Selecting and Managing Antidepressants

Drug Selection and Management
Selection of an antidepressant should depend upon the patient's previous response to that medication, anticipated side effects, and potential drug-drug interactions. If significant improvement has not occurred in patients within 4 - 6 weeks of therapy, or if there are intolerable side effects, dose adjustments or changes to drug therapy are needed.

Bupropion should not be used in patients with a history of seizures or psychosis. Since bupropion may lower the seizure threshold in patients, it is important to know methods for reducing the overall risk of seizures. These methods include avoiding concomitant medications that lower the seizure threshold, not using bupropion in patients with a history of seizures, not exceeding bupropion 150 mg single dose or bupropion 400 mg/day, and gradual dose tritration of bupropion.

Typically, SSRI associated headache, nausea, nervousness, and agitation occur during the first 1 - 2 weeks of treatment, then subside. Nausea is also a side effect of venlafaxine and appears to be dose related, so dosing after meals can be helpful. Symptoms that persist should be addressed, and patients should be told to call or notify their clinician should the problems continue.