ANTIDEPRESSANT COMPARISON CHART 1,2,3,4 www.RxFiles.

ca Prepared by: Loren Regier, Brent Jensen Jul 03

NAME: Generic / TRADE RECEPTOR SIDE EFFECTS COMMENTS & ADDITIONAL USES INITIAL & USUAL ADULT $
AFFINITY ACH. SED. OTHER (Bold indicates official indication in Canada) MAX. DOSE DOSE RANGE /Month

✘
Citalopram CELEXA escitalopram LEXAPROUSA SSRIs SE in General Therapeutic Uses: 8,9 10-20mg am 20mg po od 52
+ + Ÿfew drug interactions
(20, 40mg scored tabs) abr=CC S(+) citalopram 10-20mg od nausea {21%(F) - 36% (X)}, √ OCD (esp. F, P,S,X) 60mg/d 40mg po od 52
Fluoxetine PROZAC anxiety, insomnia {~14%}, Ÿmost anorexic & stimulating √ Panic(esp. P,S;F,CC,X) 10-20mg od (10mg po od) ✝ 40
(10,20mg cap & 4mg/ml solution) abr=F 0 0 agitation,anorexia,tremor Ÿlong half-life (5 wk washout) √ GAD (P); ?others 20mg po od am 32
somnolence {11-26%}, Ÿ90mg weekly avail. in USA √ Bulimia nervosa (F) 80mg/d 40mg po od am 57
Fluvoxamine LUVOX 5HT sweating, dry mouth, Ÿmost nauseating, constipating √Diabetic neurop.(CC) 25-50mg hs 100mg po hs 33
SELECTIVE 0/+ ++ & deter use of EtOH 150mg po hs 45
(50,100mg tab) abr=X headache, dizziness, & sedating SSRI; ↑ DI's 300mg/d
√ PTSD(P,S),√PMDD(F,P,S) 50mg am & 150mg hs 58
diarrhea {12% (F,P)-17% (S),
Paroxetine PAXIL SSRI's Ÿmost anticholinergic of SSRIs √Social Phobia (P,S) 10-20mg am 20mg po od am 67
constipation {13-18%}
(20,30mg tab), (10mg tab ✘ ) abr=P + + Ÿmost official anxiety √ Pediatric (F,S,X) 30mg po od am 70
sexual dysfx.5,6 ,SIADH,EPS disorder indications +ve effect on headache? 60mg/d 40mg po od am 126
Sertraline Toxicity can→depression Ÿflat dose response
ZOLOFT Ÿmost diarrhea & male sexual 100mg po od cc 35
(25,50,100mg cap) abr=S
D/C Syndrome 7→flu-like (majority of depressed 25-50mg am
0 + dysfx of SSRIs pts respond at the lowest 50mg am &100mg pm 60
Sx's 'FINISH' flu,insomnia, Ÿfew drug interactions10 200mg/d 100mg po bid cc 63
nausea,imbalance,sensory dist., hyper. effective dose)

Nefazodone SERZONE As for SSRIs +: ↓ BP Ÿleast stimulating serotonergic 50-100mg bid 100mg po bid DISCONTINUED 36
Ÿuseful in anxiety &
(50,100,150,200mg tab) abr-Z SARI 5HT + +++ (nausea, dizziness, constipation, Ÿless wt gain;less sex dysfx,DI's 150mg po bid in Canada, 36
insomnia
Selective dry mouth) Rare:hepatotoxicity11 Ÿmay try entire dose at hs12 600mg/d (300mg po hs) 27NOV03 36
Trazodone DESYREL SSRI+5HT2 ↓↓ BP, dizzy, headache, √dementia 50mg hs (insomnia, √ Panic, chr. pain 50mg bid 50mg po hs 14
(50,100mg tab) rec. antagonism 0 ++++ nausea; (α1 blockade); sundowning, aggression); less √ Sleep disorders: 100mg po bid pc 29
(150mg Dividose tab:50/75/100/150mg ✘ ) priapism 1/6000, (Tx epi) cardiac effects than TCAs 50-100mg hs 600mg/d 200mg po bid pc 51
Amitriptyline ELAVIL Ÿ10-30mg hs for sleep 10-25mg hs 50 mg po hs 15
+++++ +++++ Therapeutic Uses 14
(10, 25,50mg; 75mg✘ tab) General TCA SE: disorders & chronic pain ŸCp 300mg/d 200mg po hs 34
5HT & NE √ Pain Syndromes
Clomipramine ANAFRANIL ↑HR, ↓BP (Tx: fluid+/- Ÿespecially effective for OCD 10-25mg hs 50 mg po hs 22
EFFECTS & sleep disorders15
(10, 25, 50mg tab) +++++ ++++ Florinef), weight gain, ŸMost serotonergic TCA; ŸCp 150mg po hs 51
(amitriptyline; but
sexual dysfx, sweating, Ÿhigher risk of seizures 300mg/d 200mg po hs 65
tertiary (3°) 2° TCA nortriptyline
Doxepin SINEQUAN rash, tremors, ECG ŸMost histamine block; ŸCp 10-25mg hs 50 mg po hs 15
amine TCA's +++ ++++ also useful and often
(10,25,50,75,100,150mg cap) abnormalities, seizures Ÿ√ psychoneurotic/anxious dep. 300mg/d 200mg po hs 52
be better tolerated)
Imipramine TOFRANIL Ÿfatal in overdose 13 ŸCp √ Neuropathy 10-25mg hs 50 mg po hs 18
+++ +++ 150mg po hs 40
(10, 25, 50mg tab) (¾2gm) due to cardiac & √ Childhood enuresis (age 6+) √ Agitation & 300mg/d 200mg po hs 51
neurologic toxicity. insomnia
Desipramine NORPRAMIN --------------------------------------------------------------- ŸMost NE activity √ Panic→ imipramine 10-25mg hs 50 mg po hs 20
(10, 25, 50, 75,100mg tab) ++ ++ Ÿ2°° amines generally ŸLeast ACH side effects
√ Migraine
150mg po hs (3x50mg) 44
(50mg tabs better price in SK)
NE > 5HT ŸCp 300mg/d 200mg po hs (4x50mg) 56
better tolerated then 3° prophylaxis16
secondary (2°) ŸLeast hypotensive TCA
Nortriptyline AVENTYL
amine TCA's
amines (less dry mouth, (esp. amitriptyline, 10mg hs 25mg po hs 15
(10, 25mg cap) dizziness & weight gain) ŸCp (response may be higher at nortriptyline)
+++ ++ 50mg po hs 21
low end ≈50mg of dosage √ ADD(ie. desipramine) 150mg/d 100mg po hs 33
range17)
Venlafaxine EFFEXOR ŸAs dose↑↑: ↑BP, agitation, Ÿinitial nausea; “clean TCA” √Generalized & 18.75-37.5mg 37.5mg po bid cc 63
SNRI tremor,sweating,nausea~37%, Ÿside effects similar to SSRIs; social anxiety disorder 75mg po bid cc 119
(Reg. 37.5, 75mg reg, )
++ + bid
(XR 37.5mg, 75mg, 150mg caps) 5HT & NE headache, sleep disturbances Ÿlow wt. gain;few drug interaction √for BPAD depressed; 75mg or150mg XR po od 63
(contents of XR caps may be sprinkled) (also some DA) Ÿcaution:withdrawal effects Ÿadjust dose for ↓ renal fx relapse prevents & ↓ recurrence 375mg/d 225mg XR po daily 122
Bupropion SR WELLBUTRIN NDRI agitation, insomnia, tremor, Ÿ↑’d risk of seizure ~0.4% 400mg/d =ZYBAN → 100mg od am 100mg po bid 45
0 0 ↓appetite, GI upset, psychos.
(100mg, 150mg tab) ☎▼ DA & NE Ÿless sex dysfx, low wt. gain D/C smoking;√ BPAD 450mg/d 150mg po bid 64
MAOIs: non-selective & irreversible; ✓ atypical/refractory depression; enzyme effect ~10days; many DIs & food cautions (tyramine-hypertensive crisis);phenelzine NARDIL 15mg tab bid-tid; tranylcypromine PARNATE 10mg tab bid-tid
Mirtazapine REMERON 30mg tab NaSSA5HT & NE +++ ++++ Dry mouth,sedation,DI-clonidine ↑ appetite&weight ;↓ sexual dysfx √Anxiety,Somatization 15-45mg/day 30mg po hs 51
Moclobemide MANERIX RIMA Dry mouth, dizzy, Ÿno dietary tyramine precaution √Atypical, 100mg bid 150mg po bid pc 28
(100,150,300mg tab) (150mg tab cheaper) Selective & + 0 headache, nausea, tremor, Ÿenzyme effect lasts ~24hrs √Anxious-phobic, 300mg am&150pm pc 38
Reversible restless, less sex dysfx DI:meperidine,sympathomimetics,DM… √Co-morbid anxiety 600-900mg/d 300mg po bid pc 58
☎ EDS ✘ non-formulary in SK ▼ prior approval Indian affairs COST for Sask. pt. (includes markup & dispensing fee) 5HT =serotonin ACH =anticholinergic effects (dry mouth,constipation,urinary hesitancy,blurred vision) ADD =attention
deficit disorder BP =blood pressure Cp =plasma levels avail DA =dopamine DI =drug interactions epi =epinephrine GI =gastro-intestinal HR =heart rate MAOI =monoamine oxidase inhibitors NE =norepinephrine OCD =obsessive
compulsive disorder RIMA reversible inhibitor of MAO-A SE =side effects SED =sedation SSRI =selective 5HT reuptake inhibitor TCA =tricyclic antidepressant Tx =treatment wk =week wt =weight INITIAL DOSE -Lower initial
dose rec for elderly/sensitive pts. ✝ =initial dose lower than usual effective dose. Pregnancy: C agents: fluoxetine (most clinical experience) & paroxetine (inactive metabolites). B agents: bupropion & sertraline but less clinical experience.
39
 Antidepressants – Supplementary Tables www.RxFiles.ca Prepared by: Loren Regier, Brent Jensen Jul 03
Table 1:Adverse Effects:Management Options 18,19 Table 2: Precautions 29
Table 3: Switching Antidepressants:
ŸDizziness Fcheck BP for orthostatic hypotension; mild symptoms may TCAs: benign prostatic hypertrophy, history of urinary Recommended washout period (DAYS) in
attenuate over several weeks; ↓ dose or switch agent; encourage adequate retention, uncorrected angle closure glaucoma, history of seizure, outpatients43,44,45
fluid intake & avoid excessive salt restriction; Florinef 0.1mg po od & titrate post-MI - acute recovery phase, cardiovascular disease, The more critical recommendations are in bold; risks
ŸSedation/ feeling medicated/ foggy Fmay attenuate over 1-2 weeks; of toxicity are greater with higher dosage regimens
cholinergic rebound upon withdrawal from high doses (dizziness, and inadequate washout period. Some urgent cases
give single dose 1-2 h prior to bedtime; ↓ dose or choose alternative agent nausea, diarrhea, insomnia, restlessness, cardiac conduction delays, heart may necessitate shorter delays in switching.
ŸPeripheral anticholinergic effects F tolerance may develop over block; arrhythmias)
several weeks; switch to alternative agent; treatment options for some Sx: FROM
SSRIs: hepatic dysfunction (↑ levels & half-life), irritable bowel
Ÿblurry vision-pilocarpine eye drops;methylcellulose drops for dry eyes syndrome, CNS overstimulation (e.g. serotonin syndrome) 30 amitriptyline 1* 1
#
1-7 7✝ ✝
1✝ 1-7✝
Ÿurinary hesitancy - bethanechol 25-50mg po tid-qid clomipramine 1* #
1 7-14
✝
7✝ 1✝ 7-14✝
especially if used in combination with other serotonergic drugs
Ÿabdominal cramps, nausea, diarrhea - adjust dose
Ÿdry mouth - sugarless gum; saliva substitutes(e.g.ORAL balance Gel)
(buspirone, lithium, MAOI, meperidine, mirtazapine, ondansetron, doxepin 1* 1
#
1-7 ✝
7✝ 1✝ 1-7✝
silbutramine, St. John’s Wort, sumatriptan, tramadol, tryptophan, TCA)31; imipramine 1* #
1-7✝ 7✝ 1✝ 1-7✝
Ÿconstipation - adequate hydration, activity, bulk forming laxatives 1
withdrawal syndrome: dizziness, GI upset, headache, 1✝
ŸWeight gainF modify & monitor diet & activity;switch to alternate agent desipramine 1* 1
#
1-7✝ 7✝ 1-7✝
agitation/restlessness, sleep disturbance (usually mild & transient; less
ŸSexual dysfunction F distinguish etiology (drug vs illness); switch to: common with fluoxetine) 32 nortriptyline 1* 1
#
1-7✝ 7✝ 1✝ 1-7✝
(bupropion,mirtazapine,moclobemide, venlafaxine↓ dose); adjust dose; MAOIs: hypertensive crisis can occur secondary to foods mirtazapine 1
#
1 ✝
3 ✝
7✝ 3✝ 3✝
Other: Ÿ↓ libido→ neostigmine 7.5-15mg 30min prior to intercourse
containing tyramine {e.g. HIGH → Unpasteurized cheese (cheddar, venlafaxine 1
#
1 ✝
3 ✝
7✝ 3✝ 3✝
Ÿimpaired erection → bethanechol 10mg po tid camembert, blue), yeast extract, herring, aged unpasteurized meats, broad ! ! ! ! ! !
Ÿanorgasmia → cyproheptadine (Periactin) 4mg po qam fluoxetine 35 35 1 35 35 1
bean pods; MODERATE→ avocado, meat extract, certain ales & beers,
Ÿantidepressant induced erectile dysfunction → sildenafil may help 20 fluvoxamine 1-7✝ 7 ✝
1
#
7✝ 1✝ 1+
wines; LOW→ fruits, cream & cottage cheese, distilled spirits,
ŸMyoclonusF ?TCA toxicity; reassess dose/levels; clonazepam 0.25mg tid chocolate}; Contraindicated in: cerebrovascular / cardiovascular paroxetine 1-7✝ 7✝ 1
#
10✝ 1✝ 1+
ŸInsomnia & anxiety (5HT related)F ↓dose; administer in am; + short disease, pheochromocytoma, geriatric or debilitated, hx. of sertraline 1-7✝ 7✝ 1
#
10✝ 1✝ 1+
course of trazodone 50-100mg hs; switch to alternate agent (e.g. nefazodone)
severe headache. nefazodone 1-3✝ 3 ✝
1
#
7✝ 1✝ 1+
ŸSIADH (syndrome of inappropriate antidiuretic hormone
Bupropion: Contraindicated in patients with seizure disorder, trazodone 1-7✝ 7 ✝
1
#
7✝ 2✝ 1+
secretion) (hyponatremia) F DC causative agent; fluid restriction (1 l/d) ##
ŸSerotonin Syndrome21 (e.g. excitement,diaphoresis,rigidity,↑ temp,
history of bulimia or anorexia nervosa phenelzine 10-14 14 10-14 14 2 14
Pediatric Precautions: Safety of antidepressants in children is not ##
↑reflexes, ↑HR, ↓BP) D/C serotonergic agents; Tx: Periactin 4mg po q4h tranylcypromine 10-14 14 10-14 14 2 14
ŸDiscontinuation syndrome with abrupt withdrawal of agents a flu-like well established. Imipramine is indicated for enuresis in kids ¾6 yrs. bupropion 1-3✝ 1✝ 1✝ 7✝ 3✝
syndrome (FINISH: flu, insomnia, nausea, imbalance, sensory disturbances & hyperactivity) Fluoxetine depression & OCD, fluvoxamine OCD & sertraline OCD are FDA approved.
moclobemide 2 2 2 2 2
may occur. Tx: TAPER off original antidepressants slowly over several days Pregnancy: Consider risk versus benefit! ECT &

citalopram,sertraline,nefazodone,trazodone
or give benztropine (for cholinergic rebound→nausea/vomiting, sweating), psychotherapy are non-drug options. TCAs & SSRIs have the

fluoxetine, fluvoxamine, paroxetine

lorazepam (for agitation/insomnia), propranolol (for akathisia) as necessary. most clinical data to substantiate their safety (Pregnancy category SWITCH
.

amitriptyline,clomipramine
22 B agents: bupropion & sertraline but less clinical experience.

desipramine,nortriptyline
Table 4: Individualizing Therapy Considerations

mirtazapine,venlafaxine
TO

doxepin, Imipramine
Anxiety/Panic ✔SSRIs, venlafaxine Some C agents may be preferable: fluoxetine (most clinical

tranylcypromine
moclobemide
experience) & paroxetine (no active metabolites). Use lowest

phenelzine

bupropion
Anxiety, Comorbid ✔moclobemide, mirtazapine, ? buspirone
Atypical* ✔moclobemide, MAOIs, SSRIs dose and try to taper off 5-10 days before delivery.33,34,35,36,37,38,39
Bipolar ✔mood stabilizer (+/- antidepressant) Elderly: extra caution required; med dose: start low & go slow
e.g. lithium, valproic acid, carbamazepine Relative Seizure Risk:40
Cardiac Condition ✔SSRIs, MAOIs, bupropion HIGH→ maprotiline, amoxapine, clomipramine, bupropion
Chronic Pain/Neuropathy23 ✔amitriptyline, desipramine, LOW→amitripyline,imipramine,trimipramine,nortriptyline,desipramine,doxe
Elderly 24,25 ✔ SSRI(CC,P,S,X,Z);venlafaxine;RIMA;bupropion;2°° TCA LOWEST→ trazodone, SSRI’S, MAOI’S, moclobemide, venlafaxine
Migraine26 ✔ amitriptyline, nortriptyline * Atypical depression defined as: mood reactivity;
Obsessive Compulsive ✔SSRI (high dose), clomipramine irritability; hypersomnia; hyperphagia; psychomotor * no washout required; use equivalent dose;
Orthostatic Hypotension ✔venlafaxine(↑BP); nortriptyline, agitation & hypersensitivity to rejection. ✝ taper first drug; start 2nd drug at a low dose; nd
SSRIs (ambulation, hydration, gradual dose titration) # taper first drug over 3-7day prior to initiating 2 drug;
DRUG INTERACTIONS: Various cytochrome P450 inhibition41 by SSRI's. ## taper if high dose;maintain dietary restriction for 10d;
Phobic ✔moclobemide, MAOI, paroxetine? Less DI's 42: citalopram, mirtazapine, moclobemide, sertraline & venlafaxine.
! use lower doses of 2nd drug initially;longer tapering period
Psychotic ✔+ antipsychotic (or amoxapine) (8 weeks) may be required for high doses of fluoxetine
Seizure History ✔trazodone,SSRIs,moclobemide,venlafaxine Drug CYP450 1A2 CYP450 2C9 CYP450 2C19 CYP450 2D6 CYP450 3A4
Sleep Disorders27 ✔trazodone, amitriptyline citalopram 0 0 0 + 0 Antidepressant
Smoking Cessation ✔bupropion, nortriptyline fluoxetine + ++ + to ++ +++ + to ++ drug interactions:
fluvoxamine +++ ++ +++ + ++
Weight Gain, Less28 ✔ bupropion, SSRIs, RIMA,venlafaxine see page 37.
paroxetine + + + +++ +
sertraline + + + + to ++ +
38
1
Jefferson J, Greist JH. Mood Disorders in Textbook of Psychiatry, 2nd Ed. Editors: Hales RE, Yudofsky SC, Talbot JA. American Psychiatric Press, Washington, 1994.
2
Micromedix Drug Information, 2003.
3
Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003 Feb 22;361(9358):653-61.
4
Treatment Guidelines: Drugs for Psychiatric Disorders. The Medical Letter: July, 2003; p. 69-76.
5
Modell JG, Katholi CR, Modell JD, et. al. Comparative sexual side effects of bupropion fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther 1997;61(4):476-87.
6
Gonzalez M, Llorca G, Izquierdo JA, et.al. J Sex Marital Ther 1997;23(3):176-94.
7
Ditto KE. SSRI discontinuation syndrome. Awareness as an approach to prevention. Postgrad Med. 2003 Aug;114(2):79-84.
8
Grady-Weliky TA. Clinical practice. Premenstrual dysphoric disorder. N Engl J Med. 2003 Jan 30;348(5):433-8.
9
Pearlstein T. Selective serotonin reuptake inhibitors for premenstrual dysphoric disorder: the emerging gold standard? Drugs. 2002;62(13):1869-85.
10
Bezchlibnyk-Butler K. Serotonergic antidepressants: Drug response and drug-drug interactions. Pharmacy Practice:National CE Program 1998;Aug:1-8.
11
Stewart DE. Hepatic adverse reactions associated with nefazodone. Can J Psychiatry. 2002 May;47(4):375-7.
12
Voris JC, Shaurette GN, Praxedes S et.al. Nefazodone: Single versus Twice Daily Dose. Pharmacotherapy 1998;18(2)379-380.
13
Buckley NA, McManus PR. Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. BMJ. 2002 Dec 7;325(7376):1332-3.
14
Furukawa TA, McGuire H, Barbui C. Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review. BMJ. 2002 Nov 2;325(7371):991.
15
Houdenhove BV, Onghena P. Pain and Depression in Depression and Physical Illness. Editors: Robertson MM, Katona CLE. Wiley & Sons, New York, 1997.
16
Pryse-Phillips WEM, Dodick DW, Edmeads JG. Guidelines for the diagnosis and management of migraine in clinical practice. Can Med Assoc J 1997;156:1273-87.
17
Wells BG, Mandos LA, Hayes PE. Depressive Disorders in Pharmacotherapy: A Pathophysiologic Approach 3rd Ed., 1996.
18
Tollefson GD. Antidepressant treatment and side effect considerations. J Clin Psychiatry 1991;52(5-suppl):4-13.
19
Cole JO, Bodkin JA. Antidepressant side effects. J Clin Psychiatry 1990;51(1):21-26
20
Nurnberg HG, Hensley PL, Gelenberg AJ, Fava M, Lauriello J, Paine S. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA. 2003 Jan 1;289(1):56-64.
21
Shulman RW. The Serotonin Syndrome: A tabular guide. Can J Clin Pharmacol 1995;2(3):139-144.
22
Bhatia SC, Bhatia SK. Major Depression: Selecting Safe and Effective Treatment. Am Family Physician 1997;55(5):1683-1694.
23
Watson CPN. Antidepressant Drugs as Adjuvant Analgesics. J Pain Symptom Manage 1994;9:392-405.
24
Finkel SI. Efficacy and tolerability of antidepressant therapy in the old-old. J Clin Psychiatry 1996;57(suppl 5):23-8.
25
Menting JEA, Honig A, Verhey FRJ, et. al. Int Clin Psychophamacology 1996;11:165-175.
26
Pryse-Phillips WEM, Dodick DW, Edmeads JG. Guidelines for the diagnosis and management of migraine in clinical practice. Can Med Assoc J 1997;156:1273-87.
27
Reite M, Ruddy J, Nagel K. Evaluation and management of sleep disorders, 2nd Ed. Am Psychiatric Press, Washington, 1997.
28
Drugs and Therapy Perspectives 1998;12(7):14-15.
29
AHFS (American Hospital Formulary System) Drug Information: Antidepressants. 2003.
30
Birmes P, Coppin D, Schmitt L, Lauque D. Serotonin syndrome: a brief review. CMAJ. 2003 May 27;168(11):1439-42.
31
Hansten, PD and Horn JR. Drug Interactions Analysis and Management. Applied Therapeutics Incorporated. Vancouver, WA. 2003.
32
Stahl MM, Lindquist M, Pettersson M, et.al. Withdrawal reactions with selective serotonin re-uptake inhibitors as reported to the WHO system. Eur J clin Pharmacol 1997;53(3-4):163-9.
33
Kulin AK, Pastuszak A, Sage SR, et.al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA 1998;279:609-610.
34
Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation 6th Ed. Williams & Wilkins, Media, Pennsilvania, 2002.
35
Simon GE, Cunningham ML, Davis RL. Outcomes of prenatal antidepressant exposure. Am J Psychiatry. 2002 Dec;159(12):2055-61.
36
Ward RK, Zamorski MA. Benefits and risks of psychiatric medications during pregnancy. Am Fam Physician. 2002 Aug 15;66(4):629-36.
37
Altshuler LL, Cohen LS, Moline ML, Kahn DA, Carpenter D, Docherty JP; Expert Consensus Panel for Depression in Women. The Expert Consensus Guideline Series. Treatment of depression in women. Postgrad Med. 2001
Mar;(Spec No):1-107.
38
Misri S, Burgmann A, Kostaras D. Are SSRIs safe for pregnant and breastfeeding women? Can Fam Physician. 2000 Mar;46:626-8, 631-3.
39
Spencer JP, Gonzalez LS 3rd, Barnhart DJ. Medications in the breast-feeding mother. Am Fam Physician. 2001 Jul 1;64(1):119-26.
40
Skowron DM, Stimmel GL. Antidepressants and the risk of seizures. Pharmacotherapy 1992;12(1):18-22.
41
Clinical Guidelines for the Treatment of Depressive Disorders. The Canadian Journal of Psychiatry June 2001.
42
Clinically significant drug interactions with antidepressants in the elderly. Spina E, Scordo MG. Drugs Aging 2002;19(4):299-320.
43
Product monographs 2003
44
Bezchlibnyk-Butler K, Jeffries JJ, eds. Clinical handbook of psychotropic drugs, 11th ed. Toronto: Hogrefe & Huber, 2001.
45
Bezchlibnyk-Butler K. Serotonergic antidepressants: Drug response and drug-drug interactions. Pharmacy Practice:National CE Program 1998;Aug:1-8.