Protriptyline
[Vivactil] First-line tricyclic, low sedation/anticholinergic/hypotension risk. More noradrenergic.
Medication
Nortriptyline
[Pamelor] First-line tricyclic, low sedation/anticholinergic/hypotension risk. More
noradrenergic.
Desipramine
[Norpramin] Second-line tricyclic, low sedation/anticholinergic/hypotension risk. More
noradrenergic.
Doxepin
[Sinequan/Silenor] Treats sleep in low-dose (esp early am awakening), depression in higher
doses (tricyclic).
Venlafaxine
[Effexor] Not ideal among the SNRIs (hypertension, WD risks, weight gain), but very effective for some and treats hot flashes in low doses.
Milnacipran
[$ Savella] Approved for fibromylagia in US and depression abroad (parent compound of
levomilnacipran).
Levomilnacipran
[$ Fetzima] Most noradrenergic of the SNRIs, good for fatigue, with side effect profile similar to
bupropion. Isomer of milnacipran (used in fibromylagia).
Duloxetine
[Cymbalta] Approved for child anxiety. Risk of urine retention (but treats urine incont). Liver
risk.