Table 3: Antidepressants Important Characteristics

Table 3:
Antidepressants: Important Characteristics
Generic	Trade	Drug Class	Starting Dose (mg/dose)	Therapeutic Daily Dose (mg/dose)	Half-Life (hours)	Schedule	Sedation	Comments
Buproprion	Wellbutrin SR	OTHER	150	300-450	21	BID	-	Risk of seizures at doses > 450 mg
Fluoxetine	Prozac	SSRI	10	20-80	7-9 Days	QD	-	Can be overly activating
Sertraline	Zoloft	SSRI	25	50-200	26	QD	+	Causes same degree of CYT P450 IID inhibition as other SSRIs at doses > or equal to 100 mg
Paroxetine	Paxil	SSRI	10	20-60	21	QD	+	Antichoinergic properties
Nefazodone	Serzone	OTHER	50	300-600	5-7	BID	+	Nausea, drowsiness may occur
Venlafaxine	Effexor XR	OTHER	37.5	150-375	12	QD	-	May have special efficacy in patients with pain
Mirtazapine	Remeron	OTHER	15	15-45	20-40	QD	+	Weight gain, orthostatic hypotension, postural hypotension
Citalopram	Celexa	SSRI	10	20-40	35	QD	-	May cause fewer side-effects than other SSRIs
Fluvoxamine	Luvox	SSRI	25	50-150	16	QD	+	Has antidepressant properties, but not yet approved by FDA for treatment of depression
These agents are listed by sequence of FDA approval. Citalopram, comparable to other SSRIs, is lower on the list because it has only recently been approved for use in the United States. Fluvoxamine, also an SSRI, is not yet approved for treatment of depression in the U.S.

Generic	Trade	Drug Class	Starting Dose (mg/dose)	Therapeutic Daily Dose (mg/dose)	Half-Life (hours)	Therapeutic Plasma Level (mg/ml)	Schedule	Sedation	Comments
Tertiary Amine
Amitriptyline	Elavil	TCA	25	150-300	22-26		HS	++++	Most anticholinergic of the TCA listed. Avoid if possible.
Doxepin	Sinequan	TCA	25	150-300		100-250	HS	++++	Antihistamine properties cause excess weight gain & sedation
Imipramine	Tofranil	TCA	25	150-300	30	150-250	HS	+++
Secondary Amine
Desipramine	Norpramin	TCA	25	150-300		150-300	HS	±	Metabolite of imipramine
Nortriptyline	Pamelor	TCA	10	75-150	26	50-150	HS	±	Metabolite of amitriptyline
Protriptyline	Vivactil	TCA	5	15-60	NA	15-60	TID	-	Metabolite of amitriptyline
Tertiary amine TCA tend to cause more anticholinergic symptoms (eg, dry mouth, constipation, blurred vision), sedation, and postural hypotension than secondary amines. Nortriptyline is the TCA least likely to cause postural hypotension. All TCA have qunidine-like effects that can produce a clinically significant delay of His-bundle conduction especially if there is an existing delay prior to TCA treatment. A baseline electrocardiogram (ECG) should be obtained in all individuals prior to TCA treatment. Weight gain is the most common cause for premature discontinuation of all TCA. All TCA are potentially lethal in overdose (OD).
Copyright 2002 The Cleveland Clinic Foundation
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