Table 2. Antidepressants.
| Substance group, substances | Initial dose (mg/d) | Standard dose (mg/d) | High dose*1 (mg/d) | Side effect, risk, and interaction profile (selected) | Neurochemical properties |
| Tricyclic antidepressants: | Anticholinergic effects (dry mouth, constipation, impaired accommodation, urinary retention, delirium, cognitive impairment); orthostatic hypotension; sedation, increased appetite, weight gain (esp. with amitriptyline, doxepine, and trimipramine); heart block, cardiac arrhythmia; potentially lethal toxicity with overdose: beware of accidental (impaired memory) or suicidal overdoses | Inhibition of serotonin and noradrenaline reuptake; also, blockade of muscarinic acetylcholine receptors, histamine1 receptors, and α1-adrenergic receptors | |||
| amitriptyline, clomipramine, desipramine, doxepine, imipramine, lofepramine, nortriptyline, trimipramine | 25–50 | 150 | 300 | ||
| Tetracyclic antidepressant: | |||||
| maprotiline | |||||
| MAO inhibitors: | For tranylcypromine, pay close attention to drug information (a low-tyramine diet is necessary—beware of hypertensive crises! Danger of serotonin syndrome when combined with serotonergic medications, or given at too short an interval before or after them!). Side effects: sleep disturbance, orthostatic hypotension, dry mouth. | Tranylcypromine: irreversible MAO-A and MAO-B inhibition; Moclobemide: reversible MAO-A inhibition | |||
| Irreversible: tranylcypromine | 10 | 10–30 | 80 | ||
| Reversible: moclobemide | 150 | 300–600 | 900 | ||
| SSRI: | Nausea, inner unrest, sleep disturbance, sexual dysfunction, SIADH*2. With fluoxetine, paroxetine, and fluvoxamine, beware of the major risk of interactions with many other drugs because of inhibition of cytochrome P450 isoenzymes! | Selective inhibition of serotonin reuptake | |||
| Citalopram, fluoxetine, paroxetine | 20 | 20–40 | not indicated | ||
| Escitalopram | 10 | 10–20 | |||
| Fluvoxamine, sertraline | 50 | 50–150 | |||
| SNRI: | Nausea, inner unrest, sexual dysfunction, rise in blood pressure (esp. venlafaxine), SIADH*2, dry mouth, diaphoresis | Selective inhibition of serotonin and noradrenaline reuptake | |||
| Venlafaxine | 75 | 150–225 | 375 | ||
| Duloxetine | 60 | 60 | 120 | ||
| Autoreceptor blockers: | Sedation, increased appetite, weight gain; mianserin: risk of changes in blood count (check periodically!) | Blockade of presynaptic autoreceptors and thus inhibition of negative feedback | |||
| Mianserine | 30 | 60–120 | 180 | ||
| Mirtazapine | 15 | 15–45 | 80 | ||
| Other: | Sedation, sleep disturbance, increased appetite, weight gain, orthostatic hypotension, priapism (inform patient!) | Blockade of serotonin2 receptors and presynaptic autoreceptors, moderate inhibition of serotonin reuptake | |||
| Trazodone | 50–100 | 200–400 | 600 | ||
| Bupropion | 150 | 150–300 | 450 | Unrest, sleep disturbance, headache, rise in blood pressure, dry mouth | Inhibition of dopamine and noradrenaline reuptake |
| Reboxetine | 8 | 8 | 10 | Tachycardia, orthostatic hypotension, inner unrest, sleep disturbance, dry mouth, diaphoresis, urinary retention | Selective inhibition of noradrenaline reuptake |
*1High-dose treatment requires more frequent monitoring, sometimes on an inpatient basis, and will predictably result in a higher rate of undesired effects.
*2SIADH, syndrome of inappropriate ADH secretion