multi class comparison
Antidepressant Classes: SSRI vs SNRI vs TCA vs MAOI — Efficacy, Safety Profile, Critical Interactions
All four classes treat depression effectively, but their safety profiles are drastically different. Picking the wrong answer on overdose lethality, dietary restrictions, or first-line status costs you NCLEX points — and in practice, costs lives. The exam loves asking which class requires food restrictions and which kills in overdose.
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Side-by-side4 compared
Focus
Comparevs
Dimension
SSRIs
SNRIs
TCAs
MAOIs
Class & mechanism
- Selective serotonin reuptake inhibition
- Block 5-HT + NE reuptake
- Block 5-HT + NE reuptake
- Also block ACh, histamine, α1
- Inhibit MAO: ↑ 5-HT, NE, dopamine
Indications
- Depression
- Usual first-line antidepressant
- Depression
- Neuropathic pain
- Depression
- Neuropathic pain
- Depression
- ★Refractory / atypical depression
Onset
- Full effect in 4–6 weeks
- Full effect in 4–6 weeks
- Full effect in 4–6 weeks
- Full effect in 4–6 weeks
Key assessment
- Assess suicide risk, especially early
- Assess suicide risk, especially early
- ★Monitor for dose-related ↑ BP
- Assess suicide risk, especially early
- Orthostatic BP
- Assess urinary retention, constipation
- Assess suicide risk, especially early
- Orthostatic BP
- Review diet & meds before starting
Monitoring
- No routine drug levels
- No routine drug levels
- ECG at baseline (cardiotoxic)
- No routine drug levels
Adverse effects
- GI upset
- Sexual dysfunction
- GI upset
- Dose-related ↑ blood pressure
- Sexual dysfunction
- Anticholinergic effects
- Orthostatic hypotension
- Orthostatic hypotension
Black box & toxicity
- Black box: suicidality, age < 25
- ★Safest class in overdose
- Black box: suicidality, age < 25
- Black box: suicidality, age < 25
- ★Cardiotoxic — wide QRS, lethal overdose
- Black box: suicidality, age < 25
Contraindications & interactions
- Serotonin syndrome with serotonergic drugs
- Serotonin syndrome with serotonergic drugs
- Serotonin syndrome with serotonergic drugs
- Serotonin syndrome with serotonergic drugs
- ★Tyramine foods: hypertensive crisis
Patient teaching
- Taper; do not stop abruptly
- Taper; do not stop abruptly
- Taper; do not stop abruptly
- Taper; do not stop abruptly
- Avoid aged cheese, cured meats, wine
Class & mechanism
SSRIs
- Selective serotonin reuptake inhibition
SNRIs
- Block 5-HT + NE reuptake
Indications
SSRIs
- Depression
- Usual first-line antidepressant
SNRIs
- Depression
- Neuropathic pain
Onset
SSRIs
- Full effect in 4–6 weeks
SNRIs
- Full effect in 4–6 weeks
Key assessment
SSRIs
- Assess suicide risk, especially early
SNRIs
- Assess suicide risk, especially early
- ★Monitor for dose-related ↑ BP
Monitoring
SSRIs
- No routine drug levels
SNRIs
- No routine drug levels
Adverse effects
SSRIs
- GI upset
- Sexual dysfunction
SNRIs
- GI upset
- Dose-related ↑ blood pressure
- Sexual dysfunction
Black box & toxicity
SSRIs
- Black box: suicidality, age < 25
- ★Safest class in overdose
SNRIs
- Black box: suicidality, age < 25
Contraindications & interactions
SSRIs
- Serotonin syndrome with serotonergic drugs
SNRIs
- Serotonin syndrome with serotonergic drugs
Patient teaching
SSRIs
- Taper; do not stop abruptly
SNRIs
- Taper; do not stop abruptly
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Clinical Pearl
SSRIs = safest first-line. TCAs = cardiac death in overdose. MAOIs = no aged cheese or you spike the BP.
Component Topics
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