Table 2.

Commonly used antidepressant for late-life depression

Medication	Starting dose	Common Therapeutic Doses	Half-life (hour)	Common side effects	Comments
SSRI (Selective serotonin-reuptake inhibitors):				Nausea, dyspepsia, anorexia, tremors, anxiety, insomnia, sexual dysfunction, jitteriness, hyponatremia	Risk of serotonin syndrome if combined with certain drugs.
Fluoxetine	5 mg	10 – 40 mg once daily	70-80		Very long acting.
Sertraline	12.5 mg	50 – 200 mg once daily	25-30	Loose stools, diarrhea
Citalopram	10 mg	20 – 40 mg once daily	40-50
Escitalopram	2.5 mg	10– 30 mg once daily	40-50
Paroxetine	10 mg	20 – 50 mg once daily	10-20	Dry mouth, drowsiness, fatigue, weight gain,	More anticholinergic side effects. High risk of discontinuation syndrome if drug stopped abruptly.
SNRIs (Serotonin-norepinephrine reuptake inhibitors)				Nausea, drowsiness, fatigue, weight gain, hyponatremia, diastolic hypertension at higher doses	Risk of serotonin syndrome if combined with certain drugs. High risk of discontinuation syndrome if medication stopped abruptly.
Venlafaxine XR	37.5 mg	75-225g once daily	5 – 9
Duloxetine	20 mg	20-60mg once daily	8 – 17
	Other newer antidepressants
Mirtazapine	15mg	15-45mg at bedtime	20 -40	Sedation, increased appetite / weight gain	No sexual side effects.
Bupropion SR	100mg	100-150 mg twice daily	15		No sexual side effects. Contraindicated in patients with seizures. Not recommended for patients with comorbid anxiety.
TCAs (Tricyclic antidepressants)				Sedation, weight gain, dry mouth, urinary retention, constipation, blurry vision, orthostatic hypotension, impairment of cardiac conduction	High risk in overdose: 10 days of typical daily dose may result in a fatal cardiac arrhythmia. Get baseline ECG and follow-up ECG at steady state or if new cardiac symptoms occur.
Nortriptyline	10mg	50-125mg every night	18–56	Fatigue	Therapeutic blood levels range from 50 to 150 ng/mL
Desipramine	25mg	100-200mg once daily	12–28	Insomnia, agitation