ABSTRACT

Mechanisms of action: generally, inhibition of norepinephrine and 5-HT ■ re-uptake into the presynaptic nerve terminal (see Figure 39.2); some e.g. imipramine, have signifi cant dopamine D1 and D2 receptor blocking activity. Indications: ■

Uses, adverse effects, precautions and contraindications: ■ long delay before benefi t seen (may be 2-3 weeks) ❚ ECT (electroconvulsant) therapy may be needed initially ❚ many adverse effects due to widespread interference with adrenergic ❚ and serotonergic activity centrally and peripherally (for example):

Irreversible – block MAOI activity for days to weeks

disturbances, e.g. paranoia, delirium in children (see BNF for more comprehensive details)

Other antidepressants: ■ trazodone ❚

neither tri-nor tetracyclic ♦ mechanism: 5-HT re-uptake inhibitor + blockade of 5-HT ♦ 2 receptors.