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Anxiety: Antidepressant medications

Table 4.2 First- and second-line antidepressant medications,
indications, doses and cautions
 

medication

indications*

usual daily dose (mg)

cautions

First-line antidepressants

SSRI

Citalopram (Celexa) Escitalopram (Cipralex) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft)

 

PD

GAD, OCD, PD OCD, PD, PTSD OCD, PD, SAD GAD, OCD, PD, PTSD, SAD GAD, OCD, PD, PTSD, SAD

 

20 – 40

5 – 40

5 – 60

50 – 250

10 – 50

50 – 200

 

Initial agitation, worsening of panic attacks, increased suicidal ideation

in young patients (< 25 years). Weight gain, sexual problems.

SNRI

Duloxetine (Cymbalta) Venlafaxine  XR (Effexor)

 

GAD

GAD, PD, PTSD, SAD

 

60 – 120

37.5 – 225

 

As above.

Second-line antidepressants

TCAs Imipramine Clomipramine

 

PD

OCD, PD

 

25 – 150

25 – 150

 

Cardiac toxicity, overdose effects. Seizure risk at higher doses.

Novel action

Bupropion-SR (Wellbutrin) Mirtazapine (Remeron)

 

Augmentation

Augmentation

 

150 – 300

30 – 60

 

Agitation. Sedation, weight gain.

RIMA/MAOI Moclobemide (Manerix) Tranylcypromine (Parnate)

SAD

OCD (third line)

300– 900

20 – 60

Dietary restrictions at all doses for tranylcypromine and higher doses for moclobemide.

 

*Canadian Anxiety Disorder Treatment Guidelines Initiative Steering Committee, 2006.