- blocks DA, NE and 5HT reuptake in CNS; local anesthetic action from Na⁺ channel blockade

- increase NE: sympathomimetic effect- increase DA: psychotic episodes, paranoia, hallucinaions, dyskinesias, endocrine disturbances- increase 5HT: behavioral changes, aggressiveness, decreased appetite

Toxicity- excess NE: arrhythmias- excess DA: major psychosis- excess 5HT: serotonin syndrome