Antidepressants: Classification, Doses, Safety, Adverse Effects

Antidepressants: Classification, Doses, Safety, Adverse Effects

Mechanisms & classification	Start dose	Standard dose	Lethality in overdose	Insomnia and agitation⁽ⁱⁱ⁾	Sedation	Nausea or GI effects	Sexual dysfunction	Weight gain
	mg/day
Selective serotonin-reuptake inhibitors (SSRIs)⁽ⁱ⁾
paroxetine	10-20	20-40	No (unless if combined with other CNS drugs)	++	++	+++	+++	++
sertraline	25-50	50-150	Low	+	- /+	+	+	+⁽ⁱⁱⁱ⁾
citalopram	10-20	20-40	No	+++	+++	+++	++	+⁽ⁱⁱⁱ⁾
escitalopram	5-10	10-20	No (unless if combined with other CNS drugs)	++	++	+++	++	+⁽ⁱⁱⁱ⁾
Mixed or dual-action reuptake inhibitors
duloxetine	30	30-60	Yes (at > 1000 mg)	++	+++	+++	++	+
venlafaxine	37.5-75	75-225	Yes	+++	+++	+++	++	++
Mixed-action newer agents
mirtazapine	30	30-60	Low	- /+	++	- /+	- /+	++

Frequencies of adverse effects as reported in clinical studies, frequencies are not placebo-corrected.
Rare (> 1/10,000 to < 1/1000): rare
Uncommon (> 1/1000 to < 1/100): +
Common (> 1/100 to < 1/10): ++
Very common (> 1/10): +++

The information on the starting dose and side effects is mostly issued from the European product label of the individual drug

For many persons, SSRI induction may be associated with adverse effects (sexual dysfunction, GI tract, dizziness, anxiety, panic attacks). Commencing at lower doses (i.e. 10, 25 & 10 mg for paroxetine, sertraline and citalopram, respectively) and increasing to the above starting doses after 4 to 7 days if tolerated may reduce such effects
Insomnia is associated with DTG and other INSTI-containing ART regimens and with the use of some antidepressants. Clinicians should be aware when prescribing DTG or other INSTI and antidepressants together
Weight gain may be significant but gradual and insidious