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114 PCN Anti-Depressant Agents – Notes

Name Number Notes
Escitalopram 5-20 qd fewer interactions
Citalopram 10-40 qd fewer interactions
Fluoxetine 5/10-60 qd longer half-life, taper when discontinuing
Paroxetine 10 qPM – 40 sedating, significant interactions
Sertraline 12.5/25-200
Venlafaxine 37.5 qAM or bid-150 bid stimulating (not use with anxiety), taper
Duloxetine 10/20 q AM -60 bid use with coexistent anxiety, Nausea, dry mouth, constipation
Desipramine 10/25 qhs- 150/day
Nortriptyline 10 qhs – 150 fewer anti-cholinergic side effects
Mirtazapine 7.5/15 qhs-60 sedation, weight gain NE, 5HT antagonist
Bupropion 75-100 qAM – 450/day useful with fatigue, low energy not with seizures, bulimia, anorexia weak NE, 5HT, Dop antagonist
Methylphenidate 2.5/5 qAM or noon – 60/day side effects: nervousness, agitation
Drug Notes
Citalopram
  • reduces agitation, anxiety
  • Not as activating as fluoxetine
  • Not as sedating as paroxetine
  • “neutral
Mirtazapine
  • sedation, increased appetite, enhances effect of Coumadin
  • not effective for pain
  • consider with combination of nausea/anorexia/insomnia/depression
Fluoxetine activating
Bupropion activating
Duloxetine
  • better tolerated in elderly
  • consider with depression/anxiety/neuropathic pain in elderly
Tri-cyclic agents: contraindicated with CHF, liver failure, BPH

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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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