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First line antidepressants

 

Table 2.1: First-line antidepressant medications, doses and profiles
first-line antidepressants Generic name (brand name) usual daily dose (mg) efficacy1 tolerability2 anxiety3
SSRI        
citalopram (Celexa) 20-40   x  
escitalopram (Cipralex) 10-20 x x x
fluoxetine (Prozac) 20-40      
fluvoxamine (Luvox) 100-200      
paroxetine (Paxil) 20-40     x
sertraline (Zoloft) 50-150 x x x
SNRI        
desvenlafaxine (Pristiq) 50-100      
duloxetine (Cymbalta) 60-120 ±    
venlafaxine-XR (Effexor) 75-225 x   x
Novel action        
bupropion-SR (Wellbutrin) 150-300 ±    
mirtazapine (Remeron) 30-60 ±    
trazodone (Desyrel) 200-400      
RIMA        
moclobemide (Manerix) 450-600   x  

 

  1. Evidence  for efficacy superiority based on meta-analyses and head-to-head trials.
  2. Evidence for better tolerability based on meta-analyses (Gartlehner et al., 2007).
  3. Evidence  for efficacy in anxiety disorders based on Canadian guidelines (Canadian Anxiety Disorder Treatment Guidelines Initiative Steering Committee, 2006).

 

SSRI = selective serotonin reuptake inhibitor

SNRI = serotonin and norepinephrine reuptake inhibitor

RIMA = reversible monoamine oxidase inhibitor