Table 1

Main antidepressants available for palliative care patients

DrugRecommended dose (mg/day)CYT P450 enzymes involved in metabolismContraindications; all antidepressants are contraindicated in patients with a history of hypersensitivity to any componentAccessory effectsHalf-life
Amitriptyline10–3001A2, 2C9, 2C19, 2D6, 3A4Cardiac arrhythmias, myocardial infarction, glaucoma, urinary retention, prostatic hypertrophy, use of MAOI in the past 14 daysPain, appetite stimulant10–50
Nortriptyline25–150Sedative, anxiety, pain, insomnia20–100
Doxepin10–30017 h
Imipramine25–20011–25 h
Fluoxetine20–802C9, 2C19, 2D6, 3A4Concomitant use of MAOIs, liver impairmentAnxiety, insomnia, borderline personality disorder1–4 days
Sertraline50–1002B6, 2C9, 2C19, 2D6, 3A4Anxiety, post-traumatic stress disorder26 h
Escitalopram10–202C19, 2D6, 3A4Anxiety27–32 h
Citalopram20–6035 h
Paroxetine20–602D6, 3A4Anxiety, post-traumatic stress disorder21 h
Duloxetine30–1202D6, 1A2Concomitant use of MAOIs or SSRIs, for duloxetine: chronic alcohol use or liver diseasePain, hot flushes, fibromyalgia8–17 h
Venlafaxine37.5–2252D6Anxiety, hot flushes2.5–7.3 h
Milnacipran50–100NonePain, fibromyalgia8 h
Trazodone150–3753A4NoneInsomnia, anxiety3–9 h
Mirtazapine15–452D6/1A2, 3A4Concomitant use of MAOIsHypnotic, antiemetic, appetite stimulant20–40 h
Tianeptine37.5IIIA3Concomitant use of MAOIsAnxiety, erectile dysfunction2.5 h
Bupropion100–4502B6History of epilepsy, active brain tumours, anorexia nervosa, bulimia, alcohol or benzodiazepine withdrawalStop smoking12–30 h
Agomelatine25–501A2/2C9Liver impairmentInsomnia2.3 h
  • h, hours; MAOI, monoamine oxidase inhibitor; SSRI, selective serotonin reuptake inhibitor.