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Examples:

isocarboxazid, phenelzine, selegiline, and tranylcypromine

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Dry mouth.
Nausea, diarrhea or constipation.
Headache.
Drowsiness.
Insomnia.
Dizziness or lightheadedness.
Skin reaction at the patch site.

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MHRA/CHM advice: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery (January 2021)

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Common or very common

Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; depersonalisation; diarrhoea; dizziness; drowsiness; dry mouth; fever; gastrointestinal discomfort; haemorrhage; headache; hyperhidrosis; malaise; memory loss; menstrual cycle irregularities; myalgia; mydriasis; nausea (dose-related); palpitations; paraesthesia; QT interval prolongation; sexual dysfunction; skin reactions; sleep disorders; taste altered; tinnitus; tremor; urinary disorders; visual impairment; vomiting; weight changes; yawning

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£4-£20

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Phenelzine is £120 for 100 tabs

Tranylcypromine is £514.49 for 28 tabs

Isocarboxazid is £274.01 for 56 tabs

Moclobemide is £9.33 for 30 (2nd line treatment)

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Mechanism of Action: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It works by increasing the levels of serotonin, a neurotransmitter in the brain, by inhibiting its reuptake into the presynaptic cell. This helps in maintaining higher levels of serotonin in the synaptic cleft, leading to improved mood and emotional well-being.

Absorption and Metabolism: Fluoxetine is well absorbed orally and has a long half-life. It is metabolized in the liver by the cytochrome P450 system, primarily by the CYP2D6 isoenzyme.

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Prescribe TCAs with caution to people with:

A history of bipolar disorder or psychosis.

Increased risk of suicide.

Cardiovascular disease.

Older age (increased susceptibility to adverse effects).

Chronic constipation.

Epilepsy.

Diabetes mellitus.

Mild to moderate hepatic impairment.

Hyperthyroidism (risk of arrhythmias).

Susceptibility to angle-closure glaucoma.

Phaeochromocytoma (risk of arrhythmias).

Prostatic hypertrophy.

Urinary retention.

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Lofepramine

Imipramine

Amitriptyline

Dosulepin

Clomipramine

Doxepin

Trimipramine

Nortriptyline

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Akathisia; anxiety; appetite increased; arrhythmia; asthenia; behaviour abnormal; blood disorder; confusion; constipation; dizziness; drowsiness; dry mouth; dysuria; hallucination; headache; hyperhidrosis; insomnia; jaundice; nausea; paraesthesia; peripheral neuritis; postural hypotension (more common in elderly); reflexes increased; skin reactions; suicidal behaviours; tremor; vision blurred; vomiting; weight increased.

Risk of postural hypotension and hypertensive responses. Discontinue if palpitations or frequent headaches occur.