Antidepressant Treatment Algorithm
- Is patient currently taking any medication?
If YES
If NO
Symptoms improving but not resolved: Increase dose of current medication
If patient is on therapeutic dose (see table below) for 4 – 8 weeks that has not helped: Consider changing medication, and use the information below to select a course of treatment
Does patient have a history of taking an antidepressant that has helped?
• If YES: Prescribe the same medication that helped the patient in the past, and use the information below to help with dosage
• If NO: Use the information below to select a course of treatment
First Line Treatment
Other SSRI Options
Medication
sertraline (Zoloft)
fluoxetine (Prozac)
citalopram (Celexa)
escitalopram (Lexapro)
Starting dose
25 mg
10 mg
10 mg
5 mg
How to up
up to 50 mg after 4 days, up to 100 mg after 7 days, then up by 50 mg until symptoms remit
up to 20 mg after 4 days, then up by 10 mg until symptoms remit
up to 20 mg after 4 days, then up by 10 mg until symptoms remit
up to 10 mg after 4 days, then up by 10 mg up to 20 mg until symptoms remit
Therapeutic range
50 – 200 mg
20 – 60 mg
20 – 40 mg
10 – 20 mg
In general, if an antidepressant has helped, it is best to continue it during lactation
General Side Effects of Medications
Temporary
- Nausea
- Constipation/diarrhea
- Lightheadedness
- Headaches
Long-Term
- Increased appetite/weight gain
- Sexual side effects
- Vivid dreams/insomnia
Recommend patients take medication with food to decrease side effects Tell women only to increase dose if tolerating; otherwise wait until side effects dissipate before increasing For effects on fetus/neonate, see Discussing Antidepressant Use with Perinatal Patients.
2. Repeat EPDS in 2 – 4 weeks and re-evaluate depression treatment plan via clinical assessment
If no/minimal clinical improvement after 4-8 weeks
If clinical improvement and no/minimal side effects
If patient has no or minimal side effects, increase dose If patient has side effects that are severe/intolerable, or that do not resolve after 1-2 weeks, switch to a different medication
Reevaluate every month and at postpartum visit
This resource has been adapted with permission from the MCPAP for Moms Pediatric Toolkit for Postpartum Depression.
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