1. untreated depression worsens prognosis of CVS disease
2. LOFEPRAMINE: LESS Cardiotoxic, LESS postural hypo, LESS arryth, relatively safe in OD
3. ELDERLY
   1. TCAs
      1. ANTIcholenergic effects, postural Hypo, sedation, wt gain, seizures, cog impair
      2. LOFEPRAMINE IS SAFEST
      3. DOSULEPIN AND AMITRIP ARE MOST TOXIC (seizures , arryth)
      4. Inc sedation with benzos
   2. SSRIs
      1. AVOID PAROXETINE : dry mouth, sedation, wt gain, orofacial dyskinesia
      2. CITALOPRAM : safest dg interaction wise, NOT SAFE IN OD
      3. INCREASED RISK OF FALLS, GI bleeds
   3. RELATIVE SAFETY IN OD: SSRI (not Citalopram) > VENLAFAX > TCA (Not Lofepramine)
4. HYPONATREMIA
   1. Consider when restarting - REBOX, LOFEPRA (NA effect) OR MOCLO
   2. NO AD has been shown not be asso
5. POST-STROKE DEPRN
   1. SSRIS {SERTRA, FLUOX, CITALO, REBOX} AND NORTRIPTYLINE
   2. PROPHYLAXIS : NORTRIP, FLUOX, SERTRA, ZISPIN
   3. NB: SSRIS protect agnst embolic stroke but provoke haemorrhagic stroke!
6. BLEEDING
   1. Upper GIT bleed : x3 risk
   2. greatest risk in those that have high affinity to SEROTONIN TRANSPORTER
   3. ADD GIT protecting drug
7. DM
   1. FIRST LINE: SSRIs - FLUOX , SNRI also safe
      1. SSRIs -improve HbA1c, reduce insulin req, wt loss and enhanced insulin sensitivity,
   2. AVOID : TCAs AND MAOI
      1. TCAs : inc appetite, wt gain, hyperglycemia
      2. MAOI : Irreversible MAOIs cause extreme HYPOs and wt gain
8. CARDIAC EFFECTS
   1. SSRIs
      1. SERTRALINE , Others are generally SAFE post-MI
      2. BEWARE: cytochrome mediated dg interaction, , bleeding
      3. may protect against MI
   2. TCAs
      1. CONTRAINDICATED POST MI
      2. QT prolongs, slows conduction, IHDs, sudden deaths, Arryth (ventricular in OD, DOSE RELATED)
   3. VENLAFAXINE
      1. AVOID post MI
      2. evidence of arryth is slim (arryth is RARE even after massive OD)
   4. others
      1. ZISPIN
         1. NO major effects but caution with recent MI
      2. trazodone
         1. arrythmia ++
      3. duloxetine
         1. Hypertention (important effect)
9. SEXUAL DYSFUNCTION
   1. 1. Decreased libido 2. Erectile dysfn 3. Delayed orgasm 4. Impaired ejaculation
      1. NB: spontaneous remission in 10%, partial in 11%
      2. COCHRANE : Adding Sildenefil, Tadalafin, bupropion may improve Fn but other Rx don't
   2. SSRIs
      1. 60-70% , 1&3 (paroxetine - 2 + & dec vaginal lubrication)
   3. Venlafaxine
      1. 70% ; 1,3, less 2
   4. Duloxetine
      1. 46%
   5. TCAs
      1. 30% ,all (clomipramine- 3++)
   6. MAOI
      1. 30% , LIKE TCAs (Moclo is better 4% vs 40%)
   7. Mirtazapine
      1. 25% , 1, 3, less 2
   8. Riboxetine
      1. 5-10% , various
10. SUICIDE
    1. Effect is NOT unique to any class