Choosing an antidepressant medication

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List and explain all of the considerations when choosing an antidepressant medication

Factors to Consider When Choosing and Starting an Antidepressant
· Side effect profile
· Side Effects, Costs and Clinical Indications for:
o Secondary Amine Tricyclics (TCAs)
o Tertiary Amine TCAs
o Selective Serotonin Reuptake Inhibitors (SSRIs
· Clinical indications and contraindications
· Age: Elderly patients are at higher risk for side effects and drug interactions. In these patients, the newer antidepressants (SSRIs) are generally better tolerated.
· Suicidality: In patients who have made suicide attempts or who are considered
at significant risk for making a suicide attempt, SSRIs are recommended because they are much safer in the case of overdose.
· Drug interactions with concurrent medications - e.g., avoid a combination of antidepressants and monoamine oxidase inhibitors (MAOIs). Be aware that tricyclic antidepressants (TCAs) can potentiate the effects of quinidine, leading to a complete heart block. SSRIs can raise serum levels of such medications as digoxin, anticonvulsants, and warfarin (see Drug Interactions & Selective Serotonin Reuptake, Inhibitors).
· TCAs are contraindicated in patients with certain coordination defects or narrow angle glaucoma (Tertiary Amine TCAs).
· Cost - TCAs are usually cheaper, but total cost for health care services over a 6-month period may be about the same. Older (tertiary) tricyclics (TCAs) are significantly cheaper than newer (secondary) ones, but have worse side-effect profiles.
Special patient populations: elderly, medically ill, pregnant or breast feeding
For all special populations, start slow (lower initial dose) and go slow (slower rise in dose). Monitor more frequently for side effects. Consider psychiatric ...