Dosing
Approximately 75% of patients respond to the initial
low dose of antidepressants (with the exception of
OCD). In some patients, such as the elderly, treatment
should be started with half the recommended
dose or less in order to minimize initial adverse drug
events. In particular, patients with panic disorder
may be sensitive to serotonergic stimulation and
may easily discontinue treatment because of initial
jitteriness and nervousness. For tricyclic antidepressants
(TCAs), it is recommended to initiate the drug
at a low dose and increase the dose every 3 – 5 days.
The antidepressant dose should be increased to the
highest recommended therapeutic level if the initial
treatment with a low or medium dose fails. For
OCD, medium to high doses are recommended. If
pharmacokinetic data support once daily dosing,
taking medications in a single dose may increase
compliance. In patients with hepatic impairment, a
dosage adjustment or use of medications with primarily
renal clearance (e.g., pregabalin) may be
required.