Author name: Emma Samelson-Jones

When should you stop an SSRI trial for depression due to lack of efficacy?

30 yo woman with generalized anxiety disorder presents in her first major depressive episode. She is depressed, hopeless, sleeping poorly, exhausted, and losing weight (6 pounds in the last month). She has never taken psychiatric medications before. She would like to try a medication to treat both depression and anxiety (so bupropion is out).  You prescribe …

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How do you evaluate for bipolar disorder in depressed patients? 

Olivia is a 19 yo woman who presents to primary care during her first major depressive episode. She feels depressed every day with a deep sense that she will always be a failure. She can’t concentrate well enough to read anymore, though she can follow short TV shows. She has low energy and wakes up every morning at …

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How do you taper long-term benzodiazepines?

We return to Mr. Davis, a 75-yo man who has taken temazepam 30mg at bedtime for 15 years for insomnia. He recently fell and fractured his wrist. You discussed the risks and benefits of continuing vs stopping temazepam and the rationale for tapering the medication as described in the prior PsychSnap. Mr. Davis decides to move forward …

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Beyond seasonal depression: how can bright light therapy be used in the management of mood disorders?

Michelle is a 45 yo woman with a history of recurrent major depression. She took several antidepressants in her 20s that were either intolerable (escitalopram) or ineffective (sertraline, venlafaxine). She has been taking fluoxetine 20mg for many years, which she says “puts a floor” on her depression. Higher doses of fluoxetine make her feel too activated. She …

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When a young adult is hearing voices and psychiatry is unavailable for months, how can you help? (part 2)

The initial published case has been modified slightly in response to feedback from colleagues. We return to Juan, the 20 yo man from our last PsychSnap. He started hearing the voice of a little boy saying things like “why won’t you help me” three months ago. He now hears the voice multiple times a day, which …

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When a young adult is hearing voices and psychiatry is unavailable for months, how can you help? (part 1)

The initial published case has been modified slightly in response to feedback from colleagues. Juan is a 20 yo young man who is brought to his PCP’s office by his mother for “hearing voices.” You speak with Juan alone first. For 3 months, he has been hearing the voice of a young boy, talking directly to him, …

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Which antidepressants are least likely to cause weight gain?

After almost 2 years of discussing pharmacotherapy, a 48 year old woman with severe generalized anxiety disorder (GAD) agrees to take medication. She starts taking escitalopram and increases the dosage. After 8 weeks on a daily dose of escitalopram 20mg, her anxiety symptoms are in remission. She has no side effects. However, when you see her 6 months …

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If Adderall XR is unavailable, what else can you prescribe?

Your patient is a 34 yo man with ADHD who has been stable on Adderall XR 30mg for 15 years. He can’t get the medication due to the nationwide shortage. What else can you prescribe if Adderall XR is not available in pharmacies? There are only two types of stimulants that are prescribed for ADHD – methylphenidate …

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How do you choose an antidepressant?

You see a 24 yo woman in a severe major depressive episode and offer her sertraline and a referral to therapy. After the visit, the medical student rotating with you asks why you chose sertraline for this patient. He follows with, “I guess I’m asking…how do you choose an antidepressant?” You answer his question in three …

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