Table 1.

Classes, SEs, and prescribing considerations for ADT.

Class	Drugs	SE	Considerations
TCA	Imipramine Amitriptyline Doxepin Desipramine Nortriptyline	Weight gain, sedation, dry mouth, nausea, blurred vision, constipation, tachycardia	Generally not first-line therapy due to increased anticholinergic and cardiotoxic SE
MAOI	Isocarboxazid Phenelzine Tranylcypromine Selegiline	Weight gain, fatigue, sexual dysfunction, hypotension	Generally not first-line therapy due to serotonin syndrome and hypertensive crises
SSRI	Fluoxetine Paroxetine Sertraline Citalopram Escitalopram	Headaches, GI distress, insomnia, fatigue, anxiety, sexual dysfunction, weight gain	Often first-line treatment due to safer SE profile. Subtle SE differences must be weighed by the prescriber
SNRI	Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran	Nausea, insomnia, dry mouth, headache, increased blood pressure, sexual dysfunction, weight gain	SEs are similar to but may be slightly more frequent than with SSRI
Atypical	Bupropion	Headache, agitation, insomnia, loss of appetite, weight loss, sweating	Increased seizure risk in eating disorder and epilepsy patients. No sexual dysfunction or weight gain. May also help to quit smoking
	Mirtazapine	Sedation, increased appetite, weight gain	Sedation may be less with higher dose. Much reduced nausea and sexual dysfunction compared with SSRI/SNRI. Some risk of reduced white blood cell count
	Trazodone	Sedation, nausea, priapism (rare)	Lower risk of weight gain and sexual dysfunction, but may cause priapism. Often used to induce sleep as a positive effect
	Vilazodone	Nausea, diarrhea, insomnia	Better SE profile than most ADTs with lower risk of sexual dysfunction or weight gain
	Vortioxetine	Nausea, diarrhea, dizziness	Similar SE profile to the SSRI. May have precognitivebenefits in adults with MDD

ADT, antidepressant treatment; MAOI, monoamine oxidase inhibitor; MDD, major depressive disorder; SE, side effect; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.