Revised - March 2009
Therapeutic Dose Range (mg/day)
20 – 40
Initial Suggested Titration Schedule Dose** Selective Serotonin Reuptake Inhibitors (SSRIs)
20 mg in morning with food (10 mg in elderly or those with panic disorder) Maintain initial dose for 4 weeks before dose increase. If no response, increase in 10 mgincrements every 7 days as tolerated. Increase to 20 mg if partial response after 4-weeks
Helpful for anxiety disorders. Few drug interactions. Generic available.
10 – 30 mg
10 mg for escitalopram
10 – 80
20 mg in the morning with food (10 mg in elderly and those with comorbid panicdisorder)
Maintain 20 mg for 4-6 weeks and 30 mg for 2-4 weeks before additional dose increases. Increase in 10 mg increments at 7-day intervals. If significant side effects occur within 7 days, lower dose or change medication.
More potent s-enantiomer of citalopram, 10 mg dose effective for most. FDA labeling for general anxiety disorder. Reduces all three symptom groups of PTSD. Helpfulfor anxiety disorders. Long half-life good for poor adherence, missed doses; less frequent discontinuation symptoms. Reduces all three symptom groups of PTSD. Generic available.
More expensive than citalopram.
Slower to reach steady state and eliminate when discontinued. Sometimes too stimulating. Active metabolite has halflife ~10 days and renal elimination. Inhibitor of cytochrome P450 2D6and 3A4. Use cautiously in the elderly and others taking multiple medications. No generic available.
Fluoxetine Weekly (Prozac Weekly) Paroxetine (Paxil)
10 – 50 (40 in elderly)
Initiate only after patient stable on 20 mg daily 20 mg once daily, usually in the morning with food (10 mg in elderly and those with
Start 7-days after last dose of 20 mg. Maintain 20 mg for 4-weeksbefore dose increase. Increase in 10 mg increments at intervals of approximately FDA labeling for most anxiety disorders. Reduces all three symptom groups of PTSD.
Sometimes sedating. Anticholinergic effects can be troublesome. Inhibitor of CYP2D6 (drug
comorbid panic disorder)
7 days up to maximum dose of 50 mg/day (40 elderly)
interactions) Discontinuation/withdrawal symptoms. Generic not available
25 – 62.5 (50 in elderly)
25 – 200
15 – 45
Increase by 12.5 mg at weekly intervals, maintain 25 mg for 4 weeks before dose increase 50 mg once daily, Maintain 50 mg for 4 weeks. usually in the morning Increase in 25-50 mg with food (25 mg for increments at 7-day intervals elderly) astolerated. Maintain 100 mg for 4 weeks before next dose increase. Serotonin and Norepinephrine Antagonist 15 mg at bedtime Increase in 15 mg increments (7.5 mg in elderly) as tolerated. Maintain 30 mg for 4 weeks before further dose increase.
25 mg daily (12.5 mg in elderly and those with panic disorder)
May cause less nausea and GI distress. FDA labeling for anxiety disorders including PTSD.Safety shown post MI. Generic available
Weak inhibitor of CYP2D6 – drug interactions less likely.
Bupropion † (Wellbutrin)
200 – 450
Few drug interactions. Less or no sexual dysfunction. Less sedation as dose increases. May stimulate appetite. Generic available Norepinephrine and Dopamine Reuptake Inhibitor 100 mg twice a day Increase to 100 mg three Can be stimulating. Less (once a day inelderly) times a day after 7 days or no sexual dysfunction. (slower titration for elderly) Generic available After 4-weeks, increase to maximum 150 mg three times a day if necessary. Hepatic impairment: 75 mg/day 150 mg once a day (100 mg in elderly) Increase to 150 mg twice a day after 7 days (100 bid elderly). Increase to 200 mg twice a day after 4 weeks (150 bid elderly) if insufficient...