What class of antidepressants should not be used prior to certifying an individual?

First generation antidepressants, which primarily include tricyclic antidepressants (TCAs), should not be used prior to certifying an individual due to their side effect profile and potential for significant adverse effects. These medications can cause sedation, orthostatic hypotension, and cardiotoxicity, which may impair an individual’s ability to safely operate a vehicle or perform other tasks that require full attention and motor skills.

Additionally, they have a narrower therapeutic index, meaning that the difference between an effective dose and a toxic dose is smaller compared to newer classes of antidepressants. This increases the risk of overdose and complicates monitoring during treatment. Therefore, these factors make first generation antidepressants less suitable for individuals who require certification for tasks that demand an optimal level of mental and physical capability.

In contrast, second generation antidepressants (such as SSRIs) and third generation antidepressants typically have more favorable safety profiles and are less likely to cause sedation and other impairments. Natural antidepressants may also have varying impacts depending on the individual and the specific substance used, but they are generally not categorized in the same way as pharmacological treatments.