*Common Side Effects in All Ssris: Insomnia, Restlessness, Agitation, Fine Tremor, GI Distress

Drug Name Starting Dose in Titration Schedule High Dose Side Effects Elderly (mg) Serotonin Reuptake Inhibitors (SSRIs)* Citalopram 10 qd Increase to 20 mg after 1 wk, 40 Dry mouth, relatively few drug (Celexa) To 30 mg after 4 wks, interactions To 40 mg after 6 wks

Escitalopram 10 qd Increase to 20 mg after 1 wk 20 Few drug interactions (Lexapro)

Fluoxetine 10 qd Increase to 20 mg after 1 wk, 40-50 Fluoxetine has a very long half life (Prozac) To 30 mg after 4 wks, To 40 mg after 8 wks

Paroxetine 10 qd Increase to 20 mg after 1 wk, 40-50 Dry mouth, constipation, weakness/ (Paxil) To 30 mg after 4 wks, fatigue To 40 mg after 6 wks

(Paxil CR) 25 qd Slow release formulation (less risk of discontinuation symptoms?)

Sertraline 25 qd Increase to 50 mg after 1 wk, 150-200 (Zoloft) To 100 mg after 3 wks, To 150 mg after 6 wks

Serotonin and Norepinephrine antagonist Mirtazapine 15 qhs Increase to 30 qhs after 3 wks, 45 Sedation, weight gain (Remeron) To 45 qhs after 6 wks

Norepinephrine- and dopamine- reuptake inhibitor Bupropion 75 qd Increase to 75 bid after 4 days, 450 Insomnia/agitation (Wellbutrin SR, To 100 bid after 2 wks, Risk of seizures at high does Wellbutrin XL) To 150 bid after 4 wks, To 150 tid after 6 wks,

100 qd (SR) Increase to 100 bid after 1 wk, 450 Once or twice daily dosing with SR To 150 after 3 wks, preparation To 150 tid after 6 wks

Serotonin and Norepinephrine reuptake inhibitor Venlafaxine 25 qd Increase to 25 bid after 4 days, 250 Nausea, agitation/insomnia (Effexor, Effexor To 50 bid after 2 wks, Elevations in BP at higher doses XR) To 75 bid after 3 wks, (>150mg/day) To 100 bid after 5 wks, To 150 qam/100 qhs after 6 wks

37.5 qd (XR) Increase to 75 after 1 wk, 225 Slow release preparation allows once / To 150 mg after 3 wks, daily dosing To 225 mg after 6 wks Primarily Norepinephrine reuptake inhibitor Desipramine 25 qam Increase by 25-50 mg/week 150-200 Tachycardia, insomnia/agitation (Norpramin, Pertofrane)

Nortriptylline 10 qhs Increase to 10-20 mg/week 75-125 Weakness/fatigue (Aventyl, Pamelor)

*Common side effects in all SSRIs: insomnia, restlessness, agitation, fine tremor, GI distress (nausea, headache, dizziness, sexual dysfunction)