Which of the following antidepressants causes sedation and pain relief?

Ans. c (Amitriptyline) (Ref. Harrison 18th/ p 74. Table 11-1; Table 371-3)Painful conditions that respond to tricyclic antidepressants# Postherpetic neuralgia# Diabetic neuropathy# Pension headache# Migraine headache# Rheumatoid arthritis# Chronic low back pain# Central post-stroke pain# CancerAntidepressantsClass/AgentsMechanismSide effects and CommentsTricyclic antidepressants (TCAs)(amitriptyline, Imipramine, nortriptyine desipramine)Block reuptake of NE and 5HT# Anticholinergic# Alpha blockage# Sedation# Seizure threshold# Overdose: triad ("3 Cs"): coma, convulsions# Drug interactions: do not mix with SSRIs and MAOIs: potentially fatalHeterocylics(amoxopine, bupropion, maprotiline trazodone, mirtazapine, nefazodone venlafaxine)Mechanism varies# Trazodone causes priapism, sedation# Amoxapine causes EPS (also dopamine receptor blocker)# Maprotiline, amoxapine, seizures, cardiotoxicity# Nefazodone, venlafaxine: P450 inhibitors# Bupropion used in smoking cessationSelective serotonin reuptake inhibitors (SSRIs) (fluoxetine, sertraline, citalopram, fluvoxamine, paroxetine)Block reuptake of 5HT# Anxiety, agitation, insomnia# Nausea# Sexual dysfunction# Serotonin syndrome (muscle rigidity, hyperthermia, myoclonus, ANS instability), seizures occurs with TCADs, MAOIs, meperidine, dextromethorphanMAO inhibitors (MAOIs)(phenelzine, tranylcypromine, isocarboxazid)Interferes with metabolism of NE and 5HT by blocking monoamine oxide (MAO) types A and B# Orthostatic hypotention, weight gain# Hypertensive crisis if patient consumes food with tyramine and other indirect-acting sympathomimetics# Serotonin syndrome when combined with SSRIs