Antidepressants

 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

Low

+

- /+

+

++

++

sertraline

25-50

50-150

Low

+

- /+

+

+

+

citalopram

10-20

20-40

Low

+

- /+

+

+

+

escitalopram

5-10

10-20

Low

+

- /+

+

+

+

Mixed or dual-action reuptake inhibitors

venlafaxine

37.5-75

75-225

Moderate

++

- /+

+

+

-/ +

Mixed-action newer agents

mirtazapine

30

30-60

Low

- /+

++

- /+

- /+

++

- none
+ moderate
++ severe

  1. For many PLWH, SSRI induction may be associated with adverse effects (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
  2. 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 and INSTI and antidepressants together