• Prescription-only

Key safety considerations

Do NOT use with:

• MAO inhibitors (within 14 days before or 21 days after)
• Certain drugs like linezolid or methylene blue

Risk: serious, potentially life-threatening reactions

Important risks:

• Suicidal thoughts/behavior (especially in young people)
• Serotonin syndrome (dangerous overload of serotonin)
• Bleeding risk (especially with NSAIDs, aspirin, warfarin)
• Low sodium (hyponatremia)—more common in elderly
• May trigger mania in people with bipolar disorder

Who needs caution?

• Elderly (risk of low sodium)
• History of:
  • Bipolar disorder
  • Seizures
  • Bleeding problems
  • Glaucoma
• Breastfeeding: uncertain safety

How to take it?

• Usually 10 mg once daily, may increase up to 20 mg/day
• Take same time daily, with or without food
• Do NOT stop suddenly → withdrawal symptoms can occur

Drug interactions (very important)

• Interacts with many medications, especially:
  • Other antidepressants
  • Pain meds (e.g., tramadol, fentanyl)
  • Migraine drugs (triptans)
  • Blood thinners & NSAIDs
  • Herbal supplements like St. John’s wort

Always tell your doctor all medications you take

Serious side effects (seek medical help)

• Suicidal thoughts, agitation, unusual behavior
• Signs of serotonin syndrome:
  • Confusion, fever, sweating, tremor
• Bleeding (bruising, blood in stool/urine)
• Seizures
• Severe allergic reactions

Common side effects

More common:

• Sexual problems (low libido, difficulty with orgasm/erection)
• Constipation
• Dry mouth

Less serious:

• Nausea, dizziness, gas, unusual dreams

Other important points

• Regular doctor check-ups are needed
• May cause dizziness → be careful driving
• Can affect results of some medical tests

Bottom line

• Effective antidepressant for MDD
• Must be used carefully due to:
  • Significant drug interactions
  • Risk of serotonin syndrome and withdrawal
• Requires close medical supervision