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Mercy Managed Behavioral Health
Adult Depression Medication Guideline
Category
Dosage [Adult]
Comments
Color changed re: generic status
Celexa® (citalopram)
Possible side effects: diarrhea, dizziness, nausea, sexual.
Paxil® (paroxetine)
Possible side effects: diarrhea, dizziness, nausea, sexual.
Discontinuation Syndrome.
Possible side effects: diarrhea, dizziness, nausea, sexual.
Paxil CR®
Zoloft® (sertaline)
Possible side effects: diarrhea, dizziness, nausea, sexual.
Discontinuation Syndrome.
Possible side effects: diarrhea, dizziness, nausea, sexual.
Prozac® (fluoxetine)
Discontinuation Syndrome (less of one).
Prozac Weekly®
Reserved for patients stable on 20mg/day.
Possible side effects: diarrhea, dizziness, nausea, sexual.
Lexapro® (escitalopram)
Discontinuation Syndrome (less of one).
Possible side effects: diarrhea, dizziness, nausea, sexual.
Pexeva® (paroxetine)
Vibryd (vilazodone
Possible side effects: diarrhea, dizziness, nausea, sexual.
Initial: 10 mg/day for 7 days Usual: 40 mg QD
Cymbalta® (duloxitine)
Nausea, Monitor BP, Possible sexual side effects.
Monitor BP. Withdrawal Syndrome due to short half life. 10%
Effexor® (venlafaxine)
Initial: 37.5mg BID Usual: 75 - 375mg/day
have ↑ BP at > 300mg/day. Sexual side effects.
Effexor XR®
Pristiq (desvenlafaxine)
Less discontinuation and possibly less sexual side effects.
Titrate at intervals > 1 wk. Decreased sedation if > 15mg/day.
Remeron® (mirtazapine)
Reports of: Liver failure in 1/250,000 to 1/300,000 patients /
year. Caution with cardiac meds. Anxiolytic effect. Titrate at
Serzone® (nefazodone)
Initial: 100mg BID Usual: 300 - 600mg/day
intervals > 1 wk.
Take with food. Titrate at intervals > 3 days. Caution with cardiac
Desyrel® (trazodone)
meds (calcium channel blockers). ↑ Priapism.
Titrate at intervals > 3 days. Divide doses by 6 hours to manage
Wellbutrin® (bupropion)
Initial: 100mg BID Usual: 100 - 450mg/day
risk of seizure. Avoid with Zyban.
Divide doses by 8 hours to manage risk of seizure. Avoid with
Wellbutrin SR®
Wellbutrin XL®
Aplenzin (bupropion
Lethal in OD due to cardiac toxicity. Weight gain possible. Sexual
Norpramin® (desipramine)
Pamelor® (nortriptyline)
Vivactil® (protriptyline)
Lethal in OD (2000mg) due to cardiac toxicity. Weight gain.
Elavil® (amitriptyline)
Initial: 25 - 100mg QHS Usual: 50 - 300mg/day
Monitor BP/P during initial therapy.
Ascendin® (Amoxipine)
Same as above.
Risk of T-D.
Ludiomil® (maprotoline)
Sinequan® (doxepin)
Tofranil® (imipramine)
Tofranil PM®
Surmontil® (trimipramine)
= Generic Available
SSRIs or Buproprion SR are generally preferred first-line pharmacotherapy treatments.
* Reduce dose in renal and hepatic dysfunction.
** Consult the Product Insert for a complete list of drug interactions and other warnings.
*** MAOI's are available - Consider referral to psychiatry to assess.
**** Abilify is approved for MDD's as an adjunct medication in conjuction with another antidepressant.
Source: http://www.mbh-eap.com/wp-content/uploads/Depression-Medication-Guidelines.pdf
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