Medication*	Starting dosage (per day)†	Usual dosage (per day)	Onset of action	Clinical considerations	Cost of generic (brand)‡
Amitriptyline§	10 to 25 mg	25 to 100 mg	4 to 8 weeks	Anticholinergic effects common (sedation, delirium, urinary retention, orthostatic hypotension); may lower seizure threshold¹⁷	$12
Amitriptyline§	10 to 25 mg	25 to 100 mg	4 to 8 weeks	Useful agent for neuropathy¹⁷	$12
Bupropion (Wellbutrin)§	100 to 200 mg	200 to 450 mg	4 to 8 weeks	Lowers seizure threshold; may cause insomnia, nausea, and dry mouth	$30 ($108)
Bupropion (Wellbutrin)§	100 to 200 mg	200 to 450 mg	4 to 8 weeks	Minimal sexual adverse effects	$30 ($108)
Citalopram (Celexa)§∥	10 mg	20 to 40 mg	4 to 8 weeks	Causes dose-dependent QT interval prolongation	$17 ($120)
Citalopram (Celexa)§∥	10 mg	20 to 40 mg	4 to 8 weeks	Maximum dosage of 20 mg per day recommended in older patients	$17 ($120)
Desipramine (Norpramin)	10 to 25 mg	25 to 100 mg	4 to 8 weeks	Fewer anticholinergic adverse effects than amitriptyline¹⁷	$33 ($41)
Duloxetine (Cymbalta)	30 to 60 mg	60 mg	4 to 8 weeks	Noradrenergic activity may cause dry mouth, excessive sweating, and constipation	NA ($182)
Duloxetine (Cymbalta)	30 to 60 mg	60 mg	4 to 8 weeks	May help with neuropathic pain	NA ($182)
Escitalopram (Lexapro)∥	5 to 10 mg	10 to 20 mg	4 to 8 weeks	Causes dose-dependent QT interval prolongation	NA ($120)
Fluoxetine (Prozac)§∥	5 to 10 mg	20 to 40 mg	4 to 8 weeks	Fluoxetine associated with weight loss, others associated with weight gain	$15 ($214) for 10 mg
Fluoxetine (Prozac)§∥	5 to 10 mg	20 to 40 mg	4 to 8 weeks	Fluoxetine and paroxetine have high potential for drug-drug interactions caused by potent CYP2D6 inhibition¹⁷	$15 ($214) for 10 mg
Methylphenidate (Ritalin)	2.5 to 5 mg	10 to 20 mg	1 to 3 days	Dose in the morning and at noon to avoid insomnia¹⁷	$45 ($65) for 5 mg
				Well tolerated in most patients, with most having good response at lower doses¹⁷
				May also help with fatigue, opioid-induced sedation, and appetite¹⁷
Mirtazapine (Remeron)§	7.5 to 15 mg	15 to 45 mg	4 to 8 weeks	Administer at bedtime because of sedative effects	$50 ($135) for 30 mg
				May increase appetite
				Antinausea effects have been reported
Nortriptyline (Pamelor)§	10 to 25 mg	25 to 100 mg	4 to 8 weeks	Fewer anticholinergic adverse effects than amitriptyline¹⁷	$18 ($696)
Paroxetine (Paxil)§\|\|	10 mg	20 to 40 mg	4 to 8 weeks	Fluoxetine and paroxetine have high potential for drug-drug interactions due to potent CYP2D6 inhibition¹⁷	$30 ($117)
Paroxetine (Paxil)§\|\|	10 mg	20 to 40 mg	4 to 8 weeks	Withdrawal toxicity more likely to occur with paroxetine	$30 ($117)
Sertraline (Zoloft)§\|\|	12.5 to 25 mg	50 to 200 mg	4 to 8 weeks	—	$20 ($138)