Table 2.

Antidepressant choices for older patients

GENERIC NAMETRADE NAMESTARTING DOSE, MG/DAVERAGE DOSE, MG/DMAXIMUM RECOMMENDED DOSE, MG/DCOMMENTS AND CAUTIONS
SSRI
  • CitalopramCelexa1020–4020 for those older than 65 y 40 for othersQTc prolongation
  • EscitalopramCipralex510–2010 for those older than 65 y 20 for othersQTc prolongation
  • SertralineZoloft2550–150200Like all SSRIs, risk of nausea, SIADH
SNRI
  • VenlafaxineEffexor37.575–225375*Might increase blood pressure
Other
  • BupropionWellbutrin100100, twice daily150, twice dailyMight cause seizures
  • MirtazapineRemeron1530–4545Might cause sedation, especially at lower doses
Tricyclic
  • DesipramineNorpramin10–2550–150300Anticholinergic properties; cardiovascular side effects; monitor blood levels
  • NortriptylineAventyl10–2540–100200Anticholinergic properties; cardiovascular side effects; monitor blood levels
  • SIADH—syndrome of inappropriate secretion of antidiuretic hormone, SNRI—serotonin noradrenergic reuptake inhibitor, SSRI—selective serotonin reuptake inhibitor.

  • * For severe depression.

  • Modified from the Canadian Coalition for Seniors’ Mental Health with permission.1