First Among Equals
For some time I’ve had dosage equivalents of SSRIs and SNRIs on the SSRI & SNRI Tachyphylaxis page. Obviously those are only SSRIs and SNRIs. Not only that, they are at or near minimum therapeutic dosages. When I first put that mine together I didn’t like any of existing equivalencies there were based upon efficacy, so I did mine based upon each med’s pharmacology. There are much better ones now, although I still prefer my pharmacology-based approach. Mainly because it doesn’t rely upon the existence of a randomized control trial, and a few key ones are missing. The big downside to pharmacology-based equivalencies is they are restricted to meds with similar mechanisms of actions. I can compare SSRIs and SNRIs with each other, and, theoretically, TCAs with each other, but clomipramine and Tofranil (imipramine) is the only TCAs I could really compare with SSRIs & SNRIs.
fluoxetine 40 mg/day was equivalent to agomelatine 53.2 mg/day, amitriptyline, 122.3 mg/day, bupropion 348.5 mg/day, clomipramine 116.1 mg/day, desipramine 196.3 mg/day, dothiepin 154.8 mg/day, doxepin 140.1 mg/day, fluvoxamine 143.3 mg/day, imipramine 137.2 mg/day, maprotiline 118.0 mg/day, mirtazapine 50.9 mg/day, moclobemide 575.2 mg/day, nefazodone 535.2 mg/day, paroxetine 34.0 mg/day, reboxetine 11.5 mg/day, sertraline 98.5 mg/day, trazodone 401.4 mg/day, and venlafaxine 149.4 mg/day. — --Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials
In terms of dosages you can actually take2, that works out to:
40 mg/day of Prozac (fluoxetine) = 100–125 mg/day Anafranil (clomipramine) = 200 mg/day desipramine = 150 mg/day dosulepin/dothiepin = 125–150 mg/day doxepin = 12 mg/day Edronax (reboxetine) = 150 mg/day Effexor (venlafaxine) = 125 mg/day Elavil (amitriptyline) = 150 mg/day Luvox (fulvoxamine) = 600 mg/day Manerix (moclobemide) = 120–125 mg/day maprotiline = 37.5 - 40 mg/day Paxil (paraxotine) = 45 mg/day Remeron (mirtazapine) = 500 mg/day Serzone (nefazodone) = 150 mg/day Tofranil (imipramine) = 400 mg/day trazodone = 50 mg/day Valdoxan (agomelatine) = 350 mg/day Wellbutrin (bupropion) = 100 mg/day Zoloft sertraline
I excluded Lexapro (escitalopram), lofepramine, mianserin, and Pamelor (nortriptyline) because the evidence of the studies used was determined by Dr. Hayasaka to be low. If it’s not moderate or better it’s no good to me3. Other gaping holes due to lack of comparative studies meeting the study’s inclusion criteria include Celexa (citalopram), Cymbalta (duloxetine).
I thought I had a shitload of randomized controlled trials comparing Celexa to Prozac, and a couple of decent ones comparing it with Cymbalta. Turns out all I had were studies of lower quality. Damn. Looks like that’s all we have.
The above equivalencies is solely for efficacy! If you’re taking 150 mg a day of Effexor and want to immediately switch to 350 mg a day of Wellbutrin, you’re going to find yourself in a world of hurt. If you’re taking an SSRI or SNRI and want/need to quickly switch to another med, you’re stuck with another SSRI or SNRI if you wish to avoid SSRI/SNRI discontinuation syndrome. Here are the dosage equivalents for SSRIs and SNRIs I’ve worked out based on pharmacology:
20mg Celexa (citalopram) = 10mg Lexapro (escitalopram) = 50mg Luvox (fluvoxamine) = 10mg Paxil (paroxetine) = 20mg Prozac (fluoxetine) = 50mg Zoloft (sertraline) = 75mg Effexor (venlafaxine) = 50mg Pristiq (desvenlafaxine) = 20mg of Cymbalta (duloxetine) = 50mg? of Savella (milnicipran)
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1 Because, according to Dr. Hayasaka, fluoxetine is the most-used AD when doing randomized controlled trials of two or more ADs. Paroxetine comes in second, and her team used paroxetine as a secondary test.
2 The dosages given are for depression spectrum disorders. Dosages for insomnia are typically lower. Sometimes much lower.
3 For something like this. Experimental off-label uses are another story.
Antidepressant Dosage Equivalents by Jerod Poore is copyright © 2015 Jerod Poore
|Last modified on Sunday, 14 June, 2015 at 10:32:12 by JerodPoore||Page Author: Jerod Poore||Date created: 09 June 2015|
All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.
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