Article Figures & Data
Tables
Generic Name US Trade Name Class* Dosage Forms Usual Frequency Pregnancy Category† Breastfeeding Safety‡ Generic Available Retail Available§ Cost‖ Amitriptyline Elavil TCA Tablet Once a day C NR Yes Yes $ Bupropion Wellbutrin NDRI Tablet Three times daily C NR Yes No $$ Wellbutrin SR Twice a day Yes No $$ Wellbutrin XL Once a day Yes No $$$ Citalopram Celexa SSRI Tablet, solution Once a day C R:B Yes Yes $ Desvenlafaxine Pristiq SNRI Tablet Once a day C NR No No $$$$ Duloxetine Cymbalta SNRI Capsule Once a day C NR No No $$$$ Escitalopram Lexapro SSRI Tablet, solution Once a day C R:B Yes No $$$ Fluoxetine Prozac SSRI Tablet, capsule, solution Once a day C NR Yes Yes $ Prozac Weekly Capsule Once a week Yes No $$$ Fluvoxamine¶ Luvox SSRI Tablet Twice a day C R:B Yes No $$$ Luvox CR Capsule Once a day No No $$$$ Milnacipran¶ Savella SNRI Tablet Twice a day C NR No No $$$ Mirtazapine Remeron NaSSA Tablet Once a day C R:B Yes No $ Remeron SolTab Oral disintegrating tablet Yes No $$ Nefazodone** Serzone SARI Tablet Twice a day C NR Yes No $$ Nortriptyline Pamelor TCA Capsule, solution Once a day D NR Yes Yes $ Paroxetine Paxil SSRI Tablet, solution Once a day D Safe Yes Yes $ Paxil CR Tablet Yes No $$$ Sertraline Zoloft SSRI Tablet, solution Once a day C Safe Yes Yes $ Trazodone Desyrel SARI Tablet Three times daily C R:B Yes Yes $ Oleptro Once a day No No $$$ Venlafaxine Effexor SNRI Tablet Twice a day C NR Yes No $$ Venlafaxine ER Once a day Yes No $$$ Effexor XR Capsule Once a day No No $$$$ Vilazodone†† Viibryd SPARI Tablet Once a day C NR No No $$$$ ↵* TCA, tricyclic antidepressant; NDRI, norepinephrine dopamine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin norepinephrine reuptake inhibitor; NaSSA, noradrenergic specific serotonergic antidepressant; SARI, serotonin antagonist reuptake inhibitor; SPARI, serotonin partial agonist reuptake inhibitor.
↵† C, no adequate or well-controlled studies in humans; D, positive evidence of human fetal risk based on adverse reaction data or studies in humans.
↵‡ NR, not recommended; R:B, weigh risk-benefit; safe, safe for nursing; based on Lexicomp Online Clinical Databases (http://online.lexi.com).
↵§ Available for a low monthly cost through programs offered by large chain stores (e.g., Walmart, Kroger, Sam's Club, Target, Costco, CVS, Kmart, Walgreens).68
↵‖ $ = <$50 per month; $$ = $50 to $100 per month; $$$ = $100 to $150 per month; $$$$ = >$150 per month; based on 2011 Consumer Reports Health Best Buy Drugs.68
↵¶ In the United States, fluvoxamine is approved only for obsessive-compulsive disorder; milnacipran is approved only for fibromyalgia; both agents are used off-label to treat depression.19,24
↵** Serzone, the brand name form of nefazodone, was discontinued in 2004 because of hepatotoxicity; generic nefazodone is available with a black box warning for liver failure.57
↵†† Approved in 2011, vilazodone is the newest antidepressant in a novel therapeutic class; given that data is limited, it is not discussed in this article.
Symptom Cluster Recommended Classes Classes to Avoid First-line Antidepressants Anxiety SSRI NDRI Citalopram Tearfulness SNRI Escitalopram Obsessive-compulsiveness Fluvoxamine Sertraline NDRI, norepinephrine dopamine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin norepinephrine reuptake inhibitor.
Symptom Cluster Recommended Classes Classes to Avoid First-line Antidepressants Fatigue NDRI NaSSA Bupropion Anhedonia SNRI SARI Desvenlafaxine Weight gain Activating SSRI Fluoxetine Venlafaxine NaSSA, noradrenergic specific serotonergic antidepressant; NDRI, norepinephrine dopamine reuptake inhibitor; SARI, serotonin antagonist reuptake inhibitor; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.
Symptom Cluster Recommended Classes Classes to Avoid First-line Antidepressants Insomnia NaSSA NDRI Mirtazapine Hyperarousal SARI SNRI Nefazodone Weight loss Sedating SSRI Paroxetine Trazodone NaSSA, noradrenergic specific serotonergic antidepressant; NDRI, norepinephrine dopamine reuptake inhibitor; SARI, serotonin antagonist reuptake inhibitor; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.
Symptom Cluster Recommended Classes Classes to Avoid First-line Antidepressants Chronic pain TCA None Amitriptyline Headache SNRI Duloxetine Somatization Milnacipran Nortriptyline SNRI, serotonin norepinephrine reuptake inhibitor; TCA, tricyclic antidepressant.
