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Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs01:28

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Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
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Serotonin, a crucial neurotransmitter synthesized by enterochromaffin cells, plays a cardinal role in regulating gastrointestinal (GI) motility. With over 90% of the body's total serotonin in the GI tract, its influence on digestive processes is profound. Serotonin is swiftly released upon various stimuli, such as food boluses or certain drugs, triggering intrinsic sensory neurons in the myenteric plexus and extrinsic vagal and spinal sensory neurons. This leads to the activation of the...
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The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
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Related Experiment Video

Updated: Dec 2, 2025

Rapid In Situ Hybridization using Oligonucleotide Probes on Paraformaldehyde-prefixed Brain of Rats with Serotonin Syndrome
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Serotonin Syndrome/Serotonin Toxicity.

Cynthia Wright Talton1

  • 1is a Nurse Practitioner in the Outpatient Mental Health Clinic at the Veterans Affairs Medical Center in Salem, Virginia.

Federal Practitioner : for the Health Care Professionals of the VA, Dod, and PHS
|November 2, 2020
PubMed
Summary
This summary is machine-generated.

This review details serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS), covering 2014-2019. It emphasizes preventing potentially lethal drug combinations through informed prescribing and patient education.

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Area of Science:

  • Pharmacology
  • Clinical Toxicology
  • Neurology

Background:

  • Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are serious conditions.
  • Understanding their pathophysiology, etiology, and diagnosis is crucial for patient safety.

Purpose of the Study:

  • To review the literature on serotonin syndrome and neuroleptic malignant syndrome from 2014 to 2019.
  • To highlight potentially lethal drug combinations and identify offending medications.
  • To present diagnostic criteria for both conditions.

Main Methods:

  • Literature review of studies published between 2014 and 2019.
  • Analysis of pathophysiology, etiology, and diagnostic criteria for SS and NMS.
  • Identification of commonly prescribed medications associated with these syndromes.

Main Results:

  • The review outlines three key criteria for diagnosing serotonin syndrome.
  • Diagnostic criteria for neuroleptic malignant syndrome are also presented.
  • Potentially lethal drug combinations involving common medications are highlighted.

Conclusions:

  • Prevention of serotonin toxicity is achievable through informed clinicians and educated patients.
  • Careful prescribing, diligent monitoring, and avoidance of multidrug regimens are essential.
  • Early recognition and management are critical for improving patient outcomes.