115 Antidepressant Medication Considerations (CoMorbid Neuro/Med and Psych Symptoms)

Symptom(s): Depression + Consider Avoid
Anxiety SNRI None
OCD Fluoxetine TCA, Bupropion
Psychosis SSRI, SNRI + Anti-psych TCA, Bupropion
Somatization Duloxetine TCA
Abulia Bupropion TCA, Paroxetine
Delerium or Dementia Citalopram TCA, Bupropion
Fatigue Bupropion, Fluoxetine TCA, Paroxetine
Insomnia Mirtazapine TCA, Fluoxetine
Pain Duloxetine, TCA SSRI
Parkinsonism Bupropion, Mirtazapine Sertraline, Paroxetine
Seizures SSRI, SNRI Bupropion
Tremor Mirtazapine SSRI, SNRI
Stroke Citalopram TCA
Vertigo Fluoxetine TCA
Advanced Age Citalopram, Bupropion TCA
Constipation Bupropion, SSRI, SNRI TCA
Diarrhea Mirtazapine, TCA SSRI, Bupropion
DM Bupropion, SSRI, SNRI TCA, Paroxetine
Glaucoma Bupropion, SSRI, SNRI TCA
Heart Disease SSRI TCA, Mirtazapine
Hypotension Bupropion, SNRI TCA
Renal Failure Fluoxetine Bupropion
Hepatic Failure Bupropion Duloxetine, Citalopram
Nausea, GERD None Paroxetine, Sertraline
Overweight Bupropion TCA, Mirtazapine
Pregnancy SSRI, SNRI TCA
Sexual Dysfunction Bupropion Paroxetine, SSRI
Smoker Bupropion TCA
Urine Retention Bupropion TCA

(SSRI,SNRI,Bupropion,Mirtazapine)

  • no agent superior for associated pain, anxiety, insomnia
  • higher incidence of side effects:
    • Venlafaxine > nausea
    • Sertraline > diarrhea
    • Mirtazapine > weight gain
    • Bupropion > less sexual dysfunction
    • Mirtazapine > faster onset of action

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Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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