Antidepressant Medications

Antidepressant medications are classed into several different types, which include the following:

■ Selective serotonin reuptake inhibitors (SSRI)

■ Selective serotonin norepinephrine reuptake inhibitors (SSNRI)

Antidepressant medications have several different mechanisms of action. The tricyclic antidepressants (TCAs; see Table 5.1), such as ami-triptyline, inhibit presynaptic uptake of norepinephrine and serotonin, as do the SSNRIs, such as duloxetine. Other less studied actions for TCAs include a mild opioid action at the mu binding sites, sodium and calcium channel blockade, NMDA site antagonism, and adenos-ine activity (Lynch & Watson, 2006). The SSRI medications, such as fluoxetine, inhibit serotonin at the presynaptic junction site (American Society of Pain Management Nurses [ASPMN], 2009). The effect of this inhibition decreases the ability of the pain stimulus to be transmitted higher up the central nervous system. These medications are most commonly used as adjunct medication for neuropathic-type pain, such as postherpetic neuralgia, painful diabetic neuropathies, and neuropathic syndromes (Lynch & Watson, 2006). They are also a good adjunct in patients with cancer and neuropathic pain when opioids have provided suboptimal pain relief (APS, 2008).

Table 5.1 ■ Tricyclic Antidepressants

Common TCAs

Starting Dose

Effective Dose

amitriptyline (Elavil)

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