If we prescribe an antidepressant, what dose do we start and how do we increase it? A slower antidepressant up-titration may reduce side effects and improve initial adherence, but it may also delay clinical response
How do you individualize antidepressant prescribing? (Part 2) Read More »
Understanding the patient’s prior experiences with psychotropic medications allows you to individualize your prescribing – pick the right medication, the right starting dose, and the right titration for this person.
How do you individualize antidepressant prescribing? (Part 1) Read More »
Drug-induced sexual dysfunction is a common reason that people stop SSRI/SNRIs. By evaluating and managing sexual side effects, we can improve antidepressant treatment adherence.
How do you manage SSRI/SNRI-induced sexual side effects? (part 2) Read More »
There are three strategies for switching between antidepressant medications: sequential titration, cross-titration, and direct switch. In most situations, I use the cross-titration strategy.
How do you switch from one antidepressant medication to another? Read More »
Strategies to manage sexual side effects include deprescribing, reducing the dose, temporarily reducing the dose via drug holidays, switching medications, adding a medication to treat the side effect, and accepting the sexual side effects given the benefits of the medication.
How do you manage SSRI/SNRI-induced sexual side effects? Read More »
Contingency management (incentivizing and rewarding positive behavior change) is the standard of care, most evidence-based treatment for pts w/ stimulant use disorder (StUD). While there are no FDA-approved medications for StUD, mirtazapine and naltrexone+bupropion Xl show promise for reduction in stim use.
What treatments help patients stop using methamphetamine? Read More »
An adequate trial of an antidepressant for the acute treatment of major depressive disorder requires adequate adherence (80% of doses) to an adequate dose (moderate dose of an SSRI or mirtazapine, FDA max dose for venlafaxine) for an adequate duration (4-8 weeks).
When should you stop an SSRI trial for depression due to lack of efficacy? Read More »
On average, people gain weight on SSRIs and SNRIs in the long term, but there is wide variation among individuals. Among the SSRIs, fluoxetine is the least likely to cause weight gain.
Which antidepressants are least likely to cause weight gain? Read More »
2 out of 5 people with a history of recurrent major depression in remission who remain on their medications will experience a relapse of depression within the next year.
Mirtazapine (Remeron) is at least as effective as the SSRIs for depression, and is also commonly used off-label for anxiety, PTSD, and insomnia. Mirtazapine doses of 3.75-7.5mg are helpful for sleep maintenance. Higher doses (30-45mg) are necessary for the antidepressant and anti-anxiety effects.
What change could reduce anxiety in a patient with partial benefit from an SNRI? Read More »
