Kevin Leehey, M.D.
1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835
MEDICATIONS FOR DEPRESSION, ANXIETY,
AND OBSESSIVE-COMPULSIVE DISORDER (
Page 2)

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Group Main Use Medication
Brand/Generic
Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group
Remeron
(depression booster, sleep, and appetite increase)

Remeron
mirtazapine

Tablet,
Scored
15 mg
30 mg
45 mg

Solutab
15, 30, 45mg
Once a day, evening Child:7.5-30 mg
Adoles:7.5-45 mg
Adult 15-45 mg
Sedation, often increases appetite. May be less sedation at higher doses. Less GI or sexual side effects than SRI group. Helps sleep, agitation and anxiety. Combination of Norepinephrine and serotonin boost. May boost other meds. Few interactions. No Routine labs or EKG. May help GI. Generic As with all antidepressants, avoid combinations or overlap with MAOI. Same time onset as SRI or TCA.
Wellbutrin
(depression, booster)

Wellbutrin
bupropion HCI





Aplenzin
bupropion HBr


Zyban

Tablet
(not scored)
75 mg
100mg



174, 348 = 300, 522mg


SR
100, 150, 200mg
150mg XL
300mg XL

Given 2-3 times a day.
Start in the a.m.
SR 1-2 times a day.


XL once a day

Aplenzin once a day
Child: 37.5-150mg
Adoles: 75-300mg
Adult:  150-450mg
Increased energy.
Decreased appetite.
No significant sexual side effects. No labs or EKG needed. Very few interactions.

May help Attention Deficit Hyperactivity Disorder.

Good for boosting other meds.

Approved to help stop smoking.

Generic
Avoid if personal seizure history. Caution if family seizure history. Avoid if bulimia. Probably less effective than SRI for severe anxiety.

Same time onset as SRI and TCA and all other antidepressants.
(depression
sleep)
Desyrel
trazodone
Tablets
50mg, 100mg, 150mg, 300mg
Usually bedtime only
Child: 25-200mg
Adoles: 25-300mg
Adult: 50-600mg
Sedation significant especially with Trazodone. Dizziness. Excellent sleep aid. Often used to help sleep along with SRI or Wellbutrin. Not habit forming. Inexpensive generic. One in 10,000 risk of priapism. Trazodone relatively weaker antidepressant and anti-anxiety medication.
SNRI
Serotonin and Norepinephrine Inhibitors

(depression, anxiety, panic, OCD, pain)







Savella (fibromyalgia, depression)

Fetzima
(depression)
Effexor
(venlafaxine)


Effexor XR
(venlafaxine)



Pristig XR
(desvenlafaxine)
tablet, scored
25, 37.5, 75, 100 mg

XR (extended release)
37.5, 75, 150 mg

XR tablets
50, 100 mg
2 or 3 times a day




XR once a day
Child: 25-200 mg
Adoles: 75-300 mg
Adult: 150-450 mg

50 -  < 400 mg

Similar to SRI plus a bit more night sweat and constipation sometimes. Effexor and other SNRI's  increase both serotonin and norepinephrine thus affecting two important neurotransmitter systems, unlike SRI's. May be broader spectrum effect because of two transmitters increased.
Fewer interactions.



Same as Effexor. Research shows some benefit against pain. FDA approval of Cymbalta for pain is a plus.
Slight risk increased blood pressure at doses over 200 mg total a day. (less than 5% chance.)

Discontinuation syndrome (nausea, dizziness, "flu-ish," "out of sorts" may occur if stopped suddenly without taper or skip on or several days. Not dangerous, but unpleasant. More likely with Paxil or Effexor, not with Prozac because it lasts longer. Can occur with SRI, SNRI, or TCA.

Cymbalta rare liver injury especially if alcohol abuse.
Cymbalta
(duloxetine)
capsule
20 mg
30 mg
60 mg
once or twice a day 30-120 mg usually 60 mg for adults Similar to SRI and Effexor above.
Tends to increase energy and weight neutral.
Although Savella is an SNRI like others and approved in Europe for depression, it is FDA approved so far only for Fibromyalgia.
Fetzima is approved for depression, not fibromyalgia. These 2 emphasize norepinephrine more than serotonin.
Both are brand only.
Because it is an SNRI avoid use with an SRI or other SNRI.

These 2 SNRI meds are very similar to other 3.
Newer in US.
Savella
milnacipran


Fetzima
levomilnacipran
Tablets
12.5, 25, 50, 100mg

XR capsules
20, 40, 80, 120mg
Usually twice a day


Once a day
12.5 to 200mg
100mg is adult usual dose after building up slowly.

40-120mg adults
Like other SNRIs. Can affect liver or urine flow. Nausea and constipation are most common. Little weight effect if any.

All these medications should be taken 7 days a week to be effective. Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All antidepressants may increase mania risk in persons with Bipolar (manic-depressive) disorder. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.

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