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Higher doses are necessary for treatment of obsessive compulsive disorder.
For most indications the SSRIs are considered first-line as they are better tolerated and have a wider safety margin than the tricyclic antidepressants (TCAs) and irreversible nonselective monoamine oxidase inhibitors (MAOIs).
MAOIs (phenelzine, tranylcypromine) are now rarely used because of their severe, and potentially fatal, interactions with some foods and medications.
Treatment resistant cases should be referred to secondary care.
SSRIs are better tolerated and are safer in overdose than other classes of antidepressants.
Other factors to consider include: Some people experience withdrawal effects after missing 1 or 2 doses, especially when using a drug with a short half-life (e.g. At the end of a treatment course, taper antidepressant over several weeks and monitor for withdrawal symptoms. SSRIs are relatively activating and usually best given as a single daily dose each morning.
Routine use of doses above those recommended rarely increases antidepressant effect.
start with 25–50 mg of nortriptyline and increase by 25 mg every third night to 100 mg.
It is usual to take SSRIs in the morning due to the risk of insomnia and TCAs at night because they may be sedative.
Continuation of the same antidepressant can also be considered in patients who show a partial response at 6 weeks.Tags: Adult Dating, affair dating, sex dating