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Antidepressant medications: Usual dosing in adults and half-life information

Antidepressant medications: Usual dosing in adults and half-life information
Generic drug name Trade name (United States) Usual starting dose (mg)* Low starting dose (mg)* Usual daily dose (mg) Available oral doses (mg) Mean half-life, hours (active metabolites)
Selective serotonin reuptake inhibitors (SSRIs)
Citalopram Celexa 20 10 20 to 40Δ◊ 10, 20, 40, L 35; prolonged in hepatic impairment and older adults
Escitalopram Lexapro 10 5 to 10 10 to 20 5, 10, 20, L 27 to 32; prolonged in hepatic impairment and older adults
Fluoxetine Prozac 20 5 to 10 20 to 60Δ 10, 20, 40, 60, L 120 (223); prolonged in severe hepatic impairment
Fluoxetine weekly Prozac Weekly 90   NA 90
Fluvoxamine Luvox 50 25 50 to 300Δ

25, 50, 100

100, 150 (controlled release)
15; prolonged in older adults
Paroxetine Paxil 20 5 to 10 20 to 60Δ 10, 20, 30, 40, L 21
Paroxetine CR Paxil CR 25   25 to 62.5 12.5, 25, 37.5 15 to 20
Sertraline Zoloft 50 12.5 to 25 50 to 200Δ 25, 50, 100, L 26 (66)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Desvenlafaxine Khedezla, Pristiq 50 25 50 to 100 25, 50, 100 11; prolonged in severe renal and hepatic impairment
Duloxetine Cymbalta, Irenka 30 20 60 to 120 20, 30, 40, 60 12; prolonged in older female patients
Venlafaxine Effexor 37.5 25 75 to 375 25, 37.5, 50, 75, 100 5 (11); prolonged in severe renal and hepatic impairment
Venlafaxine XR Effexor XR 37.5   75 to 225 37.5, 75, 150, 225

CR: controlled release; L: liquid; NA: not applicable; XR: extended release.

* Lower starting doses are recommended for older adult patients and patients with panic disorder, significant anxiety, or hepatic disease.

¶ Mean half-lives of active metabolites are given in parentheses.

Δ Dose varies with diagnosis. Refer to text for specific guidelines.

◊ 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. Refer to topic review of pharmacology of SSRI antidepressants for more information. Specific interactions of citalopram and other medications may be determined using the drug interactions tool (Lexi-Interact) included in UpToDate.
Data from: Martinez M, Marangell LB, Martinez JM. Psychopharmacology. In: American Psychiatric Publishing Textbook of Psychiatry, 5th ed, Hales RE, Yudofsky SC, Gabbard, GO (Eds), American Psychiatric Publishing, Inc, 2008 and Lexicomp Online. Copyright © 1978-2024 Lexicomp, Inc. All Rights Reserved.
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