[Verse 1] Tricyclics in the bloodstream, old school but they hit hard Amitriptyline, nortriptyline, desipramine on the card Block the reuptake — norepinephrine, serotonin double catch Sodium channel blockade underneath, that's the cardiac scratch Anticholinergic? Dry mouth, retention, blurry sight Constipation creeping in, QTc stretching overnight Screen that ECG before you write the script, don't skip PR prolonging, QRS widening — watch the interval slip Overdose is lethal, narrow therapeutic lane Arrhythmia, seizures, coma — don't minimize the pain Nortriptyline and desipramine got the cleaner side-effect curve Desipramine less sedating — match the molecule to the nerve [Chorus] Давай, давай — TCAs блокируют канал SNRIs raise the pressure, watch the sodium fall Antidepressants on the pain clock, não é só tristeza Duloxetine, venlafaxine — dor com mais certeza QRS widening means danger, narrow window, fatal dose SNRIs discontinue slow — taper every one of those [Verse 2] SNRIs stepping up — duloxetine leads the pack Fibromyalgia, neuropathy, chronic low back Venlafaxine shares the lane, milnacipran joins the floor All three inhibit NE and serotonin at the core But pressure climbs — hypertension is a documented fact Baseline the vitals, monitor the trajectory, then react Hyponatremia sneaks in through SIADH at the gate Elderly patients, diuretics stacked — that's the highest-risk slate Discontinuation syndrome — electric shock sensations, dread Skip a venlafaxine dose and feel the zaps inside your head Taper gradual, extend the interval, bridge if necessary The half-life of venlafaxine short — respect that inventory [Chorus] Давай, давай — TCAs блокируют канал SNRIs raise the pressure, watch the sodium fall Antidepressants on the pain clock, não é só tristeza Duloxetine, venlafaxine — dor com mais certeza QRS widening means danger, narrow window, fatal dose SNRIs discontinue slow — taper every one of those [Verse 3] SSRIs walk in last — fluoxetine, the crowd knows the name Analgesic evidence? Sparse, inconsistent, weak the claim Serotonin reuptake only, NE barely touched the dial For chronic pain specifically, the data doesn't clear the trial But interactions? That's the hazard hiding in the cabinet Serotonin syndrome when you stack triptans — acknowledge it MAOIs combined? Contraindicated, critical, deceased Tramadol plus SSRI — serotonergic storm released Bleeding risk elevated — platelets need that serotonin store NSAIDs alongside SSRIs and the GI bleeds encore So for pure analgesia SSRIs fall to third-tier rank TCAs and SNRIs carry more weight in the pain bank [Bridge] Амитриптилин ночью — седативный эффект помогает спать But the morning anticholinergic fog is a price you calculate A dor não tem cor — pain doesn't show on any scan Escolha a molécula certa — pick the right drug for the plan Cardiac history? Reconsider every TCA you draft Check that ECG, baseline sodium, pressure fore and aft
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