Fluoxetine

• Prozac
• SSRI
• Long t_1/2
• Dose: 20-60mg per day
• Activating
• AE: HA, stomach upset, weight loss/gain, sexual dysfunction
• Primarily inhibits CYP450 2D6, 3A3/3A4

Sertraline

• Zoloft
• SSRI
• Intermediate t_1/2
• Activating
• P450 2C and 2D6 (inhibitor)
• Withdrawal symptoms
• May require doses up to 200mg/day
• SE: GI, agitation, insomnia, sexual dysfunction, weight neutral (?)

Paroxetine

• Paxil
• SSRI
• Intermediate t_1/2
• Dose 20-60mg/day
• Least activating
• Potent CYP 2D6 inhibitor
• Mild anticholinergic symptoms
• Withdrawal symptoms
• Avoid in hypersomnia, motor retardation
• Increase in major congenital malformations compared to other antidepressants

Citalopram

• Celexa
• S- and R-isomers
• Dose: 20-60mg/day
• Highly selective SSRI
• Inhibitor of 3A4, weak inhibitor of 2D6
• Less sexual dysfunction?
• Withdrawal
• Avoid in agitation and sleep disturbance

Fluvoxamine

• Luvox
• SSRI
• Long t_1/2
• Dose: 50-300mg/day
• Withdrawal syndrome
• GI adverse events
• Inhibits CYP 1A2, 2C19, and 3A4
• AE: GI (N/V), agitation, insomnia, and sexual dysfunction

Venlafaxine/Desvenlafaxine

• Effexor
• SNRI
• Mixed 5HT-NE reuptake inhibitor
• Short t_1/2= given bid
• Dose: 37.5-225mg/day
• May cause dose related hypertension
• Low potency 2D6 inhibitor, low incidence of drug interaction
• May be more dangerous in overdose situations

Duloxetine

• Cymbalta
• PK-Tmax 6hrs, t_1/2 15hrs
• Metabolized by hydroxylation CYP2D6 and CYP1A2
• Dose: 30-90+mg/day
• Moderate inhibitor of 2D6. 
• Levels increased by medications that inhibit 1A2 and 2D6
• AE: Nausea, dry moutlh, constipation, insomnia, dizziness
• May help in treatment of diabetic neuropathy

Trazodone and Nefazodone

• Desyrel
• Mixed selective serotonin reuptake inhibitor & receptor blockers
• Good for sleep
• Possible serotonin  syndrome when combined with SSRIs, MAOIs
• Dizziness, sedation, and cognitivie slowing are dose related
• Nefazodone may cause hepatic failure (black box warning); 3A4
  • 3A4 inhibitor-DI with BZDs; Ritonavir

Bupropion

•  Wellbutrin, Zyban
• Mixed reuptake inhibitor
• Immediate release-bid or tid dosing
  • Controlled release (SR) is given bid, but may be given daily in doses <200mg
  • Extended release (XL) is given daily in doses <450mg
• May lower seizure threshold (DI with antiepileptics); Ritonavir (↑Bupropion levels)
• AE: agitation, nausea, insomnia, psychosis, dose related seizures
• No known withdrawal
• Less sexual dysfunction

Mirtazepine

• Remeron
• Mixed selective serotonin reuptake inhibitor & receptor blockers
• Histaminic properties-sedating at lower doses, less at higher doses
• Anxiolytic
• Weight gain
• Metabolized by: 2D6, 1A2, 3A4,2C9
• Few drug interactions