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.
Comparison
Side-by-side4 compared
Comparevs
Dimension
SSRIs
SNRIs
TCAs
MAOIs
Class & mechanism
- Selective serotonin reuptake inhibition
- Block serotonin + norepinephrine reuptake
- Block 5-HT/NE reuptake + anticholinergic
- Inhibit monoamine oxidase → ↑ monoamines
Indications
- First-line depression & anxiety
- Depression
- Neuropathic pain
- Depression
- Neuropathic pain
- ★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 BP — may ↑ blood pressure
- Assess suicide risk, especially early
- Orthostatic BP; anticholinergic effects
- Assess suicide risk, especially early
- 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
- Anticholinergic effects
- Orthostatic hypotension
- Orthostatic hypotension
- Insomnia, agitation
Black box & toxicity
- Suicidality risk in patients <25 (black box)
- ★Safest class in overdose
- Suicidality risk in patients <25 (black box)
- Suicidality risk in patients <25 (black box)
- ★Cardiotoxic — wide QRS, lethal overdose
- Suicidality risk in patients <25 (black box)
Contraindications & interactions
- Risk of serotonin syndrome with serotonergic drugs
- Risk of serotonin syndrome with serotonergic drugs
- Risk of serotonin syndrome with serotonergic drugs
- Risk of serotonin syndrome with serotonergic drugs
- ★Tyramine foods → hypertensive crisis
Patient teaching
- Do not stop abruptly (discontinuation syndrome)
- Do not stop abruptly (discontinuation syndrome)
- Do not stop abruptly (discontinuation syndrome)
- Do not stop abruptly (discontinuation syndrome)
- Avoid aged cheese, cured meats, wine
Class & mechanism
SSRIs
- Selective serotonin reuptake inhibition
SNRIs
- Block serotonin + norepinephrine reuptake
Indications
SSRIs
- First-line depression & anxiety
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 BP — may ↑ blood pressure
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
Black box & toxicity
SSRIs
- Suicidality risk in patients <25 (black box)
- ★Safest class in overdose
SNRIs
- Suicidality risk in patients <25 (black box)
Contraindications & interactions
SSRIs
- Risk of serotonin syndrome with serotonergic drugs
SNRIs
- Risk of serotonin syndrome with serotonergic drugs
Patient teaching
SSRIs
- Do not stop abruptly (discontinuation syndrome)
SNRIs
- Do not stop abruptly (discontinuation syndrome)
★ marks the fact that sets a column apart.
Clinical Pearl
SSRIs = safest first-line. TCAs = cardiac death in overdose. MAOIs = no aged cheese or you spike the BP.
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