Antidepressants | |||
| NAME | USUAL DAILY DOSE, mg | SIDE EFFECTS | COMMENTS |
|---|---|---|---|
| SSRIs | |||
Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro) | 10-80 50-200 20-60 100-300 20-60 10-30 | Headache; nausea and other GI effects; jitteriness; insomnia; sexual dysfunction; can affect plasma levels of other medicines (except sertraline); akathisia rare | Once-daily dosing, usually in the morning; fluoxetine has very long half-life; must not be combined with MAOIs |
| TCAs and tetracyclics | |||
Amitriptyline (Elavil) Nortriptyline (Pamelor) Imipramine (Tofranil) Desipramine (Norpramin) Doxepin (Sinequan) Clomipramine (Anafranil) Maprotiline (Ludiomil) | 150-300 50-200 150-300 150-300 150-300 150-300 25-150 | Anticholinergic (dry mouth, tachycardia, constipation, urinary retention, blurred vision); sweating; tremor; postural hypotension; cardiac conduction delay; sedation; weight gain | Once-daily dosing, usually qhs; blood levels of most TCAs available; can be lethal in overdose (lethal dose = 2 g); nortriptyline best tolerated, especially by elderly FDA approved for OCD |
| Mixed norepinephrine/serotonin reuptake inhibitors (SNRI) and receptor blockers | |||
| Venlafaxine (Effexor) | 75-375 | Nausea; dizziness; dry mouth; headaches; increased blood pressure; anxiety and insomnia | Bid-tid dosing (extended release available); lower potential for drug interactions than SSRIs; contraindicated with MAOIs |
| Desvenlafaxine (Pristiq) | 50-400 | Nausea, dizziness, insomnia | Primary metabolite of venlafaxine; no increased efficacy with higher dosing |
| Duloxetine (Cymbalta) | 40-60 | Nausea, dizziness, headache, insomnia, constipation | May have utility in treatment of neuropathic pain and stress incontinence |
| Mirtazapine (Remeron) | 15-45 | Somnolence, weight gain; neutropenia rare | Once-a-day dosing |
| Vilazodone (Viibryd) | 40 | Nausea, diarrhea, headache; dosage adjustment if given with CYP3A4 inhibitor/stimulator | Also 5-HT1a receptor partial agonist |
| Vortioxetine (Brintellix) | 5-20 | Nausea, diarrhea, sweating, headache; low incidence of sedation or weight gain | No specific p450 effects; 5-HT3a and 5-HT7 receptor antagonist, 5-HT1b partial agonist, and 5-HT1a agonist |
| Levomilnacipran (Fetzima) | 40-120 | Nausea, constipation, sweating; rare increase in blood pressure/pulse | Most noradrenergic of SNRIs |
| Mixed-action drugs | |||
| Bupropion (Wellbutrin) | 250-450 | Jitteriness; flushing; seizures in at-risk pts; anorexia; tachycardia; psychosis | Tid dosing, but sustained release also available; fewer sexual side effects than SSRIs or TCAs; may be useful for adult ADD |
| Trazodone (Desyrel) | 200-600 | Sedation; dry mouth; ventricular irritability; postural hypotension; priapism rare | Useful in low doses for sleep because of sedating effects with no anticholinergic side effects |
| Trazodone extended release (Oleptro) | 150-375 | Daytime somnolence, dizziness, nausea | |
| Amoxapine (Asendin) | 200-600 | Sexual dysfunction | Lethality in overdose; EPS possible |
| MAOIs | |||
Phenelzine (Nardil) Tranylcypromine (Parnate) | 45-90 20-50 | Insomnia; hypotension; edema; anorgasmia; weight gain; neuropathy; hypertensive crisis; toxic reactions with SSRIs; narcotics | May be more effective in pts with atypical features or treatment-refractory depression |
| Isocarboxazid (Marplan) | 20-60 | Less weight gain and hypotension than phenelzine | |
| Transdermal selegiline (Emsam) | 6-12 | Local skin reaction hypertension | No dietary restrictions with 6-mg dose |