Table 4.

Additional considerations when selecting an antidepressant.

Hepatic	Cardiac	Renal
Generally, in patients with hepatic disease, start with a low dose and titrate slowly [43]. Furthermore, intravenous delivery of medications with substantial hepatic metabolism may bypass first-pass metabolic effects. Gastrointestinal disease as well as certain medications (e.g., those with anticholinergic activity) may affect drug absorption [44].	Congestive heart failure can interfere with medication absorption by reducing the perfusion of gastrointestinal and intramuscular drug absorption sites [44]. Orthostatic hypotension, conduction abnormalities, and arrhythmias are possible side effects of several psychotropics (e.g., tricyclic antidepressants (TCA), trazodone, etc.) Certain psychotropics (e.g., TCA, citalopram, ziprasidone, etc.) may prolong the QTc interval. Before starting therapy, patients with risk factors for sudden cardiac death should be referred for a cardiac evaluation [45].	Renal insufficiency has pharmacodynamic consequences [44]. Generally, in patients with renal failure, start a low dose with prolonged dosing intervals. In individuals with renal insufficiency, the rule of two-thirds states that drug dosages should be lowered by one-third of the regular amount. Certain psychotropic drugs may require dosage modifications in individuals with renal failure, including lithium, methylphenidate, venlafaxine, divalproex sodium, gabapentin, and topiramate.