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Depression in Women: Antidepressants and Mood Stabilizers |
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| Medication |
Rating for use
in pregnancy* |
Adverse
effects on breast-fed infants |
Dosage range
(mg per day)† |
Cost
(generic)‡ |
|
| Tricyclics (tertiary)§ | |||||
| Amitriptyline (Elavil) | D | None | 75 to 300 | $ 29 (3 to 5) | |
| Clomipramine (Anafranil) | C | None | 75 to 300 | 45 (37 to 40) | |
| Doxepin (Sinequan) | C | Apnea, drowsiness | 75 to 300 | 32 (9 to 13) | |
| Imipramine (Tofranil) | D | None | 75 to 300 | 42 (3 to 10) | |
| Trimipramine (Surmontil) | C | NA | 75 to 300 | 65 for 25-mg tablets | |
| Tricyclics (secondary)§ | |||||
| Amoxapine (Asendin) | C | NA | 100 to 600 | 65 (41 to 50) | |
| Desipramine (Norpramin) | C | None | 75 to 300 | 47 (18 to 22) | |
| Nortriptyline (Pamelor) | D | None | 50 to 200 | 57 (37 to 45) | |
| Protriptyline (Vivactil) | C | NA | 20 to 60 | 42 (34 to 37) | |
| Miscellaneous | |||||
| Bupropion (Wellbutrin) | B | None | 225 to 450 | 62 for 75-mg tablets; 83 for 100-mg tablets | |
| Maprotiline (Ludiomil) | B | NA | 100 to 225 | 43 (32 to 33) | |
| Mirtazapine (Remeron) | C | NA | 15 to 45 | 59 | |
| Nefazodone (Serzone) | C | NA | 300 to 600 | 58 | |
| Trazodone (Desyrel) | C | NA | 150 to 600 | 115 (21 to 32) | |
| Venlafaxine (Effexor) | C | NA | 75 to 225 | 34 | |
| Selective serotonin reuptake inhibitors§¶ | |||||
| Fluoxetine (Prozac) | C | Gastrointestinal effects, irritability, insomnia | 10 to 40 | 71 | |
| Fluvoxamine (Luvox)|| | C | NA | 100 to 300 | 64 | |
| Paroxetine (Paxil) | C | NA | 20 to 50 | 62 | |
| Sertraline (Zoloft) | C | None | 50 to 150 | 65 | |
| Monoamine oxidase inhibitors | |||||
| Phenelzine (Nardil) | C | NA | 45 to 90 | 38 | |
| Tranylcypromine (Parnate) | C | NA | 20 to 60 | 30 | |
| Mood stabilizers | |||||
| Lithium | D | Lithium toxicity | 900 to 1,200 | 8 (2 to 7) | |
NA=information not available.
*--U.S. Food and Drug Administration drug rating for use of drugs in pregnancy: B=no evidence of risk to fetus; C=risk to fetus cannot be ruled out; D=evidence of risk to human fetus.
†--Adult daily dosage range adapted from reference 11. Women may need lower daily dosages. The dosages at the higher end of the ranges, especially those for tricyclic antidepressants, are uncommon and may need to be administered in a hospital setting.
‡--For each drug, the cost figure given is for the lowest dosage of the brand-name drug, with the cost for generic drug in parentheses. Estimated cost to the pharmacist based on average wholesale prices (rounded to the nearest dollar) for one month of treatment in Red book. Montvale, N.J.: Medical Economics Data, 1999. Cost to the patient will be higher, depending on prescription filling fee.
§--Safety in pregnancy supported by the literature.27-31,33
¶--May be considered as first-line agents for the treatment of depression in women.
||--Labeled in the United States for the treatment of obsessive-compulsive disorder.
Information from references 11, and 27 through 35.
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