|
Medication |
Starting dose (mg/d) |
Usual dose (mg/d) |
|
Selective serotonin reuptake inhibitors |
||
|
Citalopram |
10-20 |
20-40 |
|
Escitalopram |
5-10 |
10-20 |
|
Fluoxetine |
10-20 |
20-60 |
|
Paroxetine |
10-20 |
20-50 |
|
Sertraline |
25-50 |
50-200 |
|
Fluvoxamine |
25-50 |
50-300 |
|
Serotonin-norepinephrine reuptake inhibitors |
||
|
Desvenlafaxine |
50 |
50-100 |
|
Venlafaxine, extended release (XR) |
37.5-75 |
75-375 |
|
Duloxetine |
30-60 |
60-120 |
|
Levomilnacipran |
20-40 |
40-120 |
|
Milnacipran |
12.5 |
50-200 |
|
Noradrenergic and specific serotonergic antidepressants |
||
|
Mirtazapine |
15 |
15-45 |
|
Norepinephrine-dopamine reuptake inhibitor |
||
|
Bupropion, sustained release (SR) |
150 |
300-400 |
|
Bupropion HCl, extended release (XL) |
150 |
300-450 |
|
Serotonin modulators and stimulators |
||
|
Vilazodone |
10-20 |
20-40 |
|
Vortioxetine |
10 |
10-20 |
|
For some of these medications (such as tricyclic antidepressants), the upper dosing limit reflects risk of toxicity or need for plasma level assessment, whereas others (such as selective serotonin reuptake inhibitors) can be used safely at higher doses in general adult population. Older adult patients, patients with anxiety disorders, patients with liver disease or other systemic medical comorbidities should receive a lower starting dose. Starting doses should be increased gradually until therapeutic dose is reached or the patient achieves remission. Maximum recommended doses of some medications may be lower in older adults due to the risk of adverse effects. |
||
|
HCl, hydrochloride. |
||