Antidepressants
Antidepressants: Classification, Doses, Safety, Adverse Effects
Mechanisms & classification |
Start dose |
Standard dose |
Lethality in overdose |
Insomnia |
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 |
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mirtazapine |
30 |
30-60 |
Low |
- /+ |
++ |
- /+ |
- /+ |
++ |
- none / + moderate / ++ severe / +++ very severe
- 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