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. 2016 Aug 2;61(9):540–560. doi: 10.1177/0706743716659417

Table 3.

Summary Recommendations for Antidepressants.

Antidepressant (Brand Name(s)) Mechanism Dose Range
First line (Level 1 Evidence)

  • Agomelatinea (Valdoxan)

 MT1 and MT2 agonist; 5-HT2 antagonist 25-50 mg

  • Bupropion (Wellbutrin)b

NDRI 150-300 mg

  • Citalopram (Celexa, Cipramil)

 SSRI 20-40 mg

  • Desvenlafaxine (Pristiq)

 SNRI 50-100 mg

  • Duloxetine (Cymbalta)

 SNRI 60 mg

  • Escitalopram (Cipralex, Lexapro)

 SSRI 10-20 mg

  • Fluoxetine (Prozac)

 SSRI 20-60 mg

  • Fluvoxamine (Luvox)

 SSRI 100-300 mg

  • Mianserina (Tolvon)

 α2-Adrenergic agonist; 5-HT2 antagonist 60-120 mg

  • Milnaciprana (Ixel)

 SNRI 100 mg

  • Mirtazapine (Remeron)c

α2-Adrenergic agonist; 5-HT2 antagonist 15-45 mg

  • Paroxetine (Paxil)d

SSRI 20-50 mg  25-62.5 mg for CR version

  • Sertraline (Zoloft)

 SSRI 50-200 mg

  • Venlafaxine (Effexor)e

SNRI 75-225 mg

  • Vortioxetine (Brintellix, Trintellix)f

Serotonin reuptake inhibitor; 5-HT1A agonist; 5-HT1B partial agonist; 5-HT1D, 5-HT3A, and 5-HT7 antagonist 10-20 mg
Second line (Level 1 Evidence)

  • Amitriptyline, clomipramine, and others

 TCA Various

  • Levomilnacipran (Fetzima)f

SNRI 40-120 mg

  • Moclobemide (Manerix)

 Reversible inhibitor of MAO-A 300-600 mg

  • Quetiapine (Seroquel)e

Atypical antipsychotic 150-300 mg

  • Selegiline transdermala (Emsam)

 Irreversible MAO-B inhibitor 6-12 mg daily transdermal

  • Trazodone (Desyrel)

 Serotonin reuptake inhibitor; 5-HT2 antagonist 150-300 mg

  • Vilazodone (Viibryd)f

Serotonin reuptake inhibitor; 5-HT1A partial agonist 20-40 mg (titrate from 10 mg)
Third line (Level 1 Evidence)

  • Phenelzine (Nardil)

  • Tranylcypromine (Parnate)

 Irreversible MAO inhibitor 45-90 mg 20-60 mg

  • Reboxetinea (Edronax)

 Noradrenaline reuptake inhibitor 8-10 mg

5-HT, 5-hydroxytryptamine (serotonin); MAO, monoamine oxidase; MT, melatonin; NDRI, noradrenaline and dopamine reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.

aNot available in Canada.

bAvailable as sustained-release (SR) and extended-release (XL) versions.

cAvailable as rapid-dissolving (RD) version.

dAvailable as controlled-release (CR) version

eAvailable as extended-release (XR) version.

fNewly approved since the 2009 Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines.