|Drug||Usual total starting dose per day |
|Usual total dose per day |
|Extreme daily dose range |
|Selective serotonin reuptake inhibitors|
|Citalopram||20||20 to 40Δ||10 to 40Δ|
|Escitalopram||10||10 to 20||5 to 30|
|Fluoxetine||20||20 to 60||10 to 80|
|Fluvoxamine||50||100 to 200||25 to 300|
|Fluvoxamine CR||100||100 to 200||100 to 300|
|Paroxetine||20||20 to 40||10 to 50|
|Paroxetine CR||25||25 to 50||12.5 to 62.5|
|Sertraline||50||50 to 200||25 to 300|
|Serotonin-norepinephrine reuptake inhibitors|
|Desvenlafaxine||25 to 50||50 to 100||50 to 400◊|
|Duloxetine||30 to 60||60||30 to 120§|
|Levomilnacipran||20||40 to 80||20 to 120|
|Milnacipran||12.5||100 to 200||50 to 300|
|Venlafaxine||37.5 to 75||75 to 375||75 to 375|
|Venlafaxine XR||37.5 to 75||75 to 225||75 to 375|
|Agomelatine¥ (not available in United States)||25||25 to 50||25 to 50|
|Bupropion||200||300 (maximum single dose 150 mg)||100 to 450|
|Bupropion SR 12 hour||150||300 (maximum single dose 200 mg)||150 to 400|
|Bupropion XL 24 hour||150||300|| |
150 to 450 (United States)150 to 300 (Europe)
|Bupropion hydrobromide 24 hour||174||348||174 to 522|
|Mirtazapine||15||15 to 45||7.5 to 60|
|Nefazodone‡||200||300 to 600||50 to 600|
|Trazodone||100||200 to 400||100 to 600|
|Vilazodone||10||40||10 to 40|
|Vortioxetine||10||20||5 to 20|
|Tricyclics and tetracyclics†|
|Amitriptyline||25||150 to 300||10 to 300|
|Amoxapine||25||200 to 300||25 to 400|
|Clomipramine||25||100 to 250||25 to 300|
|Desipramine||25||150 to 300||25 to 300|
|Doxepin||25||100 to 300||10 to 300|
|Imipramine||25||150 to 300||10 to 300|
|Maprotiline||25||100 to 225||25 to 225|
|Nortriptyline||25||50 to 150||10 to 200|
|Protriptyline||10||15 to 60||5 to 60|
|Trimipramine||25||150 to 300||25 to 300|
|Monoamine oxidase inhibitors†|
|Isocarboxazid||10||10 to 40||10 to 60|
|Phenelzine||15||15 to 90||7.5 to 90|
|Selegiline transdermal||6 mg/24 hour patch||6 to 12 mg/24 hour patch||6 to 12 mg/24 hour patch|
|Tranylcypromine||10||30 to 60||10 to 60|
* Total daily oral doses shown in table may need to be given as two or three equally divided doses per day, depending on specific antidepressant and other factors. For additional detail, refer to individual Lexicomp drug monographs included with UpToDate.
¶ Lower doses may be useful for initiating or maintaining patients who are older or medically compromised (eg, renal or hepatic illness), or drug-sensitive patients, as well as patients with a low body mass index. High doses may be used for medications that are well tolerated but ineffective at lower doses. In patients with panic disorder, UpToDate contributors initiate treatment at one-half or less of the usual starting dose shown and titrate more gradually; refer to clinical topic on management of panic disorder.
Δ Maximum recommended dose of citalopram is 20 mg for patients >60 years of age, with significant hepatic insufficiency, or taking interacting medications that can increase citalopram levels. For more information refer to the UpToDate topic on unipolar depression in adults and selective serotonin reuptake inhibitors.
◊ Although desvenlafaxine doses up to 400 mg per day have been studied, there is no evidence that doses >50 mg per day provide any additional benefit.
§ Although duloxetine doses >60 mg/day did not confer additional benefit in clinical trials, individual patients may benefit from dose escalation up to a maximum of 120 mg/day.
¥ Agomelatine may be hepatotoxic and is contraindicated with any degree of liver impairment. Transaminase monitoring is required.
‡ Caution: can cause liver failure. Not available in Europe, Canada, and several other countries.† Conservative starting doses shown in table are lower than starting doses shown in some other references. For additional information, refer to UpToDate topics on unipolar depression in adults and cyclic antidepressants and monoamine oxidase inhibitors for treatment of adults with depression.
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