TABLE 3. Pharmacological treatment for depression after traumatic brain injury.

Class	Medication	Daily dose range (mg)	Comments	Common side effects
SSRIs	Sertraline*	25–250	Relatively short half-life; Monitor for serotonin syndrome; Contraindicated with MAOIs	Nausea, diarrhea, tremor, decreased libido
	Escitalopram	5–30	Relatively short half-life, few drug-drug interaction; Monitor for serotonin syndrome; Contraindicated with MAOIs	Suicide risk, nausea, diarrhea, insomnia, decreased libido
	Citalopram†	5–40	Relatively short half-life, few drug-drug interaction; Monitor for serotonin syndrome; Contraindicated with MAOIs	QT prolongation, nausea, dizziness, decreased libido
	Fluoxetine	10–60	Long half-life of active metabolite, increased risk of problematic drug-drug interaction; Contraindicated with MAOIs	Unusual dreams, decreased libido, anorexia, tremor
SNRI	Venlafaxine XR	37.5–225	Contraindicated with MAOIs and narrow-angle glaucoma	Hypertension, insomnia, dizziness
TCA	Nortriptyline	25–150	Relatively less anticholinergic than older TCAs	Nausea, drowsiness, dry mouth
Stimulants	Methylphenidate‡	10–60	May usefully augment partial responses to SSRIs	Anorexia, dependence/abuse, insomnia
NDRI	Bupropion XL or SR	150–450	Less associated with sexual side effects, sedation, and weight gain seen in the SSRIs	Risk of lowering the seizure threshold

MAOI: monoamine oxidase inhibitor, NDRI: norepinephrine-dopamine reuptake inhibitor, SNRI: Serotonin and norepinephrine reuptake inhibitors, SSRI: selective serotonin reuptake inhibitor, TCA: tricyclic antidepressants, XR: extended release, XL: extra long, SR: sustained release.

^*,†Canadian Clinical Practice Guideline for Rehabilitation of Adults with Moderate to Severe TBI, level of evidence C; ^‡Canadian Clinical Practice Guideline for Rehabilitation of Adults with Moderate to Severe TBI, level of evidence B.