anxiety

How do you manage the side effects of SSRIs?

What do you do when a patient taking an SSRI presents with anorgasmia, bruxism, or hyponatremia? Firstly – believe your patient. Your 60 yo may experience an increase in suicidal thoughts even though the textbook says that she shouldn’t. In general, your options for managing side effects from medication are: The balance between the medication benefits …

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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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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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