[2] Since this book was published, SSRIs or _s_elective _s_erotonin _r_euptake _i_nhibitors, have become the most commonly prescribed antidepressant medication in the U.S and many other countries. For readers interested in more information about SSRIs, see Wikipedia's article, http://en.wikipedia.org/wiki/Selective-serotonin-reuptake-inhibitor. Tricyclic antidepressants include these (trade names): Avenyl Elavil Norpramin Pamelor Sinequan Surmontil Tofranil Vivactil Approximately 70 percent of patients who take tricyclics improve. Several newer drugs--the tetracyclics, dibenzoxapines, and triazolopyridenes--are similar to the tricyclics in their effects. They include these (trade names): Asedin Desyrel Ludiomil If tricyclics do not help, MAO inhibitors (_m_onoamine _o_xidase _i_nhibitors) are usually tried. MAO inhibitors must be used with great caution because they can interact with certain foods, beverages, or drugs to produce severe high blood pressure. Many foods and beverages are prepared by fermentation processes; e.g., cheese, anchovies, pickled herring, pastrami, olives, beer, and wine, all of which patients who take MAO inhibitors must avoid. These foods and beverages contain a chemical compound, an amine called _tyramine_, which can cause dangerously high blood pressure, a hypertensive crisis, in people taking an MAO inhibitor. Furthermore, MAO inhibitors cannot be taken with antihistamines; patients who take MAO inhibitors may be warned to avoid other drug interactions. These warnings should be taken seriously because MAO inhibitors are one of the most potentially _toxic_ groups of psychoactive drugs. Yet they can make the difference between night and day for many cases of depression. {233} There are common side effects caused by all the antidepressants we've mentioned, including an uncomfortably dry mouth, dizziness, especially when standing up quickly, headaches, difficulty in urinating, nausea/vomiting, constipation or diarrhea, impotence, inability to reach orgasm, agitation/shaking, and rapid heartbeat. Some of these side effects can be annoying but will often diminish or disappear once the patient becomes accustomed to the medication. When side effects are not tolerable, the physician or psychiatrist will usually prescribe a different antidepressant that may have fewer, or no, side effects for a given patient.