Antidepressants
                        ===============
þ Trazodone (e.g., Desyrel)
 - Drug Interactions:
  + In vitro drug metabolism studies suggest that there is a potential for
    drug interactions when trazodone is given with the CYP3A4 inhibitors
    ketoconazole, ritonavir, and indinavir. It is likely that CYP3A4
    inhibitors may lead to substantial increases in trazodone plasma
    concentrations with the potential for adverse effects. If trazodone is
    used with a potent CYP3A4 inhibitor, a lower dose of trazodone should be
    considered.
  + Conversely, carbamazepine reduced plasma concentrations of trazodone when
    coadministered. Patients should be closely monitored to see if there is a
    need for an increased dose of trazodone when taken with carbamazepine.

þ Antipsychotics
  <AntiPsyc.TXT>

þ SSRI Comparison:
 - fluoxetine (e.g., Prozac)    20 mg daily     $75.04
 - sertraline (e.g., Zoloft)    100 mg daily    $68.33
 - paroxetine (e.g., Paxil)     20 mg daily     $66.84
 - citalopram (e.g., Celexa)    40 mg daily     $60.48
   [Med Ltr 1998;40(1041)]
 - fluvoxamine (e.g., Fluvox)

þ serotonin syndrome:
  <P-Serot.TXT>
                 
þ Other related (partial) drugs:
 - SNRI = Serotonin-Norepi Reuptake Inhibitors
  + Effexor (venlafexine)
   - serotonin, Dopamine and Norepi reuptake inhibitors
   - works more quickly than the 2-3 weeks required by most antidepressants
     via rapid down-regulation of central beta adrenergic receptrs
   - one case of OD with 3g had QT prolongation and seizures
  + Remeron (mirtazapine)
   - specifically blocks 5HT1 and 5HT2 postsynaptic receptors while increasing
     5HT1 transmission
   - may minimize minimize sex-related and weight-gain side effects compared
     to other antidepressants
   - OD reportely causes sedation, tachycardia, but no other side effects
  + Serzone (nefazodone)
   - similar to Desyrel (trazodone) from which it is derived
   - selective 5HT2 antagonist
   - mildly sedating in therapeutic dosing, so good for those with anxiety or
     sleep disturbance.
   - in OD, should be similar to trazodone, so may have seizures
  + Remeron (mirtazipine)
   - unique action, alters feedback receptors:
    + alpha-2 autoreceptor antagonist (inhibits NE release)
    + alpha-2 heteroreceptor antagonist (found on serotonergic terminals,
      stimulation inhibits serotonin release)
    + net effect is increase in NE and serotonin release
   - causes dry mouth, weight gain
   -OD: limited experience, CNS depressoin but no cardiovascular effects
 SNRI also = Selective Norepinephrine Reuptake Inhibitors
  + (?) reboxetine
   - no serotonergic effects, so should be no serotonin syndrome with this
   - may cause sinus tachycardia with therapeutic levels
   - no clear adverse effects in OD but not much experience
  + Buspar (buspirone)
  + Meridia (sibutramine)
  + Wellbutrin (bupropion)
   - FDA approved 1986, withdrawn from too many seizures, reintroduced at
     lower dosage in 1989
   - 450 mg/day for depression, as Zyban at 150-300mg daily for seizures (but
     often prescribed as Wellbutrin as insurance won't cover for smoking
     cessation)
   - OD:
    + seizures common (one study of 58 ODs found 21% had seizures)
    + also sinus tach (43%) and SVT, QRS widening and
      nonspecific IVCD.
    + Rx:  benzos, supportive