Atypical Antidepressants (Bupropion, Mirtazapine, Trazodone)

Atypical antidepressants are bupropion, mirtazapine and trazodone, three antidepressants that work differently from SSRIs and are each recognized by a signature effect and safety rule. Bupropion is activating, so it is given in the morning; it lowers the seizure threshold, so it is contraindicated with a seizure disorder, an eating disorder such as bulimia or anorexia, or abrupt withdrawal from alcohol, benzodiazepines or antiepileptics, and the client never doubles a missed dose or crushes an extended-release tablet. It causes little sexual dysfunction and is the same drug as Zyban for smoking cessation. Mirtazapine causes sedation and increased appetite, so it is given at bedtime, and sore throat or fever is reported because it rarely causes agranulocytosis. Trazodone is very sedating, causes orthostatic hypotension and can cause priapism, which needs emergency care right away. All three carry the boxed warning for suicidal thoughts under age 25, take weeks to work, are never given within 14 days of an MAOI and are tapered rather than stopped suddenly.