Antidepressant Medications
Drug	Starting dose	Usual Dose	Indications	Side Effects
Starting antidepressants: improvement often seen in first two weeks. If not seen by 8 weeks, likely needs new agent or second agent. Check in at least weekly when starting antidepressants. 3/3 of people with depression will improve with antidepressants.
Stopping antidepressants: Recurrence of depression is common. 64% of patients with depression had a recurrence 10 years after stopping their antidepressants. If patients do decide to stop their antidepressants, encourage them to talk with their PCP prior to stopping and help them understand that there are fewer problems when antidepressant dosages are tapered over a two week period.
Selective serotonin reuptake inhibitors (SSRIs)
Citalopram (Celexa)	10	20–40	Max FDA daily recommended dose for patients >60 yrs old is 20 mg	Jitteriness, restlessness, agitation, GI distress, nausea, diarrhea, insomnia usually improve in 2 weeks. Weight gain for some patients.
Fluoxetine (Prozac)	10	20–60	First line (weight gain less likely)
Fluvoxamine (Luvox)	50	50–300
Paroxetine (Paxil)	20	20–60	Worst for sexual dysfunction, weight gain, sedation; mild anticholinergic effects (helps diarrhea)	Same as above.
Paroxetine CR (Paxil CR)	25	25–75		Same as above.
Sertraline (Zoloft)	50	50–200		Same as above.
Dopamine-norepinephrine reuptake inhibitors
Bupropion SR (Wellbutrin SR) **When dose > 100 mg give bid.	100	300–400	Weight gain rare. May improve sexual functioning. Useful for lethargic patients.	Contraindicated in patients with seizure history or eating disorders.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Venlafaxine XR (Effexor XR)— **When dose > 75 mg, give bid.	37.5, 75 & 100	75–300		Effective for diabetic neuropathy, fibromyalgia, chronic pain.
Duloxetine (Cymbalta)—	30	60–120		Effective for diabetic neuropathy, fibromyalgia, chronic pain.
Serotonin modulators
Trazodone (Desyrel)	25–50	50–300	Useful for insomnia associated with depression/anxiety.	Doses > 50 mg can cause orthostatic hypotension or (rarely) priapism.
Tricyclics and tetracyclics
Amitriptyline (Elavil)	25–50	100–300		Anticholinergic side effects and weight gain. Elders particularly susceptible to memory change, confusion, hallucinations, sedation and orthostatic hypotension. Contraindicated in patients with recent MI, cardiac conduction problems
Amoxapine (Asendin)	50	100–400
Clomipramine (Anafranil)	25	100–250
Maprotiline (Ludiomil)	50	100–225
Doxepin (Adapin, Sinequan)	25–50	100–300
Imipramine (Tofranil)	25–50	100–300
Desipramine (Norpramin)	50	100–300
Nortriptyline (Pamelor)	25	50–200
Protriptyline (Vivactil)	10	15–60
Noradrenergic and specific serotonergic antidepressant
Mirtazapine (Remeron)	15	15–45		Causes weight gain in 50% of patients. Helpful for anxious patients with insomnia and no appetite.