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Figure 2 ; Increased risk of bleeding with selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal anti-inflammatory drug (NSAIDs). Pinto A, Farrar JT, Hersh EV. Compend Contin Educ Dent. 2009;30:142–151.
Mana Saraghi,
 Leonard Golden, and
 Elliot V. Hersh
<bold>Figure 2</bold>
Figure 2

Increased risk of bleeding with selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal anti-inflammatory drug (NSAIDs). Pinto A, Farrar JT, Hersh EV. Compend Contin Educ Dent. 2009;30:142–151.

Figure 1 ; Analgesic prodrugs, codeine and tramadol, require metabolism by CYP 2D6 to 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.
Mana Saraghi,
 Leonard Golden, and
 Elliot V. Hersh
<bold>Figure 1</bold>
Figure 1

Analgesic prodrugs, codeine and tramadol, require metabolism by CYP 2D6 to 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.

Anesthetic Considerations for Patients on Antidepressant Therapy—Part I
Mana Saraghi DMD,
 Leonard R. Golden MD, and
 Elliot V. Hersh DMD, MS, PhD
Article Category: Other
Volume/Issue: Volume 64: Issue 4
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-64-04-14
Page Range: 253 – 261

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

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Figure 1.  ; Antidepressant medications within the 4 therapeutic drug classes.
Mana Saraghi,
 Leonard R. Golden, and
 Elliot V. Hersh
<bold>Figure 1. </bold>
Figure 1. 

Antidepressant medications within the 4 therapeutic drug classes.

Figure 2.  ; Vasoconstrictor interaction with tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors.
Mana Saraghi,
 Leonard R. Golden, and
 Elliot V. Hersh
<bold>Figure 2. </bold>
Figure 2. 

Vasoconstrictor interaction with tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors.

Figure 3.  ; (A) Naïve nerve terminal. (B) Nerve terminal plus a monoamine oxidase inhibitor. (C) Nerve terminal with epinephrine. (D) Nerve terminal with ephedrine.
Mana Saraghi,
 Leonard R. Golden, and
 Elliot V. Hersh
<bold>Figure 3. </bold>
Figure 3. 

(A) Naïve nerve terminal. (B) Nerve terminal plus a monoamine oxidase inhibitor. (C) Nerve terminal with epinephrine. (D) Nerve terminal with ephedrine.

Figure 4.  ; Lack of vasoconstrictor interaction with selective serotonin reuptake inhibitors.
Mana Saraghi,
 Leonard R. Golden, and
 Elliot V. Hersh
<bold>Figure 4. </bold>
Figure 4. 

Lack of vasoconstrictor interaction with selective serotonin reuptake inhibitors.

Anesthetic Considerations for Patients on Antidepressant Therapy – Part II
Mana Saraghi DMD,
 Leonard Golden MD, and
 Elliot V. Hersh DMD, MS, PhD
Article Category: Other
Volume/Issue: Volume 65: Issue 1
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-01-10
Page Range: 60 – 65

benzodiazepine administration, and this may occur synergistically in the postictal state during a TCA overdose. Administering flumazenil can worsen seizures in the setting of a TCA overdose. 5 Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs may be involved in several notable drug interactions such as cytochrome P450 inhibition, synergistic effects with anticoagulants, and serotonin syndrome. Several SSRIs are potent CYP inhibitors, including fluoxetine, paroxetine, and fluvaoxamine. 1 Venlafaxine, an SNRI, is both an inhibitor and

Subject Index
Article Category: Research Article
Volume/Issue: Volume 64: Issue 4
Online Publication Date: Jan 01, 2017
DOI: 10.2344/0003-3006-64.4.267
Page Range: 267 – 267

, 253 SNRI, 253 Somatosensory evoked potential, 73 Spiral tube, 171 SSRI, 253 St John's Wort, 253 Subcutaneous emphysema, 85 Submental, 153 Superior mesenteric artery syndrome, 244 TCA, 253 Temperament, 17 Tension pneumothorax, 85 Third molars, 8, 80, 127, 136 Tooth extraction, 127 Tricyclic antidepressants, 253 Trismus, 97 Trisomy 9 mosaic, 29 Trisomy 13, 162 Tube-related trouble, 171 Type 2

Psychotropic Drugs: Implications For Dental Practice
Daniel E. Becker DDS
Article Category: Research Article
Volume/Issue: Volume 55: Issue 3
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006-55.3.89
Page Range: 89 – 99

) is inhibited by descending neural pathways that release norepinephrine as a neurotransmitter. Tricyclic antidepressants elevate norepinephrine concentrations within these synapses and are effective adjuncts for pain management at dosages well below those required for the treatment of depression. Their sedative influences make them particularly useful at night. Selective Serotonin Reuptake Inhibitors The selective serotonin reuptake inhibitors (SSRI) inhibit the neuronal uptake of serotonin and lack most of the annoying autonomic