Category: signaling
Antidepressant classes outside the SSRI / SNRI / MAOI groupings. TCAs (tricyclic antidepressants — amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin) inhibit both SERT + NET (varying ratios) plus block H1 + muscarinic + α1 (the "dirty" pharmacology that drives sedation + dry mouth + orthostasis). Therapeutic-index narrow: lethal in overdose (Na+-channel block + QT prolongation + anticholinergic toxidrome). Atypicals: mirtazapine (α2 + 5-HT2A/2C + H1 antagonist — sedation + appetite); bupropion (NRI + DRI — smoking cessation + ADHD); vilazodone (SERT + 5-HT1A partial); vortioxetine (covered in serotonin); agomelatine (MT1/MT2 agonist + 5-HT2C antagonist — EU only); trazodone (SARI — 5-HT2A antagonist + α1 + H1 — sleep aid at low doses, antidepressant at high); dapoxetine (short-acting SSRI for PE only).