Version July 2025
| Drug | Usual total starting dose per day (mg)¶ | Usual total maintenance dose per day (mg)¶ | Extreme daily dose range (mg)¶ |
| 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 |
| Atypical agents | |||
| 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 |
| Serotonin modulators | |||
| 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 |
CR: controlled release; SR: sustained release; XL: extended release; XR: extended release.
* Total daily oral doses shown in table may need to be given as 2 or 3 equally divided doses per day, depending on specific antidepressant and other factors. For additional detail, refer to individual Lexidrug monographs included with UpToDate.
¶ Lower doses may be useful for initiating or maintaining patients who are older or medically compromised (eg, kidney or liver disease) 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 UpToDate topics on the 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.
◊ Data regarding increased efficacy of doses >50 mg/day are limited; however, individual patients can benefit by titrating up to 100 mg/day.
§ 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: Nefazodone can cause liver failure and has been withdrawn from the market in several countries. Refer to UpToDate topic on serotonin modulators pharmacology, administration, and side effects for additional information.
† Conservative starting doses shown in table are lower than starting doses shown in some other references. For additional information, refer to UpToDate topics on the treatment of depression with antidepressants as well as cyclic antidepressants and monoamine oxidase inhibitors for treatment of adults with depression.
