Antidepressant Medications
Name Indication, starting dose, target Half-life (T1/2) Notes/Notable side effects/Precautions
symptoms, and affected CYP450 enzyme
neurotransmitters
SSRIs
Citalopram serotonin reuptake inhibitor (S- Parent drug has Notable Side Effects
(Celexa) RI) 23–45 hour
half- life • Sexual dysfunction (dose-dependent; men:
Commonly Prescribed for Weak inhibitor delayed ejaculation, erectile, dysfunction;
Depression Premenstrual of CYP450 2D6 men and women: decreased sexual desire,
dysphoric disorder (PMDD) Metabolized by anorgasmia)
Obsessive-compulsive CYP450 3A4
disorder (OCD) Panic disorder and 2C19 • Gastrointestinal (decreased appetite,
Generalized anxiety disorder nausea, diarrhea, constipation, dry mouth)
(GAD) Posttraumatic stress
disorder (PTSD) Social anxiety • Mostly CNS (dose-dependent insomnia but
disorder (social phobia) also sedation, agitation, tremors,
headache, dizziness)
The goal of treatment is
complete remission of current • Activation (short-term; patients with
symptoms as well as prevention diagnosed or undiagnosed bipolar or psychotic
of future relapses disorders may be more vulnerable to CNS-
activating actions of SSRIs)
How to Dose Initial 20 mg/day;
increase by 20 mg/day after 1 or • Sweating (dose-dependent)
more weeks; maximum 40
mg/day; single-dose • Bruising and rare bleeding Rare hyponatremia
administration, morning or (mostly in elderly patients and generally
evening reversible on discontinuation of citalopram)
• SIADH (syndrome of inappropriate
antidiuretic hormone secretion)
, Other Warnings/Precautions
Use with caution in patients with history of seizures
Use with caution in patients with bipolar disorder
unless treated with concomitant mood-stabilizing
agent
When treating children, carefully weigh the risks and
benefits of pharmacological treatment against the
risks and benefits of nontreatment with
antidepressants and make sure to document this in
the patient’s chart. Whenever possible, warn patients
and their caregivers about the possibility of activating
side effects, and advise them to report such
symptoms immediately. Monitor patients for
activation of suicidal ideation, especially children and
adolescents
Escitalopram SSRI (selective serotonin Mean terminal Notable Side Effects
(Lexapro) reuptake inhibitor half-life 27–32
hours • Sexual dysfunction (men: delayed
Commonly Prescribed for Major Substrate for ejaculation, erectile dysfunction; men and
depressive disorder (ages 12 CYP450 2C19 women: decreased sexual desire,
and older) Generalized anxiety and 3A4 No anorgasmia)
disorder (GAD) Panic disorder significant
Obsessive-compulsive disorder actions on • Gastrointestinal (decreased appetite,
(OCD) Posttraumatic stress CYP450 nausea, diarrhea, constipation, dry mouth)
disorder (PTSD) Social anxiety enzymes
disorder (social phobia) • Mostly central nervous system (insomnia
Premenstrual dysphoric disorder but also sedation, agitation, tremors,
(PMDD headache, dizziness)
• Note: patients with diagnosed or undiagnosed
, Boosts neurotransmitter bipolar or psychotic disorders may be more
serotonin Blocks serotonin vulnerable to CNS-activating actions of SSRIs
reuptake pump (serotonin Autonomic (sweating). Bruising and rare
transporter) Desensitizes bleeding Rare hyponatremia (mostly in elderly
serotonin receptors, especially patients and generally reversible on
serotonin 1A autoreceptors discontinuation of escitalopram SIADH
(syndrome of inappropriate antidiuretic
Treatment most often reduces hormone secretion)
or even eliminates symptoms,
but not a cure since symptoms Other Warnings/Precautions
can recur after medicine Use with caution in patients with history of seizures
stopped Use with caution in patients with bipolar disorder
unless treated with concomitant mood-stabilizing
Initial 10 mg/day; increase to 20 agent
mg/day if necessary; single- dose When treating children, carefully weigh the risks and
administration, morning or benefits of pharmacological treatment against the
evening risks and benefits of nontreatment with
antidepressants and make sure to document this in
the patient’s chart
Whenever possible, warn patients and their
caregivers about the possibility of activating side
effects, and advise them to report such symptoms
immediately Monitor patients for activation of
suicidal ideation, especially children and adolescents
Fluoxetine SSRI (selective serotonin Active Notable Side Effects
(Prozac) reuptake inhibitor metabolite
(norfluoxetine) • Sexual dysfunction (men: delayed
Commonly Prescribed for has 2 week ejaculation, erectile dysfunction; men and
Major depressive disorder half- life Parent women: decreased sexual desire,
(ages 8 and older) Obsessive- drug has 2–3 anorgasmia)
compulsive
• Gastrointestinal (decreased appetite, nausea,
, day half- life
disorder (OCD) (ages 7 and Inhibits CYP450 diarrhea, constipation, dry mouth) Mostly CNS
older) Premenstrual dysphoric 2D6 Inhibits (insomnia but also sedation, agitation,
disorder (PMDD) Bulimia CYP450 3A4 tremors, headache, dizziness).
nervosa Panic disorder Bipolar
depression [in combination • Note: patients with diagnosed or undiagnosed
with olanzapine (Symbyax)] bipolar or psychotic disorders may be more
Treatment-resistant depression vulnerable to CNS- activating actions of SSRIs
[in combination with olanzapine Autonomic (sweating) Bruising and rare
(Symbyax)] Social anxiety bleeding SIADH (syndrome of inappropriate
disorder (social phobia) antidiuretic hormone secretion)
Posttraumatic stress disorder
(PTSD) Life-Threatening or Dangerous Side Effects Rare
seizures Rare induction of mania Rare activation of
Boosts neurotransmitter suicidal ideation and behavior (suicidality) (short-term
serotonin Blocks serotonin studies did not show an increase in the risk of
reuptake pump (serotonin suicidality with antidepressants compared to placebo
transporter) Desensitizes beyond age 24)
serotonin receptors, especially
serotonin 1A receptors Other Warnings/Precautions Add or initiate other
antidepressants with caution for up to 5 weeks after
Treatment most often reduces discontinuing fluoxetine Use with caution in patients
or even eliminates symptoms, with history of seizure
but not a cure since symptoms
can recur after medicine Use with caution in patients with bipolar disorder
stopped unless treated with concomitant mood-stabilizing
agent When treating children, carefully weigh the
How to Dose Depression and risks and benefits of pharmacological treatment
OCD: initial dose 20 mg/day in against the risks and benefits of nontreatment with
morning, usually wait a few antidepressants and make sure to document this in
weeks to assess drug effects the patient’s chart
before increasing dose;
maximum dose generally 80
Name Indication, starting dose, target Half-life (T1/2) Notes/Notable side effects/Precautions
symptoms, and affected CYP450 enzyme
neurotransmitters
SSRIs
Citalopram serotonin reuptake inhibitor (S- Parent drug has Notable Side Effects
(Celexa) RI) 23–45 hour
half- life • Sexual dysfunction (dose-dependent; men:
Commonly Prescribed for Weak inhibitor delayed ejaculation, erectile, dysfunction;
Depression Premenstrual of CYP450 2D6 men and women: decreased sexual desire,
dysphoric disorder (PMDD) Metabolized by anorgasmia)
Obsessive-compulsive CYP450 3A4
disorder (OCD) Panic disorder and 2C19 • Gastrointestinal (decreased appetite,
Generalized anxiety disorder nausea, diarrhea, constipation, dry mouth)
(GAD) Posttraumatic stress
disorder (PTSD) Social anxiety • Mostly CNS (dose-dependent insomnia but
disorder (social phobia) also sedation, agitation, tremors,
headache, dizziness)
The goal of treatment is
complete remission of current • Activation (short-term; patients with
symptoms as well as prevention diagnosed or undiagnosed bipolar or psychotic
of future relapses disorders may be more vulnerable to CNS-
activating actions of SSRIs)
How to Dose Initial 20 mg/day;
increase by 20 mg/day after 1 or • Sweating (dose-dependent)
more weeks; maximum 40
mg/day; single-dose • Bruising and rare bleeding Rare hyponatremia
administration, morning or (mostly in elderly patients and generally
evening reversible on discontinuation of citalopram)
• SIADH (syndrome of inappropriate
antidiuretic hormone secretion)
, Other Warnings/Precautions
Use with caution in patients with history of seizures
Use with caution in patients with bipolar disorder
unless treated with concomitant mood-stabilizing
agent
When treating children, carefully weigh the risks and
benefits of pharmacological treatment against the
risks and benefits of nontreatment with
antidepressants and make sure to document this in
the patient’s chart. Whenever possible, warn patients
and their caregivers about the possibility of activating
side effects, and advise them to report such
symptoms immediately. Monitor patients for
activation of suicidal ideation, especially children and
adolescents
Escitalopram SSRI (selective serotonin Mean terminal Notable Side Effects
(Lexapro) reuptake inhibitor half-life 27–32
hours • Sexual dysfunction (men: delayed
Commonly Prescribed for Major Substrate for ejaculation, erectile dysfunction; men and
depressive disorder (ages 12 CYP450 2C19 women: decreased sexual desire,
and older) Generalized anxiety and 3A4 No anorgasmia)
disorder (GAD) Panic disorder significant
Obsessive-compulsive disorder actions on • Gastrointestinal (decreased appetite,
(OCD) Posttraumatic stress CYP450 nausea, diarrhea, constipation, dry mouth)
disorder (PTSD) Social anxiety enzymes
disorder (social phobia) • Mostly central nervous system (insomnia
Premenstrual dysphoric disorder but also sedation, agitation, tremors,
(PMDD headache, dizziness)
• Note: patients with diagnosed or undiagnosed
, Boosts neurotransmitter bipolar or psychotic disorders may be more
serotonin Blocks serotonin vulnerable to CNS-activating actions of SSRIs
reuptake pump (serotonin Autonomic (sweating). Bruising and rare
transporter) Desensitizes bleeding Rare hyponatremia (mostly in elderly
serotonin receptors, especially patients and generally reversible on
serotonin 1A autoreceptors discontinuation of escitalopram SIADH
(syndrome of inappropriate antidiuretic
Treatment most often reduces hormone secretion)
or even eliminates symptoms,
but not a cure since symptoms Other Warnings/Precautions
can recur after medicine Use with caution in patients with history of seizures
stopped Use with caution in patients with bipolar disorder
unless treated with concomitant mood-stabilizing
Initial 10 mg/day; increase to 20 agent
mg/day if necessary; single- dose When treating children, carefully weigh the risks and
administration, morning or benefits of pharmacological treatment against the
evening risks and benefits of nontreatment with
antidepressants and make sure to document this in
the patient’s chart
Whenever possible, warn patients and their
caregivers about the possibility of activating side
effects, and advise them to report such symptoms
immediately Monitor patients for activation of
suicidal ideation, especially children and adolescents
Fluoxetine SSRI (selective serotonin Active Notable Side Effects
(Prozac) reuptake inhibitor metabolite
(norfluoxetine) • Sexual dysfunction (men: delayed
Commonly Prescribed for has 2 week ejaculation, erectile dysfunction; men and
Major depressive disorder half- life Parent women: decreased sexual desire,
(ages 8 and older) Obsessive- drug has 2–3 anorgasmia)
compulsive
• Gastrointestinal (decreased appetite, nausea,
, day half- life
disorder (OCD) (ages 7 and Inhibits CYP450 diarrhea, constipation, dry mouth) Mostly CNS
older) Premenstrual dysphoric 2D6 Inhibits (insomnia but also sedation, agitation,
disorder (PMDD) Bulimia CYP450 3A4 tremors, headache, dizziness).
nervosa Panic disorder Bipolar
depression [in combination • Note: patients with diagnosed or undiagnosed
with olanzapine (Symbyax)] bipolar or psychotic disorders may be more
Treatment-resistant depression vulnerable to CNS- activating actions of SSRIs
[in combination with olanzapine Autonomic (sweating) Bruising and rare
(Symbyax)] Social anxiety bleeding SIADH (syndrome of inappropriate
disorder (social phobia) antidiuretic hormone secretion)
Posttraumatic stress disorder
(PTSD) Life-Threatening or Dangerous Side Effects Rare
seizures Rare induction of mania Rare activation of
Boosts neurotransmitter suicidal ideation and behavior (suicidality) (short-term
serotonin Blocks serotonin studies did not show an increase in the risk of
reuptake pump (serotonin suicidality with antidepressants compared to placebo
transporter) Desensitizes beyond age 24)
serotonin receptors, especially
serotonin 1A receptors Other Warnings/Precautions Add or initiate other
antidepressants with caution for up to 5 weeks after
Treatment most often reduces discontinuing fluoxetine Use with caution in patients
or even eliminates symptoms, with history of seizure
but not a cure since symptoms
can recur after medicine Use with caution in patients with bipolar disorder
stopped unless treated with concomitant mood-stabilizing
agent When treating children, carefully weigh the
How to Dose Depression and risks and benefits of pharmacological treatment
OCD: initial dose 20 mg/day in against the risks and benefits of nontreatment with
morning, usually wait a few antidepressants and make sure to document this in
weeks to assess drug effects the patient’s chart
before increasing dose;
maximum dose generally 80
