Distressing Symptom	SSRI	TCA	Psychostimulants	Other
Fatigue	+ (a)		+	+ (a)
Insomnia (b)		+		+ (b)
Neuropathic pain (c)	+	+
Opioid side effects	+		+
Constipation	+		+
Loss of appetite (weight loss)		+	+
Anxiety	+	+		+ (d)
Dry mouth/stomatitis	+	-	+

Key:

(-) use of this medication could worsen the symptom

(+) use of this medication could relieve the symptom

Notes:

(a) Although all SSRIs have the potential paradoxical side effect of hypersomnia, fluoxetine is particularly activating. Bupropion is also somewhat activating.

(b) Sedating 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.

(c) Some antidepressants are useful in treating neuropathic pain. The most studied of these are the TCAs, particularly amitriptyline.

(d) Sedating antidepressants are most useful for anxious/agitated patients. These include the TCAs, trazodone, mirtazapine, and nefazodone.

SSRI = Selective Serotonin Reuptake Inhibitor

TCA = Tricyclic Antidepressant

In 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.