Antidepressant Mechanisms

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Antidepressants Table

Selective Serotonin Reuptake Inhibitors (SSRIs)Initial Dose (Range), mgComments
Fluoxetine (Prozac)20 (20-60)Activating. Long half-life. 2D6 Inhibitor.
Paroxetine (Paxil)20 (20-60)Anticholinergic. Sedating. 2D6 Inhibitor. Sexual side effects. D/C syndrome. Pregnancy risk.
Sertraline (Zoloft)50 (50-200)Activating. Dopaminergic. 2D6 Inhibitor at higher doses. GI side effects common early in tx.
Citalopram (Celexa)20 (20-60)Few interactions. QT prolongation (>40mg/day).
Escitalopram (Lexapro)10 (10-20)Few interactions. QT prolongation.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Duloxetine (Cymbalta)30 (30-60)Short half life with risk of d/c symptoms. FDA approved for Diabetic neuropathy and Fibromyalgia. Morning dosing. Rarely sedating. May increase BP.
Venlafaxine XR (Effexor XR)37.5 (75-300)Nausea common. May increase BP. Once daily dosing with XR minimizes side effects (i.e., nausea). Reduce dose in renal insufficiency. May help with chronic pain.
Desvenlafaxine (Pristiq)50 (50-100)Active metabolite of venlafaxine. More noradrenergic activity than venlafaxine. Better choice for those with renal and hepatic insufficiency. May help with chronic pain. Short half-life with risk of d/c symptoms.
Atypical Antidepressants
Bupropion (Wellbutrin)100 (100-400)Noradrenergic and Dopaminergic. Minimal sexual side effects. May increase BP. Avoid in those with eating disorders or seizure hx. 2D6 inhibitor.
SR (BID dosing)150 (150-450)
XL (QAM dosing)
Trazodone (Desyrel)25 (25-400)Sedating. Commonly used for insomnia. May increase time in slow wave sleep. No anticholinergic properties. Histamine/α1 at low doses. Minimal sexual side effects. Warn about priapism. May be better for anxiety than depression.
Mirtazapine (Remeron)7.5 (7.5-45)Noradrenergic and serotonergic properties. Has actions at 5HT3 and therefore helps with nausea. Minimal sexual side effects. Sedation and weight gain common. Sedation usually limited to 7.5mg-15mg.

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