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Choosing an antidepressant medication Switch medication Increase, Augment or Switch Drug Interactions Checker
| Medication brandname | Starting dose (usually in am) | Initial target dose | Max dose* | Anti-cholinergic | Sedation | Insomnia / Agitation | Orthostatic Hypotension | QT | GI | Weight Gain | Sexual | Comments | |
| SSRI | Citalopram (Celexa) | 10 | 20 | 40 | 0 | 0 | 1+ | 1+ | 1+ | 1+ | 2+ | 3+ | Watch for QTc prolongation if >40 mg daily. Max dose of 20 mg in patients over 65 |
| Escitalopram (Cipralex) | 5 | 10 | 20 (30**) | 0 | 0 | 1+ | 1+ | 1+ | 1+ | 2+ | 3+ | S-isomner of Citalopram Max. dose of 10 mg in patients over 65 | |
| Fluoxetine (Prozac) | 10 | 20 | 60 | 0 | 0 | 2+ | 1+ | 1+ | 1+ | 1+ | 3+ | Long half-life useful for teenagers; however, caution in elderly Watch for drug-drug interactions | |
| Fluvoxamine (Luvox) | 50 | 100 | 300 | 0 | 1+ | 1+ | 1+ | 0 to 1+ | 2+ | 1+ | 3+ | Significant GI side effects Dosages up to 150 mg can be given at night. Divide dose above 150 mg Watch for drug-drug interactions | |
| Paroxetine (Paxil) | 10 | 20 | 50 | 1+ | 1+ | 1+ | 2+ | 0 to 1+ | 1+ | 2+ | 4+ | Short half-life; watch for discontinuation syndrome Avoid in elderly and pregnancy Watch for drug-drug interactions | |
| Sertraline (Zoloft) | 25 | 50 | 200 | 0 | 1+ | 2+ | 1+ | 0 to 1+ | 2+ | 1+ | 3+ | May be used in panic disorder; consider in postpartum | |
| Vilazadone (Viibryd) | 10 | 20 | 40 | 0 | 1+ | 1+ | 0 | 0 to 1+ | 3+ | 1+ | 0 to 1+ | Should be taken with food. Minimal sexual side effects. Significant nausea so titrate slowly. Second line treatment for depression | |
| Vortioxetine (Trintellix) | 5 | 10 | 20 | 0 | 0 | 0 | 0 | 0 | 2+ | 0 | 0 to 3+ | Sexual side effects are dose dependent Crossover when switching | |
| SNRI | Desvenlafaxine (Pristiq) | 50 | 50 | 100*** | 0 | 1+ | 2+ | 0 | 0 | 1+ | 0 | 1+ | May increase blood pressure! Watch for discontinuation syndrome |
| Duloxetine (Cymbalta) | 30 | 60 | 120*** | 0 | 0 | 2+ | 0 | 0 | 2+ | 2+ | 3+ | Also approved for several pain conditions | |
| Levomilnacipran (Fetzima) | 20 | 40 | 120 | 0 | 0 | 2+ | 1+ | 0 | 2+ | 0 | 3+ | Avoid in those with uncontrolled BP or HR, CHF or recent MI Reduce dose in renal failure Palpitations and nausea common | |
| Venlafaxine XR (Effexor) | 37.5 | 75 | 225 (300**) | 0 | 1+ | 2+ | 0 | 1+ | 1+ | 1+ | 3+ | May increase blood pressure! Short half life Watch for discontinuation syndrome | |
| NDRI | Bupropion XL (Welbutrin) | 150 | 300 | 300 (450**) | 0 | 0 | 2+ | 0 | 1+ | 1+ | 0 | 0 | Avoid in those prone to seizures and in eating disorder |
| NaSSA | Mirtazapine (Remeron) | 30 (at night) | 30 | 45 | 1+ | 4+ | 0 | 0 | 1+ | 0 | 4+ | 1+ | Significant sedation and increased appetite. |
* Based on the recommendations found in the Compendium of Pharmaceuticals and Specialties (CPS)
** Consider exceeding recommended maximum dosage in special circumstances with input from psychiatry when possible
*** CPS states that no evidence of benefit above dose of desvenlafaxine 50 mg and duloxetine 60 mg
To obtain costs of these medications in Canada and whether they are covered by your provincial formulary please download the Prescribe Smart App found at https://prescribesmart.com/