Antidepressants and other psychiatric medications in cancer care

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Medication	Class	Indication	Starting dose	Target dose	Interactions	Side effects
Citalopram (Celexa)	SSRI	Anxiety Depression	10 mg	20-40 mg	Mild 2D6 inhibition Platelet dysfunction	Nausea fatigue
Escitalopram (Lexapro)	SSRI	Anxiety Depression	5 mg	10-20 mg	Mild 2D6 inhibition Platelet dysfunction	Nausea fatigue
Fluoxetine (Prozac)	SSRI	Depression Anxiety	10 mg	20-60 mg	CYP450 2D6 inhibition Very long half-life and multiple drug interactions	Nausea Sedation
Sertraline (Zoloft)	SSRI	Depression Anxiety	50 mg	150-200 mg	Weak 2D6 inhibition Inhibits platelet function	Nausea
Venlafaxine (Effexor XR)	SNRI	Depression Anxiety	37.5 mg	150 mg	2D6 inhibition Reduces platelet function	Hypertension Nausea Flu-like withdrawal
Bupropion (Wellbutrin/Zyban)	Other antidepressant	Depression Activating	SR: 50-75 mg XR: 150 mg	150-300 mg	Strong 2D6 inhibition	Seizure risk (Black box) Anxiety
Mirtazapine (Remeron)	Other antidepressant	Anxiety Depression Insomnia	7.5 mg	30-40 mg	Neutropenia reported 2D6 substrate	Weight gain Sedation
Trazodone (Desyrel)	Other antidepressant	Anxiety Insomnia	25-50 mg	50-100 mg	3A4 substrate	Sedation Nausea
Desipramine (Norpramin)	Tricyclic	Depression Anxiety Insomnia Boost pain control	10-25 mg	Check blood levels and EKG	Strong 2D6 inhibition Rare agranulocytosis	Anticholinergic symptoms
Imipramine (Tofranil)	Tricyclic	Depression Anxiety Insomnia Boost pain control	10-25 mg	Check blood levels and EKG	Strong 2D6 inhibition Rare agranulocytosis	Anticholinergic symptoms
Nortriptyline (Pamelor)	Tricyclic	Depression Anxiety Insomnia Boost pain control	10-25 mg	Check blood levels and EKG	Strong 2D6 inhibition Rare agranulocytosis	Anticholinergic symptoms
Gabepentin (Neurontin)	Anti-seizure	Pain control Anxiety Insomnia	100 mg	Large range from 300-3600 mg	Renal excreted (i.e. not metabolized)	Sedation
Lamotrigine (Lamictal)	Anti-seizure	Elevates mood	25 mg	200 mg (for psych)	No weight gain Other anti-seizure medications can double blood levels of lamotrigine	Stevens-Johnson with any change in dose (Black box)
Aripiprazole (Abilify)	Antipsychotic	Agitation Anxiety	5 mg	15-20 mg	QTc prolongation may be less than other atypicals No CYP450 inhibition Rare agranulocytosis	Less weight gain Extrapyramidal symptoms including akathisia and risk of tardive dyskinesia when mixed with prochlorperazine (Compazine) or metoclopramide (Reglan)
Olanzapine (Zyprexa)	Antipsychotic	Agitation Insomnia Anxiety	2.5-5 mg	10 mg	QTc prolongation	Sedation Weight gain
Quetiapine (Seroquel)	Antipsychotic	Nausea Anxiety Insomnia Agitation	25-50 mg	100-300 mg	3A4 substrate, limited drug/drug interactions QTc prolongation	Sedation Weight gain
Zolpidem (Ambien)	Insomnia	Insomnia	5 mg	5-10 mg	Alcohol interaction Hepatic metabolism	Sedation Dizziness Parasomnias

Information adapted from a table created by Christine Wittmann, MD and Laurie Rosenblatt, MD. Used with permission.