What Meds to Use When - Lassila

Depression with significant insomnia

prefer trazodone or low dose mirtazapine

Depression with poor appetite or weight loss

prefer mirtazapine due to appetite stimulation and weight gain

Depression with concern for weight gain

prefer bupropion or SSRI over mirtazapine

Depression with SSRI induced sexual dysfunction

add or switch to bupropion

Depression with cognitive symptoms or pseudodementia

prefer vortioxetine or bupropion

Depression with comorbid chronic pain or neuropathy

prefer duloxetine or venlafaxine

Depression with significant anxiety

prefer SSRI and start at low dose with slow titration

Depression with history of poor medication adherence

prefer fluoxetine due to long half life

Partial response to SSRI or SNRI

prefer combination therapy rather than switching immediately

Depression with fatigue or low energy

prefer bupropion due to activating properties

Depression with need for rapid symptom improvement

consider esketamine in treatment resistant cases

Treatment resistant depression

after two failed adequate antidepressant trials consider augmentation therapy

Augmentation therapy in depression

prefer atypical antipsychotic lithium or T3 depending on patient factors

Depression with sleep maintenance insomnia

add trazodone to existing SSRI or SNRI

Depression with residual anergia on SSRI

add bupropion as combination therapy