Trazodone Β· Bupropion (Wellbutrin) Β· Mirtazapine β the ones that don't fit the SSRI/SNRI/MAOI mold
NG-101MENTAL HEALTHADHD-friendly visual edition
"Atypical" just means none of these three work through the standard SSRI/SNRI/MAOI mechanism β each has its own quirky target, and each earns its spot on the exam through one signature side effect: trazodone's priapism, bupropion's seizure risk, mirtazapine's weight gain.
π΄ Trazodone = sleepSedating β used off-label as a sleep aid; take at night.
β‘ Bupropion = seizuresLowers seizure threshold β avoid in seizure or eating disorder history.
π½οΈ Mirtazapine = appetiteSedation + weight gain β good pick for poor sleep/appetite.
π¨ PriapismErection lasting hours on trazodone = go to the ER now.
π
WHAT IT DOES
STEP 1 Β· MECHANISM
Three drugs, three different targets β none of them are classic serotonin reuptake blockers.
π§ Three different mechanisms, one drug class label
π§ βSARI sleeps, NDRI energizes, NaSSA feeds.β Match the mechanism to the side-effect profile and you'll never mix these three up.
π΄ Trazodone β the sleep-aid antidepressant
Indication: depression; very commonly used off-label as a sleep aid at lower doses because of its sedating effect.
Mnemonic:TraZZZadone / TRANCE-adone β sleepy and sedated.
π§ If the question describes a depressed client with severe insomnia getting a low-dose bedtime medication that isn't a benzodiazepine β think trazodone.
Indication: depression and as an aid to stop smoking (marketed as Zyban for that indication, same drug).
Comes in SR (sustained-release) and XL (extended-release) formulations.
π§ βBupropion helps you quit and stay energized.β It's the antidepressant of choice when a client also wants to stop smoking or is worried about sexual side effects/weight gain.
π½οΈ Mirtazapine β sedation + appetite, on purpose
Indication: depression, especially useful when the client also has significant insomnia and poor appetite/weight loss β the side effects become the therapeutic benefit.
π§ βMirtaz-appetite.β Picture a fork and a pillow β this drug makes people eat and sleep, which is exactly what an underweight, sleepless depressed client needs.
β οΈ
WATCH FOR
STEP 2 Β· SIDE EFFECTS
Each drug has one signature danger sign the exam loves to test.
π¨ Trazodone β priapism is a medical emergency
π΄ Sedation, drowsiness
π Orthostatic hypotension β dizziness with position changes
π¨ Priapism β rare but serious: an erection that persists for hours unrelated to sexual activity
Priapism is a urologic emergency β untreated, it risks permanent tissue damage. Teach the client to go to the emergency department immediately if this occurs.
π§ Rare β ignorable. Priapism is the one trazodone side effect tested over and over precisely because students forget to mention it's an emergency.
β‘ Bupropion β lowers the seizure threshold
Avoid bupropion in clients with:
π A seizure disorder or history of seizures
π½οΈ A current or past eating disorder (anorexia or bulimia nervosa) β electrolyte shifts from purging further lower the seizure threshold
π§ βBu-PRO-pion, PRO the seizures? No β PRO-tect against giving it in seizure/eating-disorder history.β Seizure risk is the #1 safety flag for this drug.
π΅ Bupropion β activating side effects
π΄β‘οΈπ³ Insomnia (opposite of trazodone/mirtazapine)
π€ Headache
βοΈ Weight loss β unlike most antidepressants
π No significant sexual side effects β a real advantage over SSRIs (see NG-205)
π§ If the question says a client switched antidepressants because of sexual dysfunction, bupropion is a classic answer choice.
βοΈ Mirtazapine β sedation & weight gain
π΄ Significant sedation β dose at bedtime
βοΈ Weight gain and increased appetite (the flip side of bupropion)
π΅ Dizziness, dry mouth
Low sexual side-effect profile, similar advantage to bupropion, but the mechanism and target population differ.
π§ Bupropion and mirtazapine are opposites on sleep and weight β insomnia/weight loss vs. sedation/weight gain β pick based on what the client needs more of.
π§ Side-effect body map β three drugs, three signature effects
π§ One glance, one drug: droopy face + warning = trazodone, alert face + down arrow = bupropion, droopy face + up arrow = mirtazapine.
π£οΈ
TEACH
STEP 3 Β· PATIENT EDUCATION
Formulation rules, timing, and what to do if a warning sign shows up.
π« Bupropion SR/XL β never crush, chew, or cut
π«Never crush
π«Never chew
π«Never cut
π«Never double up on a missed dose
Crushing/chewing an XL (extended-release) or SR (sustained-release) tablet dumps the full dose at once β this spikes blood levels and raises seizure risk sharply.
π§ Extended-release + seizure-risk drug = never crush, ever. The whole point of the SR/XL coating is to prevent exactly the kind of dose spike that could trigger a seizure.
π Trazodone β timing & interactions
π Take at night β sedation is expected and useful for sleep
Avoid alcohol and other sedatives (benzodiazepines, antihistamines) β additive CNS depression
π§ Teach slow position changes to reduce orthostatic hypotension/fall risk
π¨ Go to the ED for any erection lasting more than a few hours
π Bupropion β smoking cessation teaching
Can be started while the client is still smoking, with a target quit date set during treatment
Take earlier in the day β insomnia is common if dosed at night
Report new or worsening seizures, tremor, or agitation immediately
π½οΈ Mirtazapine β set expectations
Take at bedtime β sedation is the point, not a problem to fight
Expect increased appetite and possible weight gain β monitor weight over time
Avoid driving/operating machinery until the sedating effect is known
π§ Mirtazapine and trazodone both sedate, but only mirtazapine reliably drives appetite up β that's the differentiator.
π³ Decision path β from patient picture to drug
π― Pick the right drug for the patient
Patient picture
Best-fit drug
Why
Depressed + severe insomnia, no other complaints
Trazodone
Sedating; low-dose off-label sleep aid
Depressed + wants to quit smoking, worried about sexual side effects
Bupropion
Dual indication; no sexual side effects; energizing
π For SSRI, SNRI, and MAOI mechanisms, interactions (serotonin syndrome, tyramine reaction), and dietary teaching, see NG-205 SSRI, NG-187 SNRI vs. TCA, and NG-154 MAOI β this page assumes those baselines and focuses on the drugs that don't fit that mold.
β‘
QUICK RECALL
SAY IT OUT LOUD
π΄ Trazodonesedating, sleep aid, watch for priapism
β‘ Bupropionseizure risk β avoid in seizure/eating disorder hx, never crush SR/XL
π½οΈ Mirtazapinesedation + weight gain, good for poor sleep & appetite
π No sexual side effectsbupropion (and mostly mirtazapine) β unlike SSRIs
π― Cover & check β 4 rapid-fire questions
Q1: A client on trazodone reports an erection lasting several hours with no sexual activity. What should the nurse instruct?
Go to the emergency department immediately β priapism is a urologic emergency.
Q2: Which client would be a poor candidate for bupropion?
A client with a seizure disorder or an active/past eating disorder (anorexia or bulimia) β bupropion lowers the seizure threshold.
Q3: A client is prescribed bupropion XL. Which teaching point is essential?
Never crush, chew, or cut the tablet, and never double up on a missed dose β both spike blood levels and raise seizure risk.
Q4: Which antidepressant would best fit a depressed client with insomnia and poor appetite/weight loss?
Mirtazapine β its sedating and appetite-stimulating side effects directly address both problems.