Chapter 2
IN THIS LESSON
General considerations
if there is a history of a specific SSRI working well for pt in the past consider going back to the SAME one unless there are contraindications
More anxiety than depression → Celexa (weight neutral) or Lexapro (fast, interact with other meds less)
More depression than anxiety → Zoloft (elderly, peripartum) or Prozac (good for apathy, low motivation, eating disorders, PMDD)
🙂 Less weight gain than some other SSRIs (in fact weight loss of 0.5kg on average compared to placebo via decreasing appetite)
🙂 Good choice for patients on a lot of other meds - Less medication interactions than some other SSRIs, easy to augment (SSRI with least interaction on CYP450, 2D6, 3A4)
🙂 Faster onset of action than some other SSRIs - use when quick fix is needed
Celexa and Lexapro
🙂 Little sexual dysfunction; use it pts wary of that
🙂 Better suited for older patients than other SSRIs *max daily dose of 10mg for pts 60+, check for diuretic use, educate avoid dehydration = risk of hyponatremia (confusion, imbalance), beware of cardiac contraindications and glaucoma
🙂Better choice for agitated, anxious patients with a lot of insomnia
😟 Contraindicated when there is a history of structural heart disease, recent MI, electrolyte disturbance, bradycardia (risk of QTc prolongation)
😟 Contraindicated in eating disorders esp anorexia due to a risk of electrolyte imbalance and risk of arrhythmia
🙂 Best documented cardiovascular safety - Proven safe in cardiac conditions including recent angina/MI
🙂 Most researched to be relatively safe in pregnant and breastfeeding women (if baby becomes irritable/sedated, discontinue breastfeeding or medication depending on the clinical scenario)
🙂 The only SSRI without risk of increasing prolactin levels (use in patients who had that side effect on other meds)
🙂 good for breasfeeders
😟 More GI side effect than other SSRIs - avoid if pt has IBS or other GI condition, consider BID
🙂 Least withdrawal, works for patients who tend to miss dosages
🙂 Works well for comorbid eating disorders (binge eating, bulimia, avoid in anorexia) and affective disorders
🙂 Works well for PMDD on and off method
🙂 Works well for discontinuation symptoms of other SSRIs, SNRIs (take Prozac 10mg daily for a week, then take Prozac 10mg every second day for a week then stop)
🙂 Works well for fibromyalgia
Zoloft and Prozac
Some dopamine reuptake inhibition (Prozac > Zoloft) could contribute to agitation when starting the medication (start low) → take in the AM
🙂 For this reason they work well in atypical depression (hypersomnia, hyperphagia, fatigue)
🙂 For this reason they work well for patients who experienced cognitive flattening on other meds
*The more anxious, the slower the titration, the more likely the need for PRN anxiety (eg hydroxyzine) and sleep aids (eg trazodone)
😟 AVOID in agitated insomniacs, avoid if pt has panic attacks
😟 More prone to causing activation symptoms, worsen anxiety and insomnia (all suicide risk) at the beginning or with dose increases, more prone to cause manic flip. See “Reasons to stop” on individual medication pages
Paxil
🙂 more sedating and calming for highly anxious pt or pt with PTSD sxs (administer with dinner)
🙂 good for breasfeeders
😟 most sexual side effects, hardest to get off of due to discontinuation sxs
😟 most weight gain
😟 most orthostatic hypotension
NOT to be used in pregnancy under any circumstance
Luvox
for OCD and related disorders
-
Add a short summary or a list of helpful resources here.