Antidepressant Medications
Name Indication, Half-life Notes/Notable side effects/Precautions
starting dose, (T1/2)
target CYP450
symptoms, and enzyme
affected
neurotransmitte
rs
SSRIs
Citalopram Indication: 23-45 hours, *increasing serotonin can cause diminished
(Celexa) Depression, CYP3A4 and dopamine release-> emotional flattening, slow
PMDD, OCD, 2C19 cog, apathy
Panic disorder, *increases serotonin everywhere-> insomnia,
GAD, PTSD, diarrhea
social phobia SE: sexual dysfunction, GI: diarrhea,
Starting Dose: constiptation, dry mouth, CNS: insomnia,
20 mg/day, sedation, agitation, tremors, headache,
increase by 20 dizziness
mg/day after --rare: SIADH, hyponatremia (in elderly),
1 weeks, max: seizures, induction of mania, SI
40 mg/day -can cause serotonin syndrome when prescribed
Target with MAOI (wait 14 days after stopping MAOI to
Symptoms: prescribe)
depression, -decreases seizure threshold
anxiety, panic
attacks, -advantages: good for elderly, good for those
avoidant sedated by other SSRI’s, less sexual
behavior, dysfunction, tx hot flashes, if elderly don’t
hyperarousal, respond to drug-> MCI
reexperiencing,
sleep
disturbance
(insomnia and
hypersomnia)
, Affected NT:
increases
serotonin (1A)
Escitalopram Indication: 27-32 hours, *increasing serotonin can cause diminished
(Lexapro) MDD, GAD, no dopamine release-> emotional flattening, slow
panic disorder, significant cog, apathy
OCD, PTSD, actions of *increases serotonin everywhere-> insomnia,
social phobia, CYP450 diarrhea
PMDD enzymes SE: sexual dysfunction, GI: diarrhea,
Starting Dose: constiptation, dry mouth, CNS: insomnia,
10 mg/day sedation, agitation, tremors, headache,
Target dizziness
Symptoms: --rare: SIADH, hyponatremia (in elderly),
depression, seizures, induction of mania, SI
anxiety, panic -decreases seizure threshold
attacks,
avoidant -advantages: few drug interactions, one of best
behavior, tolerated antidepressants, less sexual
reexperiencing, dysfuntion, has faster onset (10 mg= 40 mg of
hyperarousal, citalopram), tx hot flashes, if elderly don’t
sleep respond to drug-> MCI
(insomnia, -disadvantage: more expensive than citalopram
hypersomnia)
Affected NT:
increases
serotonin (1A)
Fluoxetine Indication: 2 weeks, *increasing serotonin can cause diminished
(Prozac) MDD, OCD, inhibits dopamine release-> emotional flattening, slow
PMDD, panic CYP2D6 and cog, apathy
disorder, CYP3A4 *increases serotonin everywhere-> insomnia,
bulimia, diarrhea
bipolar SE: sexual dysfunction, GI: diarrhea,
depression (in constiptation, dry mouth, CNS: insomnia,
, combo w sedation, agitation, tremors, headache,
olanzapine), dizziness
tx resistant --rare: SIADH, hyponatremia (in elderly),
depression in seizures, induction of mania, SI
combo w -decreases seizure threshold
olanzapine,
social phobia, *the more anxious the pt, the lower the starting
PTSD dose
Starting Dose: *tapering not necessary
20-80 mg/day
(morning) for Advantages: tx atypical depression good for
depression and hypersomnia, increased appetite, can do weekly
OCD, 60-80 administration, good for kids with OCD or
mg/day for depression
bulimia Disadvatages: not good for anorexia, initiating
Target tx in severe insomnia or anxious agitated pts
Symptoms:
depression,
energy,
motivation,
anxiety, sleep
(insomnia and
hypersomnia)
Affected NT:
increases
serotonin (1A),
also 5HT2C
antagonist
(incrases NE
and DA)
Fluvoxamine Indication: 9-28 hours, *increasing serotonin can cause diminished
(Luvox) OCD, social inhibits dopamine release-> emotional flattening, slow
anxiety CYP3A4, cog, apathy
Name Indication, Half-life Notes/Notable side effects/Precautions
starting dose, (T1/2)
target CYP450
symptoms, and enzyme
affected
neurotransmitte
rs
SSRIs
Citalopram Indication: 23-45 hours, *increasing serotonin can cause diminished
(Celexa) Depression, CYP3A4 and dopamine release-> emotional flattening, slow
PMDD, OCD, 2C19 cog, apathy
Panic disorder, *increases serotonin everywhere-> insomnia,
GAD, PTSD, diarrhea
social phobia SE: sexual dysfunction, GI: diarrhea,
Starting Dose: constiptation, dry mouth, CNS: insomnia,
20 mg/day, sedation, agitation, tremors, headache,
increase by 20 dizziness
mg/day after --rare: SIADH, hyponatremia (in elderly),
1 weeks, max: seizures, induction of mania, SI
40 mg/day -can cause serotonin syndrome when prescribed
Target with MAOI (wait 14 days after stopping MAOI to
Symptoms: prescribe)
depression, -decreases seizure threshold
anxiety, panic
attacks, -advantages: good for elderly, good for those
avoidant sedated by other SSRI’s, less sexual
behavior, dysfunction, tx hot flashes, if elderly don’t
hyperarousal, respond to drug-> MCI
reexperiencing,
sleep
disturbance
(insomnia and
hypersomnia)
, Affected NT:
increases
serotonin (1A)
Escitalopram Indication: 27-32 hours, *increasing serotonin can cause diminished
(Lexapro) MDD, GAD, no dopamine release-> emotional flattening, slow
panic disorder, significant cog, apathy
OCD, PTSD, actions of *increases serotonin everywhere-> insomnia,
social phobia, CYP450 diarrhea
PMDD enzymes SE: sexual dysfunction, GI: diarrhea,
Starting Dose: constiptation, dry mouth, CNS: insomnia,
10 mg/day sedation, agitation, tremors, headache,
Target dizziness
Symptoms: --rare: SIADH, hyponatremia (in elderly),
depression, seizures, induction of mania, SI
anxiety, panic -decreases seizure threshold
attacks,
avoidant -advantages: few drug interactions, one of best
behavior, tolerated antidepressants, less sexual
reexperiencing, dysfuntion, has faster onset (10 mg= 40 mg of
hyperarousal, citalopram), tx hot flashes, if elderly don’t
sleep respond to drug-> MCI
(insomnia, -disadvantage: more expensive than citalopram
hypersomnia)
Affected NT:
increases
serotonin (1A)
Fluoxetine Indication: 2 weeks, *increasing serotonin can cause diminished
(Prozac) MDD, OCD, inhibits dopamine release-> emotional flattening, slow
PMDD, panic CYP2D6 and cog, apathy
disorder, CYP3A4 *increases serotonin everywhere-> insomnia,
bulimia, diarrhea
bipolar SE: sexual dysfunction, GI: diarrhea,
depression (in constiptation, dry mouth, CNS: insomnia,
, combo w sedation, agitation, tremors, headache,
olanzapine), dizziness
tx resistant --rare: SIADH, hyponatremia (in elderly),
depression in seizures, induction of mania, SI
combo w -decreases seizure threshold
olanzapine,
social phobia, *the more anxious the pt, the lower the starting
PTSD dose
Starting Dose: *tapering not necessary
20-80 mg/day
(morning) for Advantages: tx atypical depression good for
depression and hypersomnia, increased appetite, can do weekly
OCD, 60-80 administration, good for kids with OCD or
mg/day for depression
bulimia Disadvatages: not good for anorexia, initiating
Target tx in severe insomnia or anxious agitated pts
Symptoms:
depression,
energy,
motivation,
anxiety, sleep
(insomnia and
hypersomnia)
Affected NT:
increases
serotonin (1A),
also 5HT2C
antagonist
(incrases NE
and DA)
Fluvoxamine Indication: 9-28 hours, *increasing serotonin can cause diminished
(Luvox) OCD, social inhibits dopamine release-> emotional flattening, slow
anxiety CYP3A4, cog, apathy