List of antidepressants

This is a list of antidepressants by drug group. Generic drug names are listed first with trade names in brackets.

Anti-depressant drugs may be augmented in the treatment of depression or other mood disorders by non-antidepressant drugs (such as lithium carbonate) which have been shown to boost the antidepressant effect of a main antidepressant treatment.

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SSRIs or selective serotonin reuptake inhibitors

• citalopram (Celexa): usual dosing is 20 mg initially; maintenance 40 mg per day; maximum dose 60 mg per day.
• escitalopram oxalate (Lexapro): usual dosing is 10 mg and shown to be as effective as 20 mg in most cases. Maximum dose 20 mg. Also helps with anxiety.
• paroxetine (Paxil): Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD. Usual dose 25 mg per day; may be increased to 40 mg per day. Available in controlled release 12.5 to 37.5 mg per day; controlled release dose maximum 50 mg per day. Less cycling in patients who are bipolar.
• fluoxetine (Prozac): Also used to treat OCD, bulimia, and panic disorder. Long half-life; less withdrawal when medication is stopped. Dosing is 20 mg to a maximum of 80 mg.
• fluvoxamine maleate (Luvox): Although primary used in the treatment of OCD, a doctor may prescribe it for depression. Initial dose is 50 mg, increasing by 50 mg every 4-7 days. If daily dose is greater than 100 mg give in equally divided doses or give larger dose at bedtime not to exceed 300 mg per day.
• sertraline (Zoloft): Also used to treat panic disorder, OCD, PTSD, social anxiety disorder, premenstrual dysphoric disorder. Dosing is 50-200 mg per day and should be titrated upward.

Be aware of drug interactions. Paxil and dextromethorphan given together prevents the metabolism of the dextromethorphan resulting in lethal levels.

Drug interactions may also occur when concurrently taking phenytoin (Dilantin) and warfarin (Coumadin) (phenytoin and warfarin levels are increased).

Always check with pharmacy regarding potential drug interactions.

MAOIs or monoamine oxidase inhibitors

• isocarboxazid (Marplan®)
• moclobemide (Manerix®)
• phenelzine (Nardil®)
• tranylcypromine (Parnate®)
• selegiline transdermal system (EMSAM®)

Serious and potentially fatal adverse reactions may occur with concurrent use of other antidepressants including SSRIs, nefazodone, trazodone; also carbamazepine, cyclobenzaprine, buspirone, and many others.

Also similar potentially fatal reactions can occur with recreational drugs MDMA (Ecstasy), the AIDS drug Ritonavir and food products containing tyramine such as cheese and beer.

Moclobemide is a reversible inhibitor of monoamine oxidase type A, which in practice means that it is somewhat less problematic with dietary restrictions and drug interactions.

Tricyclics

• amitriptyline (Elavil®, Endep®)
• clomipramine (Anafranil®)
• desipramine (Norpramin®, Pertofrane®)
• dosulepin (dothiepin) (Prothiaden®)
• doxepin (Adapin®, Sinequan®)
• imipramine (Tofranil®)
• nortriptyline (Pamelor®)
• protriptyline (Vivactil®)
• trimipramine (Surmontil®)
• lofepramine

Tricyclics can cause arrhythmias and EKG changes and are very lethal in overdose.

These medications should be used with extreme caution in the elderly.

Tetracyclics

• maprotiline (Ludiomil)
• amoxapine (Asendin®)
• mianserin
• mirtazapine (Remeron): Sometimes used to stimulate appetite and improve sleep when depression is associated with these symptoms. Dosage range 15 mg - 45 mg. The 15 mg dose may be more effective as appetite stimulant. Dosed at bedtime.

Others

• bupropion (Wellbutrin®): Also used for smoking cessation (Zyban). Wellbutrin XL dosing 150 mg to 300 mg.
• duloxetine (Cymbalta®): Newest antidepressant. Dosing 40 mg two X daily or 60 mg once daily.
• nefazodone (Serzone®): Liver functioning should be monitored closely. Can cause liver failure.
• reboxetine (Edronax®): Noradrenaline (norepinephrine) reuptake inhibitor.
• trazodone (Desyrel®): Used mainly as a sleep agent. Dosing 50 mg to 400 mg maximum
• venlafaxine (Effexor®): Also used to treat generalized anxiety disorder and social anxiety disorder. Dose should be titrated upward starting at 37.5 mg X one week. Maximum dose 225 mg in XL form. Blood pressure should be monitored as this medication can increase it.
• tianeptine: currently the only selective serotonin reuptake enhancer; used as an antidepressant in Europe, Asia, and Latin America
• milnacipran: (Ixel®): Serotonin/norepinhephrine reuptake inhibitor. Manufactured in France by Pierre Fabre.