From the Guidelines
Non-benzodiazepine alternatives for treating depression include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other medications such as bupropion and mirtazapine, as recommended by the American College of Physicians 1.
Treatment Options
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) at 20-80 mg daily, sertraline (Zoloft) at 50-200 mg daily, escitalopram (Lexapro) at 10-20 mg daily, and citalopram (Celexa) at 20-40 mg daily are commonly used to treat depression.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR) at 75-225 mg daily and duloxetine (Cymbalta) at 30-120 mg daily are also effective options.
- Bupropion (Wellbutrin) at 150-450 mg daily is useful for depression with fatigue or low motivation.
- Mirtazapine (Remeron) at 15-45 mg nightly can help with sleep and appetite issues.
Recommendations
- The American College of Physicians recommends that clinicians select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences 1.
- Treatment should continue for at least 6-12 months after symptom improvement to prevent relapse, as recommended by the American College of Physicians 1.
- Cognitive behavioral therapy (CBT) is a reasonable approach for initial treatment and should be strongly considered as an alternative treatment to second-generation antidepressants where available 1.
Considerations
- Tricyclic antidepressants and MAOIs are typically reserved for treatment-resistant cases due to their side effect profiles.
- The choice of medication should be based on the patient's specific needs and medical history, as well as the potential for adverse effects 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Non-Benzodiazepine Alternatives for Treating Depression
- Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line treatment for depression, with optimal doses found to be in the lower range of their licensed dose, between 20 mg and 40 mg fluoxetine equivalents 2.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) and novel agents have also shown potential in treating depression, with some studies suggesting they may have better efficacy and tolerability than SSRIs 3.
- Other alternatives include venlafaxine and mirtazapine, which have been found to have optimal acceptability in the lower range of their licensed dose 2.
- Agomelatine, milnacipran, and mianserin have also been included as first-line alternatives in some clinical practice guidelines 4.
Comparison of Efficacy and Tolerability
- A study comparing the efficacy of SSRIs, SNRIs, and novel agents found that novel agents showed the largest mean reduction in Hamilton Depression Rating Scale (HAM-D) scores and the highest rise in quality of life (QoL) ratings 3.
- Another study found no significant differences in efficacy and tolerability between fluoxetine, sertraline, and paroxetine in patients with high levels of anxiety symptoms during the acute treatment of major depression 5.
- The choice of antidepressant should be based on individual patient needs and circumstances, taking into account factors such as efficacy, tolerability, and potential side effects 6, 4.