NR546 Antidepressant and Mood Stabilizer Medication Table Antidepressant Medications
Name Indication, starting dose, target
symptoms, and affected neurotransmittersHalf-life (T1/2)
CYP450 enzymeNotes/Notable side effects/Precautions
SSRIs Citalopram (Celexa) serotonin reuptake inhibitor (S-RI)
Commonly Prescribed for Depression Premenstrual dysphoric disorder (PMDD) Obsessive-compulsive disorder
(OCD) Panic disorder Generalized anxiety disorder (GAD) Posttraumatic stress disorder (PTSD) Social anxiety disorder (social phobia)
The goal of treatment is complete remission of current symptoms as well as prevention of future relapses
How to Dose Initial 20 mg/day;
increase by 20 mg/day after 1 or more weeks; maximum 40 mg/day; single-dose administration, morning or eveningParent drug has 23–45 hour half-
life Weak inhibitor of
CYP450 2D6 Metabolized by CYP450 3A4 and 2C19Notable Side Effects Sexual dysfunction (dose-dependent; men:
delayed ejaculation, erectile, dysfunction; men and women: decreased sexual desire, anorgasmia) Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth) Mostly CNS (dose-dependent insomnia but also sedation, agitation, tremors, headache, dizziness) Activation (short-term; patients with diagnosed or undiagnosed bipolar or
psychotic disorders may be more vulnerable to CNS-activating actions of SSRIs) Sweating (dose-dependent) Bruising and rare bleeding Rare hyponatremia (mostly in elderly patients and generally reversible on discontinuation of citalopram) SIADH (syndrome of inappropriate antidiuretic hormone secretion)
Other Warnings/Precautions Use with caution in patients with history of seizures Use with caution in patients with bipolar disorder unless treated with concomitant mood-stabilizing agent When treating children, carefully weigh the risks and benefits of pharmacological treatment against the risks and benefits of nontreatment with antidepressants and make sure to document this in the patient’s chart. Whenever possible, warn patients and their caregivers about the possibility of activating side effects, and advise them to report such symptoms immediately. Monitor patients for activation of suicidal ideation, especially children and adolescents
Escitalopram (Lexapro) SSRI (selective serotonin reuptake inhibitor
Commonly Prescribed for Mean terminal half-life 27–32 hours
Substrate for Notable Side Effects Sexual dysfunction (men: delayed ejaculation, erectile dysfunction; men and women: decreased sexual desire, anorgasmia) Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth) Mostly Major depressive disorder (ages 12 and older) Generalized anxiety disorder (GAD) Panic disorder Obsessive-compulsive disorder
(OCD) Posttraumatic stress disorder (PTSD) Social anxiety disorder (social phobia) Premenstrual dysphoric disorder (PMDD
Boosts neurotransmitter serotonin Blocks serotonin reuptake pump (serotonin transporter) Desensitizes serotonin receptors, especially serotonin 1A autoreceptors
Treatment most often reduces or even eliminates symptoms, but not a cure since symptoms can recur after medicine stopped
Initial 10 mg/day; increase to 20 mg/day if necessary; single-
dose administration, morning or eveningCYP450 2C19 and
3A4 No significant actions on CYP450 enzymescentral nervous system (insomnia but also sedation, agitation, tremors, headache, dizziness) Note: patients with diagnosed or
undiagnosed bipolar or psychotic disorders may be more vulnerable to CNS-activating actions of SSRIs Autonomic (sweating). Bruising and rare bleeding Rare hyponatremia (mostly in elderly patients and generally reversible on discontinuation of escitalopram SIADH (syndrome of inappropriate antidiuretic hormone secretion)
Other Warnings/Precautions Use with caution in patients with history of seizures Use with caution in patients with bipolar disorder unless treated with concomitant mood-stabilizing agent
When treating children, carefully weigh the risks and benefits of pharmacological treatment against the risks and benefits of nontreatment with antidepressants and make sure to document this in the patient’s chart
Whenever possible, warn patients and their caregivers about the possibility of activating side effects, and advise them to report such symptoms immediately Monitor patients for activation of suicidal ideation, especially children and adolescents
Fluoxetine (Prozac) SSRI (selective serotonin reuptake inhibitor
Commonly Prescribed for Major depressive disorder (ages 8 and older) Obsessive-Active metabolite (norfluoxetine) has 2 week half-
life Parent drug has 2–3 day half-Notable Side Effects Sexual dysfunction (men: delayed ejaculation, erectile dysfunction; men and women: decreased sexual desire, anorgasmia) Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth) Mostly CNS (insomnia but also sedation, agitation, tremors, headache,
dizziness). Note: patients with diagnosed or undiagnosed
