Author name: Emma Samelson-Jones

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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What medication could you add to a dose-optimized SSRI to help with anxiety?

Your patient is a 44 yo man with a mild radiculopathy from an old basketball injury and severe generalized anxiety disorder. He previously responded to trials of sertraline 100mg daily and venlafaxine XR 150mg daily, but both caused significant sexual side effects.  He stopped each of the medications after a year when he was feeling

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Does this patient’s history of binging and purging make it unsafe to start bupropion?

Your patient is a 25 yo woman in a current major depressive episode. She was treated with escitalopram first, and then switched to sertraline. Each medication helped her depression and caused anorgasmia, which caused her to stop them.  She is moderately depressed, and wants to know if there is anything that she can take for depression that

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Which SSRI should I choose?

What follows is a brief summary of the clinically important differences between the SSRIs, followed by 5 patient cases that ask, “Which SSRI?”   The five SSRIs most commonly used in the US for depression and anxiety are fluoxetine, paroxetine, sertraline, citalopram, and escitalopram.  The sixth SSRI, fluvoxamine, is mainly used to treat OCD.   All

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What change could reduce anxiety in a patient with partial benefit from an SNRI?

A 62 yo woman has a history of chronic pain from osteoarthritis, severe sciatica, recurrent major depression, generalized anxiety, and insomnia. She takes chronic low-dose opioids for pain and an SNRI (duloxetine, titrated to 60mg BID) for pain, depression, and anxiety, with moderate improvement in pain and depression and mild improvement in anxiety.   She currently

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What caused low energy in a patient whose other depressive symptoms were improving with escitalopram?

One year after the death of her spouse, a 75 yo woman with hypertension on hydrochlorothiazide presents in a first major depressive episode with prominent neurovegetative symptoms (difficulty sleeping, low appetite with a 10lb weight loss, low energy, mild psychomotor retardation).  You start her on escitalopram 2.5mg for 1 week, then increase to 5mg, and

What caused low energy in a patient whose other depressive symptoms were improving with escitalopram? Read More »