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surveyed had treatment that included administration of antidepressants. 5 Antidepressants are a broad and expansive group of medications, but the more common drug classes include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). A miscellaneous or “atypical” category covers other agents. The administration of sedation or general anesthesia may mitigate acute situational anxiety as it relates to dental procedures. It is important for

Impacted tooth, 127 Inhalation anesthetics, 251 Injection pain, 203 Inner wall detachment, 171 Insulin therapy, 39 Intraseptal anesthesia, 203 Intravenous anesthetics, 251 Intravenous sedation, 8 Intubation, 153 Junctional rhythm, 165 Laryngeal granuloma, 248 Laryngopharyngeal reflux disease, 248 Lidocaine, 73, 80, 203, 221, 230 Logistic regression analysis, 3 MAOI, 253 Maxillofacial trauma, 153

their active metabolites, morphine and o-desmethyltramadol, respectively. CYP2D6 inhibition by SSRIs (fluoxetine, paroxetine) may result in inadequate analgesia. From Hersh EV, Moore PA. JADA. 2004;135:298–311. Monoamine Oxidase Inhibitors (MAOIs) As noted in part I, due to increasing stores of presynaptic norepinephrine in sympathetic nervous system neurons associated with MAOIs, indirect acting sympathomimetic agents should also be avoided. Ketamine, a dissociative anesthetic that likely has indirect acting

conditions. The selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) and fluoxetine (Prozac), while as effective as other antidepressants for depression, do not possess analgesic properties. 14 They certainly may be useful for treating depression in the COP patient and hence improve coping and daily function, but actual pain levels may not decrease. The monoamine oxidase inhibitors (MAOIs) are no longer used for pain except possibly for refractory migraine. The other miscellaneous antidepressants are less useful, although trazodone can be used as a

. Monoamine Oxidase Inhibitors The monoamine oxidase inhibitors (MAOI) were the first class of drugs used to treat depression. As their name implies, they elevate norepinephrine and serotonin levels by limiting their oxidation by the enzyme monoamine oxidase (MAO). The major drawback of this drug class is its potential for serious food and drug interactions, many of which precipitate an acute hypertensive crisis. Compliance with medication instructions is critical, and the depressed patient may not be so inclined. Phenelzine (Nardil) is the only member of this

; epinephrine 10 μg. Hypertensive events attributed to drug interaction have occurred after the administration of local anesthetics containing epinephrine in patients medicated with which of the following? Nonselective beta blockers. MAOI antidepressants. SSRI antidepressants. a and b are correct