Antidepressant: Tricyclic/Tetracyclic/Dibenzoxapine
Name Formulations / Usual dose Notes
Amitriptyline
(Elavil)		 Tab: 10, 25, 50, 75, 100, 150 mg
Dose: start low dose 10-25 mg hs, up to 300 mg hs		 Anticholinergic side effects, very sedating
Doxepin (Sinequan) Cap: 10, 25, 50, 75, 100, 150 mg
Dose: start at low dose hs, up to 300 mg hs
Desipramine (Norpramine) Formulations: 10, 25, 50, 75, 100, 150 mg
Dose: start at 25 mg qd, to 300 mg qd. May have to take in am 		less sedating, less anticholinergic effect
Nortriptyline (Pamelor)

 

Antidepressant: miscellaneous non-SSRI
Trazadone (Desyrel)
  • Tab: 50, 100, 150 mg
    Dose: 25 to 50 mg hs, increase to 400 mg/day
  • Mostly a 5HT2 antagonist, often used as a hypnotic,  very sedating
  • Elimination half-life of about 5 hours.
  • Rarely cause pripiasm.
Bupropion (Wellbutrin, Zyban)
  • Tab: 75, 100 mg
    Dose: 75- 100 mg bid,  up to 450 mg/day. For smoking cessation, start at 150mg/day. Always give bid.
  • May cause agitation, insomnia, less anticholinergic side effect.
  • Avoid if there is history of psychosis.
  • Dopamine reuptake inhibitor, makes it an initial choice for depressed patients with Parkinson's disease.
  • May help to improve attention in brain damaged patients, attention deficit disorder.
  • Also used for smoking cessation.
  • May increase risk for seizure, especially dose >450mg/day
  • Further reading on Wellbutrin
Nefazodone (Serzone)
  • Tab: 100, 150, 200, 250 mg
    Dose: 100 mg bid, up to 300 mg/day, reduce dose for elderly
  • Both a serotonin reuptake inhibitor (SRI) and a 5HT2 antagonist
  • Rare cases of liver failure. The reported rate is one per 250,000 to 300,000 patient-years.
  • Watch for orthostatic hypotension.
  • Drug interactions. Increase effect of  Alprazolam, terfenadine, digoxin, Haldol etc.
  • Trazadone is one of its metabolites.
  • Alternative for patient unable to tolerate SSRI due to sexual dysfunctions.
  • Reduces symptoms of fibromyalgia and may be useful for other forms of chronic pain.
  • Further reading on Serzone
  • Nefazodone induced hepatic failure - AIM - Feb 99
Venlafaxine (Effexor)
  • Formulations: 37.5, 50, 75, 100 mg
    XR: 37.5, 75, 150, 225 mg
  • Effective in treating patients with Generalized anxiety disorder, with or without depression.
  • Dose: start at 37.5 mg qd to avoid nausea, jitteriness, up to 225 mg/day
  • Inhibits reuptake of Serotonin, Norepinephrine; to a lesser extent dopamine.
  • At doses > 200 mg per day, may increase blood pressure
  • Onset of antidepressant activity may be more rapid.
  • Discontinuation syndrome may occur with abrupt discontinuation, should be tapered by reducing the daily dose by 75 mg at weekly intervals.
  • Further reading on Effexor
Nirtazapine (Remeron)
  • Tablet: 15, 30, 45 mg
    Dose: 15-45 mg per day
  • Antagonizes 5HT2, 5HT3 and adrenergic alpha2 receptors
  • May cause sedation, weight gain.
  • No anticholinergic, adrenergic, and serotonin-related side effects
  • Has 5HT3 antagonism, useful for nausea and may have some antipsychotic effects.
  • Does not cause sexual dysfunction, orthostatic hypotension.
Further Reading

Selective Serotonin Reuptake Inhibitor
Psychiatric disorder info center

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