Choosing an Antidepressant

1. Consider starting or switching to one of the following medications approved by Health Canada* for the anxiety disorders, PTSD and OCD:

*Note that these medications are approved based on having been studied for these disorders. It is likely the benefits of SSRIs and SNRIs represent a class effect for these conditions.

2.  Additional considerations in medication selection:

• Has the patient had a particular response to a certain antidepressant in the past?
  • Consider using that medication
    
    

• Has there been a family history of response to a certain antidepressant?

  • Consider using that medication
    
    

• Is the patient on multiple medications? Consider…

  • Citalopram (Celexa)
  • Escitalopram (Cipralex)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
    
    

• Is there chronic pain? Consider…

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
    
    

• Is there cardiovascular illness? Consider…

  • Sertraline (Zoloft)
    
    

• Is the patient a child/youth (age < 18)? Consider…

  • Fluoxetine (Prozac)
    
    

• Is the patient in the perinatal period? Consider…

  • Sertraline (Zoloft) (for GAD, PTSD, OCD)
  • Escitalopram (Cipralex) (for GAD, and OCD)
  • Citalopram (Celexa) (for OCD)
  • Fluvoxamine (for OCD)
    
  • For more information, visit MotherToBaby
    
    

• Is cost an issue? If so, then consider these less costly medications…

  • Citalopram (Celexa)
  • Escitalopram (Cipralex)
  • Sertraline (Zoloft)
  • Venlafaxine (Effexor)
    • To obtain costs of  medications in Canada and whether they are covered by your provincial formulary please download the Prescribe Smart App found at https://prescribesmart.com/
      
      

• Patient preference

• Consider pregabalin for patients with GAD and social anxiety disorder unable to tolerate or have not responded to SSRIs or SNRIs