A practical approach to prescribing antidepressants
Open accessAbstract
Although antidepressant drugs do not differ much in their efficacy rates, the particular characteristics of one drug may make it a better choice in a given patient. This article provides insight into the art of prescribing antidepressants in primary care, with recommendations for prescribing for patients with chronic pain, sexual dysfunction, anxiety, chronic fatigue syndrome, fibromyalgia, severe insomnia, old age, diabetes, and heart problems.
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Nortriptyline can inhibit both NE and 5-HT reuptake while also exerting central anticholinergic effects.
“clomipramine specifically inhibits NE reuptake, and nortriptyline can inhibit both NE and 5-HT reuptake while also exerting central anticholinergic effects. 345 – 347”
From Major depressive disorder: hypothesis, mechanism, prevention and treatment (2024) · cites this paper as [347]
The Patients With Chronic Pain section names nortriptyline among TCAs that inhibit serotonin and norepinephrine reuptake and describes TCAs as having anticholinergic side effects. It does not specify that nortriptyline’s anticholinergic effects are central; the Geriatric Patients section separately says TCAs can slow cognitive function. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredClomipramine specifically inhibits NE reuptake.
“clomipramine specifically inhibits NE reuptake, and nortriptyline can inhibit both NE and 5-HT reuptake while also exerting central anticholinergic effects. 345 – 347”
From Major depressive disorder: hypothesis, mechanism, prevention and treatment (2024) · cites this paper as [347]
Table 1 (under “Patients with Sexual Dysfunction”; page unavailable) lists clomipramine as a tricyclic antidepressant but does not describe its reuptake activity. Searches for clomipramine’s norepinephrine or serotonin reuptake mechanism found no passage stating that it specifically inhibits norepinephrine reuptake. (LLM, conf=0.72)
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Cited by
Sorted by citations
Major depressive disorder: hypothesis, mechanism, prevention and treatment
Cui, L., Li, S., Wang, S., Wu, X., Liu, Y., Yu, W., Wang, Y., Tang, Y., Xia, M., & Li, B. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01738-y · Cited by 1,061 · see citing works
- Authors
- Shultz, E., & Malone, D. A.
- Affiliations
- Cleveland Clinic (US)
- Venue
- Cleveland Clinic Journal of Medicine
- Publisher
- Cleveland Clinic Journal of Medicine
- Published
- 2013-10
- Volume
- 80
- Issue
- 10
- Pages
- 625-631
- ISSN
- 0891-1150 (ISSN-L)
- 1939-2869
- OpenAlex
- W2115146009
- Cited by
- 27
- References
- 57
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 5
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cleveland Clinic Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- antidepressant prescribing, primary care, chronic pain, sexual dysfunction, anxiety, chronic fatigue syndrome, fibromyalgia, insomnia, elderly patients, diabetes mellitus, cardiovascular disease, individualized drug selection
- MeSH terms
- Age Factors, Antidepressive Agents, Anxiety, Depression, Diabetes Mellitus, Heart Diseases, Hemodynamics, Humans, Sleep Initiation and Maintenance Disorders, Sexual Dysfunction, Physiological, Weight Gain, Fatigue Syndrome, Chronic, Chronic Pain
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