • tachycardia
→ • sexual dysfunction
MAOIs
→ -Action: increases norepinephrine and serotonin by inhibiting the enzyme that
inactivates it
→ -Examples: isocarboxazid, phenelzine, tranylcypromine
→ -Common Side Effects:
→ • sedation
→ • diiness
• sexual dysfunction
→ NDRI may improve energy, alertness, and motivation; not first line treatment for
anxiety; contraindicated in clients with a history of seizures
Prescribing pearls: duloxetine (Cymbalta)
→ effective for atypical pain at higher doses; appropriate for clients who present with
somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and
diabetic neuropathy
Prescribing pearls: venlafaxine (Effexor)
→ treats both depression and anxiety disorders, ensure trial of higher dose before
switching to a different medication
Prescribing pearls: desvenlafaxine (Pristiq)
→ effective for perimenopausal vasomotor symptoms
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