Table 3 

Experts' ratings: Choice of antidepressant 

Drug 0 = not useful, 10 = very useful 
Experts comments 


Mirtazapine Round 1: Median 9.0 (710); n = 11 Round 2: Median 9.0 (710); n = 11 
Some data, good profile regarding side effects, at this time most used Seems well tolerated When side effects on sleep and appetite are handy Too soft Has useful sedative properties and well tolerated My firstline  evidence is that it is more effective than SSRIs and appetite stimulant and sedative qualities are useful side effects 


Citalopram Round 1: Median 9.0 (510); n = 11 Round 2: Median 9.0 (510); n = 13 
Side effects due to its antIHJJistaminic action 


Venlafaxine Round 1: Median 7.5 (010); n = 8 Round 2: Median 8.0 (09); n = 13 
Less side effects than tricyclics Useful if patient needs help for sedation If depression is associated with chronic high level of anxiety Not straightforward  discontinuation symptoms common. Cardiac toxicity 


Sertraline Round 1: Median 7.0 (210); n = 11 Round 2: Median 7.5 (010); n = 12 
Favourable side effect profile Interaction with dopamine system could give different and more side effects than other SSRIs Least adverse effects, presently best available 


Escitalopram Round 1: Median 8.0 (010); n = 10 Round 2: Median 7.0 (010); n = 13 
Not cost effective alternative to citalopram Better tolerated than Rcitalopram and less interaction with cytocrome 450 2D6 


Amitriptyline Round 1: Median 5.0 (19); n = 10 Round 2: Median 4.0 (08); n = 12 
Sideeffects Too sedative, effect too delayed, frequent compliance obstacle due to side effects If indicated for neuropathic pain For individual TCAs I don't think there is sufficient evidence to differentially rate, although clinically I would favour those drugs that are used most often in palliative care anyway e.g. amitriptyline An excellent antidepressant 


Paroxetine Round 1: Median 5.5 (09); n = 10 Round 2: Median 3.0 (07); n = 13 
Too many pharmacological interactions Interactions and withdrawal problems No place  withdrawal syndrome 


Fluoxetine Round 1: Median 3.0 (06); n = 10 Round 2: Median 3.0 (06); n = 13 
Too long half time, not useful for physically ill people Long t1/2 and interactions Too disinhibitory, but not better antidepressant than other SSRIs 


Imipramine Round 1: Median 5.0 (06); n = 7 Round 2: Median 2.0 (08); n = 11 
Just in patients with depressive history who have already utilized before 


Nortriptyline Round 1: Median 2.0 (09); n = 9 Round 2: Median 2.0 (07); n = 11 
If indicated for neuropathic pain Less than amitriptyline 


Mianserin Round 1: Median 5.0 (09); n = 7 Round 2: Median 0.0 (07); n = 11 
Little used in practice compared with other drugs and little evidence available No point really  it is pharmacologically similar to mirtazapine, which doesn't hit the white cells 


Rayner et al. BMC Palliative Care 2011 10:10 doi:10.1186/1472684X1010 