Generic (Trade) Name

Initial Dosage

Final Dosage

Sedative Potential

Precautions

Advantages

Other Antidepressants

Bupropion (Wellbutrin SR)

SR: 75 mg qd

SR: 150–300 mg qd

Low

Dopaminergic, noradrenergic, agitation, insomnia, seizures

Dose should be divided

May help apathetic depression

Sustained-release form available

Duloxetine (Cymbalta)

20 mg

30–60 mg

Low

Drug interactions (CYP 1A2, 2D6 substrate)

Equally SSRI and SNRI, narrow dose range

FDA approved for neuropathic pain

Hypericum perforatum, or St. John’s wort

300 mg bid

900 mg tid

Low

Use standardized, freeze-dried extract, 0.3% hypericin

Drug interactions with other antidepressants

Low side-effect profile, OTC

Mirtazapine (Remeron, Sol-tabs)

7.5 mg hs

15–45 mg hs

Moderate

Prolonged half-life, renal clearance

Dry mouth, weight gain

Serotonergic and noradrenergic

Sedative effects may improve sleep

Trazodone (Desyrel)

25–50 mg hs

100–200 mg hs

High

Very sedative

For sleep disturbance

Venlafaxine (Effexor, Effexor XR)

37.5 mg bid

XR: 75 mg qd

75–225 mg qd

Low

Headache, nausea, vomiting

Hypertension, withdrawal syndrome

Fewer drug interactions

Extended-release preparation available, may be more effective than SSRIs

Stimulants

Methylphenidate (Ritalin)

5 mg am

20 mg bid

Low

Side effects include anorexia, insomnia

Daytime use only

Quick results

For frail and apathetic patients

Modafinil (Provigil)

200 mg am

400 mg am

Low

Little used in elderly patients

Once-daily dosing, reverses daytime sedation sometimes observed with SSRIs