Anti-Depressants

  • Mechanism of Action:
    • Modulates monoamine neurotransmitters
      • Serotonin
      • Norepinephrine
      • Dopamine
    • Specific action depends on type of antidepressants
  • Treatment:
    • Major depressive disorder 
    • Dysthymia
    • Anxiety disorders
    • Obsessive–compulsive disorder
    • Eating disorders
    • Chronic pain
      • Fibromyalgia

      • Neuropathic pain
  • Effect at Rest:
    • Increase or no change in resting heart rate (ACSM 2013)
    • Decrease or no change in blood pressure (ACSM 2013)
    • Variable EKG (ACSM 2013)
  • Effects during Exercise:
    • Increase or no change in heart rate during exercise (ACSM 2013)
    • Decrease or no change in blood pressure during exercise (ACSM 2013)

Selective Serotonin Reuptake Inhibitors (SSRI)

  • Most widely prescribed antidepressants
  • Selective serotonin reuptake inhibitors (SSRI)
  • Body weight
    • Many SSRIs cause weight gain (Ness-Abramof & Apovian 2005)
    • Some SSRI cause promote weight loss (Li 2005)
      • Eg: Bupropion (Wellbutrin) (Anderson 2002)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
    • QT interval prolongation (Castro 2013)
  • Fluoxetine (Prozac)
    • Fibromyalgia patients using Fluoxetine show beneficial effects during anaerobic exercise (Ozerbil 2005)
  • Escitalopram (Lexapro)
  • Paroxetine (Paxil)
    • SSRIs, specifically Paroxetine (Paxil) may decrease time to fatigue and exercise performance in individuals with high aerobic capacity (Coelho 2014).
    • No effect on heart rate (Warrington & Lewis 1992)
    • No effect on blood pressure (Warrington & Lewis 1992)
    • No effect on EKG variables (Warrington & Lewis 1992)
    • Lowest risk of QT interval prolongation of all SSRI medications (Funk & Bostwick 2013)
  • Vilazodone (Viibryd)
  • Fluvoxamine (Luvox) SSRIs
    • Increases Barthel Index (activities of daily living performance) in stroke victims during rehab (Dam 1996)
    • Increases Muscle activation (Berends 2009)

Serotonin–norepinephrine Reuptake Inhibitors (SNRI)

  • Venlafaxine (Effexor)
    • Increases dexterity and reaction speed (Han 2014)
  • Duloxetine (Cymbalta)
    • Nerve Pain / Antidepressant prescribed for depression, anxiety, diabetic peripheral neuropathy, fibromyalgia, and chronic muscle or bone pain
    • Increase blood pressure
    • Heart Palpitations
  • Desvenlafaxine (Pristiq)
  • Maprotiline (Ludiomil) SNRI
    • Increases Barthel Index (activities of daily living performance) in stroke victims during rehab, however not great as placebo (Dam 1996)
      • Therefore, Maprotiline may hinder rehabilitation

Serotonin Modulators And Stimulators (SMSs)

  • Vortioxetine (Trintellix, Brintellix)

Serotonin Antagonists And Reuptake Inhibitors (SARI)

  • Trazodone (Desyrel)
  • Nefazodone (Serzone, Dutonin, and Nefadar)

Norepinephrine–dopamine Reuptake Inhibitor (NDRI)

  • Bupropion (Wellbutrin, Zyban, Aplenzin, Buproban, Forfivo, Wellbutrin, Budeprion)
    • Heart palpitations
      • No exacerbation of ventricular arrhythmias (Roose 1991)
      • Resting Heart Rate
      • No effect on resting heart rate (Roose 1991)
      • Small increase of resting heart rate (Thase 2008)
      • 400 mg/d: +2.28 beats/min
      • Placebo: -0.64 beats/min
    • Blood Pressure
      • No significant change of blood pressure (Thase 2008)
      • May exacerbation of baseline hypertension (Roose 1991)
    • May assist in weight loss (Gadde 2001)

Norepinephrine Reuptake Inhibitors (NRIs or NERIs)

  • Appetite Suppressant
  • Psychostimulant
  • Treatment
    • Attention deficit hyperactivity disorder
    • Narcolepsy 
    • Obesity
    • Major depressive disorder
    • Anxiety
    • Panic disorder
  • Atomoxetine (Strattera)
  • Reboxetine (Edronax, Vestra)
  • Viloxazine (Vivalan)
  • Tapentadol (Nucynta)
    • Also an agonist of μ-opioid receptor
    • Treatment
      • Pain for acute (following injury, surgery, etc.) and chronic musculoskeletal pain.
      • Pain of diabetic neuropathy
    • May cause fatigue
    • May decrease blood pressure
  • Teniloxazine, sufoxazine, sulfoxazine (Lucelan, Metatone) 
    • Also an Antagonist of 5-HT2Areceptor

Tricyclic Antidepressants (TCAs)

  • Classic antidepressants before SSRIs were discovered
  • Effect at Rest
    • Increase blood pressure (Warrington & Lewis 1992)
    • Increase arrhythmias (Warrington & Lewis 1992)
    • Weight gain (Ness-Abramof & Apovian 2005)
  • Nortriptyline (Sensoval, Pamelor)
    • Increases Rankin Scale (activities of daily living performance) in stroke victims during rehab (Adams 2011)
  • Amitriptyline (Elavil)
    • Increase heart rate (Warrington & Lewis 1992)
    • Changes EKG variables  (Warrington & Lewis 1992)
    • Fibromyalgia patients using Amitriptyline show beneficial effects during anaerobic exercise (Ozerbil 2005)
  • Imipramine (Tofranil)

Tetracyclic Antidepressants (TeCAs)

  • Mirtazapine (Remeron)
    • Increases heart rate
  • Maprotiline (Ludiomil)

Monoamine Oxidase Inhibitors (MAOIs)

  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)

References

American College of Sports Medicine (2013). Guidelines for Exercise Testing and Prescription, William & Wilkins, 9, 401.

Jones & Barlett (2011) Nurse's Handbook of Combination Drugs, Jones & Bartlett Publishers, 10th Edition.

Adams HP, Davis PH, Jang M, Jorge RE, Leira EC, Mikami K, Robinson RG (2011). Effect of antidepressants on the course of disability following stroke. American Journal Geriatric of Psychiatry 2011;19(12):1007-15.

Anderson J, Greenway F, Fujioka K, Gadde K, Mckenney J, O'neil P (2002). Bupropion SR enhances weight loss: A 48-week double-blind, placebo-controlled trial. Obes Res;10(7):633-41

Berends HI, Nijlant J, Van Putten M, Movig KL, Ijzerman MJ (2009). Single dose of fluoxetine increases muscle activation in chronic stroke patients. Clinical Neuropharmacology.;32(1):1-5.

Castro VM, Clements CC, Murphy SN, Gainer VS, Fava M, Weilburg JB, Erb JL, Churchill SE, Kohane IS, Iosifescu DV, Smoller JW, Perlis RH (2013). QT interval and antidepressant use: a cross sectional study of electronic health records. BMJ, 346.

Coelho M, Serafim A, Suares D, Teixeira-Coelho F, Uendeles-Pinto J, Wanner S (2014).. The paroxetine effect on exercise performance depends on the aerobic capacity of exercising individuals. J Sports Sci Med. 13:232-43.

Dam M, Tonin P, De Boni A, Pizzolato, G, Casson S, Ermani, M, Freo U, Piron L, Battistin L (1996). Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy. Stroke;27:1211-4.

Funk KA, Bostwick JR (2013). A comparison of the risk of QT prolongation among SSRIs. Annals of Pharmacotherapy; 47(10): 1330-1341.

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Han LX, Li CY, Li YK, Liu FD, Liu Y, Song XZ, Wang J (2014). The effects of venlafaxine on cortical motor area activity in health subjects: A pilot study. Journal of Clinical Psychopharmacology;34(1):93-98.

Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, Hilton L, Suttorp M, Solomon V, Shekelle PG, Morton SC (2005). Meta-analysis: Pharmacologic treatment of obesity. Ann Intern Med;142(7):532-46.

Ness-Abramof R, Apovian CM, Drug-induced weight gain (2005). Drugs Today;41(8):547-55.

Ozerbil O, Okudan N, Gokbel H, Levendoglu F (2005). Comparison of the effects of two antidepressants on exercise performance of the female patients with fibromyalgia. Clinical Rheumatology;25:495-7.

Roose SP, Dalack GW, Glassman AH, Woodring S, Walsh BT, Giardina EG (1991). Cardiovascular effects of bupropion in depressed patients with heart disease.
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