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CME
Treating Depressive Disorders
 
Melancholic Depression (severe)
Among the most severely depressed patients in your practice
Level of Evidence Place in Therapy Medication Usual Daily Dose1 3 Cost per
Day2
Level I Evidence and generally tolerable side effect/safety profile. 1st choice ELECTROCONVULSIVE THERAPY IS GENERALLY CONSIDERED THE MOST EFFECTIVE TREATMENT FOR MELANCHOLIC/SEVERE DEPRESSION.
NEFAZODONE
(Serzone) 		200-400 mg $0.93-1.86
VENLAFAXINE
(Effexor) 		75-225 mg $1.56-3.21
CLOMIPRAMINE
(Anafranil) 		100-250 mg $0.87-2.19
DESIPRAMINE4
(Norpramin) 		100-250 mg $0.82-2.06
IMIPRAMINE
(Tofranil) 		100-250 mg $0.04-0.09
Level II evidence or Level I evidence but less tolerable side effect/safety profile. 2nd choice NORTRIPTYLINE4
(Aventyl) 		75-150 mg $0.91-1.82
FLUOXETINE
(Prozac) 		20-40 mg $1.08-2.16
PAROXETINE
(Paxil) 		20-40 mg $1.59-3.18
SERTRALINE
(Zoloft) 		50-150 mg $1.60-3.35
Level III evidence or Level I/II evidence and significantly less tolerable side effect/safety profile. 3rd choice AMITRIPTYLINE
(Elavil) 		100-250 mg $0.03-0.08
PHENELZINE5
(Nardil) 		30-75 mg $0.60-1.50
TRANYLCYPROMINE5
(Parnate) 		20-60 mg $0.67-2.00

NOTE: Non-responding patients should be switched to an alternative 1st choice agent prior to attempting a 2nd choice antidepressant.

 

1. Usual daily doses are provided unless otherwise stated. Consult the drug monograph for details on age and condition specific dosing.
2. Approximate costs were derived from the ODB formulary (#36) or manufacturers' price lists and do not include professional fees or markups.
3. Higher doses may be required by some patients.
4. May have fewer anticholinergic side effects than other TCAs.
5. Food and drug restrictions apply. Two-week washout required after discontinuation.

From: CANMAT - Guidelines for the Diagnosis and Pharmacological Treatment of Depression (1st Edition Rev., 1999) Page 24.

Back to Treating Depressive Disorders

Back to Managing Depressive Disorders - (Selections from: CANMAT - Guidelines for the Diagnosis and Pharmacological Treatment of Depression [1st Edition Rev., 1999])

 


Over one million Canadians suffer from some form of depressive illness.