Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Levomilnacipran(click to collapse)
1/4 selected
Levomilnacipran
Fetzima
Serotonin-Norepinephrine Reuptake Inhibitor
FDA-approved indications
- Major depressive disorder (adults)
Off-label uses
- Fibromyalgia
- Neuropathic pain
Half-life12 hours
Decision GuideWhen to pick each / when to consider an alternative
Levomilnacipran
Consider when
- Prominent fatigue, anergia, or psychomotor retardation — most NE-preferring SNRI (2:1 NE:5-HT); true dual inhibition across entire dose range
- Functional impairment is the primary target — only antidepressant with FDA labeling for SDS functional improvement; ranked 3rd among ADs
- Minimal perpetrator drug interactions needed — no CYP enzyme inhibition; safe with CYP2D6 substrates unlike duloxetine
- Patient tolerates or needs activation — most activating SNRI; morning dosing aligns with stimulating noradrenergic profile
- +1 more
Consider an alternative when
- Cardiovascular risk — highest HR increase among antidepressants (+7.67 bpm Pillinger 2025); SBP +3.36, DBP +3.54 significant
- Sleep is fragile — most activating SNRI; insomnia 10–13% labeled rate; may worsen insomnia-predominant depression
- Hyperhidrosis poorly tolerated — 9% vs 2% placebo; potent noradrenergic mechanism drives sweating
- Sexual dysfunction is a priority — dose-response ED 6/8/10% across 40/80/120 mg; ejaculation failure 5%
- +1 more
Efficacy & Acceptability (1 axes)— NMA efficacy & discontinuation data (not side effects)
| Axis | Levomilnacipran |
|---|---|
| 📊 Efficacy (response rates) | |
MDDEfficacy | |
| Axis | Levomilnacipran SNRI |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
Mania / hypomania induction | |
| CNS | |
Sedation / somnolence | |
Activation / insomnia | |
Seizure risk | |
| Metabolic | |
Weight loss | |
Metabolic (glucose / lipids) | |
| Autonomic | |
Anticholinergic burden | |
Sweating | |
Angle-closure glaucoma | |
| Cardiac | |
QTc prolongation | |
Blood pressure elevation | |
Heart rate / tachycardia | |
| GI | |
Nausea / GI (general) | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |
| Electrolytes | |
Hyponatremia / SIADH | |
| Sexual | |
Sexual dysfunction | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Interactions | |
Serotonin syndrome risk | |
CYP interactions / DDI profile | |
| Safety | |
Bleeding risk | |
| Pregnancy | |
Lactation / breastfeeding safety | |