University:
West Coast University
Course:
PHAR 835 | IPC Neurology/Psychiatry
Academic year:

2024
Views:

313

Pages:

2
Author:

Asal A.

First-Line Medications These are the first treatments typically prescribed for MDD: 1. SSRIs (Selective Serotonin Reuptake Inhibitors) When to use: First choice due to fewer side effects. Use for patients with cardiac conditions (e.g., Sertraline is preferred for patients with heart issues). When to avoid: Avoid Paroxetine in pregnant patients and patients concerned about sexual side effects. Watch for QTc prolongation with Citalopram and Escitalopram. 2. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) When to use: Good for patients with chronic pain conditions like fibromyalgia or diabetic neuropathy (Duloxetine). When to avoid: Avoid if the patient has uncontrolled high blood pressure. 3. Bupropion (Wellbutrin) When to use: Great for patients with sexual side effects from other antidepressants or who have concerns about weight gain. When to avoid: Do not use in patients with a history of seizures, eating disorders, or those withdrawing from alcohol or benzodiazepines. 4. Mirtazapine (Remeron) When to use: For patients needing help with sleep or appetite stimulation. When to avoid: Avoid in patients who are overweight or have hypersomnia (excessive sleep). Second-Line Medications Aul-elok Toh Nor perme BANG Des-Nor These are prescribed if the first-line treatments don't work or cause intolerable side effects. CIOM-ANR Dox-siln 1. TCAS (Tricyclic Antidepressants) When to use: May be used when SSRIs/SNRIs fail. Secondary amines (e.g.. Nortriptyline) have fewer side effects than, tertiary amines (e.g., Amitriptyline). When to avoid: Avoid)in patients with a history of cardiac arrhythmias, seizure disorders, or if the risk of overdose is a concern. 2. MAQIs (Monoamine Oxidase Inhibitors) When to use: Reserved for treatment-resistant cases. Always avoid as a first-line treatment. Tron-par then wor • When to avoid: Do not combine with SSRIs, SNRIs, or other serotonergic agents due to the risk of serotonin syndrome. Avoid foods high in tyramine (cheese, wine, etc.) to prevent hypertensive.crises. When to Switch or Add Medications If the first-line treatment doesn't work after 4-8 weeks, consider: Increasing the dose. Switching to a different first-line medication. Adding an adjunct medication (c.g., aripiprazole, quetiapine XR, or Esketamine nasal spray for treatment-resistant cases). Key Points Cardiac Risk: Use Sertraline. Pregnancy: Avoid Paroxetine. Weight Gain/Sleep Issues: Mirtazapine may help with appetite and sleep but avoid in overweight patients. Sexual Dysfunction: Consider Bupropion or Mirtazapine if the patient has concerns about sexual side effects. Tapering: Antidepressants should be tapered off slowly (except Fluoxetine due to its long half- life).