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Table 5. Physical Symptom- and Distress-Driven Approach to Choosing an Antidepressanta in Adult Cancer Patients

Distressing Symptom  SSRI TCA  Psychostimulants  Other 
Neuropathic paind++
Opioid side effects++
Loss of appetite (weight loss)++
Dry mouth/stomatitis++

SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; + = use of this medication could relieve the symptom; – = use of this medication could worsen the symptom.
aIn general, doses should start low and increase slowly. This list does not indicate absolute indications or contraindications for particular medications. A current Physicians' Desk Reference or another reliable drug information resource and experience should guide clinical decision making.
bAlthough all SSRIs have the potential paradoxical side effect of hypersomnia, fluoxetine is particularly activating. Bupropion is also somewhat activating.
cSedating antidepressants are useful for insomnia, either alone or in addition to another antidepressant. Trazodone and mirtazapine are often used as sleep aids in combination with another antidepressant.
dSome antidepressants are useful in treating neuropathic pain. The most studied of these are the TCAs, particularly amitriptyline.
eSedating antidepressants are most useful for anxious/agitated patients. These include the TCAs, trazodone, mirtazapine, and nefazodone.