Issues in Selection of an Antidepressant

Table of Contents

1. Objectives
2. Indications
3. Antidepressant Classes
4. "Newer" Antidepressant Classes
5. Selective Serotonin Reuptake Inhibitors
   1. Serotonin (5-HT)
   2. Effects and Side Effects
6. Pharmacokinetics
7. Extra Receptor Effects
8. SSRIs in Summary
9. "New" Miscellaneous Antidepressants
10. Dual Agents
11. Special Circumstances
12. A Final Note
13. Review Questions
14. Your Feedback

Selective Serotonin Reuptake Inhibitors

Let's start by talking about the SSRIs. These drugs are generally the first line used because of their safety and tolerability. As you can see from the table below, the starting dose is very similar to the usual dose. This is in contrast to the TCAs which have so many uncomfortable side effects that one has to start at really small doses and titrate upward slowly, or else the patient will rebel and quit taking the medicine entirely!

Generic	Brand Name	Starting Dose	Usual Dose
fluoxetine	Prozac	10-20 mg	20-80 mg
sertraline	Zoloft	25-50 mg	50-200 mg
paroxetine	Paxil	20 mg	20-60 mg
fluoxetine	Luvox	50-100 mg	150-300 mg
citalopram	Celexa	20 mg	20-60 mg
escitalopram	Lexapro	10 mg	10-20 mg

Notice that escitalopram has a dollar sign next to it. That is because it is the only SSRI that is currently NOT available in generic.