Selecting and Managing Antidepressants

Selecting and Managing Antidepressants Overview
There are many types of antidepressant medications available. Older classes of drugs, such as monoamine oxidase inhibitors and tricyclic antidepressants (TCAs), have been largely replaced in clinical practice by newer classes, such as the selective serotonin reuptake inhibitors (SSRIs). Although SSRIs are not necessarily any more effective than TCAs, their safety and greater tolerability makes it reasonable to concentrate this discussion on SSRIs. If you become familiar with a few different drugs in this class, you will be able to treat most of your patients effectively.

The selective serotonin reuptake inhibitors (SSRIs) include paroxetine, fluoxetine, citalopram, sertraline, and escitalopram. These agents block the reuptake of serotonin, thereby increasing serotonin at the synaptic cleft. Some newer agents, including venlafaxine and mirtazapine, which increase both serotonin and norepinepherine neurotransmitters, have unique side effects. Bupropion is also a frequently used antidepressant that affects the dopaminergic system.

For more information, view the Antidepressant Medication handout. The handout is a listing of the most frequently prescribed antidepressants along with the available dose strengths, the half-life, starting and maximum doses, as well as possible side effects and stipulations. The half-life of a drug describes how long it takes for levels in the body to decrease by half as the drug is metabolized and excreted. In general, drugs with longer half-lives take effect more slowly, stay in the system longer when the drug is stopped, and are less subject to variations in drug levels if a dose is missed.

For more information, please refer to the SSRI algorithm recently developed by PBM.

When you view the handout, you can click on the name of an individual drug for more detailed prescribing information.