ABSTRACT
Tricyclic antidepressants (TCAs) include amitriptyline, nortriptyline, desipramine, imipramine, and doxepin. TCAs should be used with caution with selective serotonin reuptake inhibitors (SSRIs), anticholinergic medications, antiarrhythmics, clonidine, lithium, and tramadol. Venlafaxine is a novel phenylethylamine antidepressant that is chemically distinct from the older TCAs and the SSRIs. Starting in 2004 the Federal Drug Administration requested a black box warning that children and adolescents taking antidepressants had an increased risk of suicide. In 2007, this warning was increased to include older patients and it reads, in part, “Antidepressants increased the risk compared to placebo of suicidal thinking and behavior in children, adolescents and young adults in short-term studies of major depressive disorder and other psychiatric disorders.” There did not appear to be a reported risk of suicide in adults over the age of 24.
