- AP. No established clinical superiority of one. - Consider LAI early.

- If no response at 4 weeks, change medication. - If a partial response, r/a at 8 weeks unless sig interval change. - Trial: 6 weeks at optimized dose. - Following resolution of (+) sx, tx should ctn for 18 months.

- No specific recommendations. Refer to mania.

- Escitalopram, Paroxetine (+CR), Sertraline - Venlafaxine XR, Duloxetine - Pregabalin - Aglomelatine

- Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline - Bupropion - Duloxetine, Venlafaxine, Desvenlafaxine, Milnicepran - Mirtazapine - Vortioxetine - Aglomelatine - Minaserin

- Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline

- TCAs - Trazodone - Seroquel - Vilazadone - Moclobemide - Selegiline transdermal - Levomilnicepram

Medication Treatments Flashcards by Jasmin Bal

Scz 1st line

AP. No established clinical superiority of one.
Consider LAI early.

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Scz trial

If no response at 4 weeks, change medication.
If a partial response, r/a at 8 weeks unless sig interval change.
Trial: 6 weeks at optimized dose.
Following resolution of (+) sx, tx should ctn for 18 months.

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Mania monotherapy 1st line

DVP, Li
Abilify, Asenapine, Seroquel, Risperidone, Paliperidone, Cariprazine

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Mania combo therapy 1st line

DVP/Li + Abilify/Asenapine/Risperidone/Seroquel

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Bipolar I depression 1st line, mono and combo

Mono: Seroquel, Li, Latuda
(adj) Lamotrigine
Combo: Li/DVP + Latuda

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Bipolar I maintenance monotherapy 1st line

DVP, Li, Lamotrigine
Abilify (po/IM), Asenapine, Seroquel

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Bipolar I maintenance combo therapy 1st line

DVP/Li + Seroquel/Abilify

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Bipolar II hypomania

No specific recommendations. Refer to mania.

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Bipolar II depression 1st/2nd line

First line: Seroquel
Second line: Li, Lamotrigine, Bupropion (adj), Sertraline, Venlafaxine, ECT (level 3)

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Bipolar II maintenance 1st line

Seroquel (level 1)
Li, Lamotrigine (level 2)

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Bipolar II maintenance 2nd line

Venlafaxine (level 2)

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GAD 1st line

Escitalopram, Paroxetine (+CR), Sertraline
Venlafaxine XR, Duloxetine
Pregabalin
Aglomelatine

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Social anxiety disorder 1st line

Escitalopram, Fluvoxamine CR, Paroxetine (CR), Sertraline
Venlafaxine XR
Pregabalin
If performance only, consider beta blocker

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Panic disorder/Agorophobia 1st line

Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine (CR), Sertraline
Venlafaxine XR

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Specific phobia 1st line

Medications generally not recommended

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MDD 1st line

Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline
Bupropion
Duloxetine, Venlafaxine, Desvenlafaxine, Milnicepran
Mirtazapine
Vortioxetine
Aglomelatine
Minaserin

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OCD 1st line

Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline

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MDE 2nd line

TCAs
Trazodone
Seroquel
Vilazadone
Moclobemide
Selegiline transdermal
Levomilnicepram

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MDD with anxious distress

Use a med with efficacy in GAD (level 4)

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MDD with catatonic features

Benzos (level 3)

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MDD with melancholic features

No specific recommendations (level 2)

MDD with atypical features

No specific recommendations (level 2)

MDD with psychotic features

Use an AD with an AP (level 1)

MDD with mixed features

Ziprasidone (level 3)
Lurasidone (level 2)

MDD with seasonal pattern

No specific recommendations (level 2,3)

MDD with cognitive dysfxn

- Vortioxetine (level 1) - Bupropion, Duloxetine, SSRIs (level 2) - Mocolobemide (level 3)

MDD with sleep disturbances

- Aglomelatine (level 1) - Mirtazapine, Seroquel, Trazodone (level 2)

MDD 1st line adjunct

Abilify, Quetiapine, Risperidone (all level 1)

MDD 2nd line adjunct

Brexpiprazole, Olanz (level 1) Bupropion, Li, Mirtaz, Modafinil, Triiodothyronine

Mania 2nd line

In order of hierarchy - Olanz - Carbamazapine - Olanz + Li/DVP - Li + DVP - Ziprasidone - Haldol - ECT (BF)

Mania with anxious distress

DVP, Seroquel, Olanz -> Carbamazapine

Mania with mixed features

DVP + AAP

Mania with psychotic features

Combo (mood stabilizer + AP) but no AAP has shown superiority

Mania with rapid cycling

- Discontinue AD and stimulants - No superiority of any 1st line treatments

Bipolar I depression 2nd line mono

Cariprazine DVP ECT (RUL)

Bipolar I depression 2nd line combo

- Olanz + Fluoxetine (adj) SSRI/Bupriopion

Bipolar I depression, severe (ie need a fast response)

1st line) Seroquel, Lurasidone 2nd line) ECT, Cariprazine, Olanz + Fluoxetine

Bipolar I depression with anxious distress

Seroquel, Lurasidone, Olanz + Fluoxetine

Bipolar I depression with mixed features

- Will need a combo treatment - Avoid AD

Bipolar I depression with melancholic features

- No specific evidence - Experience suggests ECT

Bipolar I depression with atypical features

Tranylcypromine + Li/DVP/AAP has some evidence

Bipolar I depression with psychotic features

ECT and AAP effective

Bipolar I depression rapid cycling

- Avoid AD - No specific agents recommended

Bipolar I maintenance monotherapy 2nd line

Olanzapine, Paliperidone (>6mg), Risperidone LAI (can also be adj) Carbamazepine

Bipolar I maintenance combo therapy 2nd line

Li/DVP + Lurasidone/Ziprasidone (adj) Risperidone LAI

Geri Bipolar I mania 1st/2nd line

1st) Li, DVP 2nd) Seroquel TR) think clozapine, ECT

Geri Bipolar I depression 1st/2nd line

1st) Seroquel, Lurasidone 2nd) Li, Lamotrigine (think ECT)

Geri Bipolar I maintenance 1st/2nd line

1st) think about what you used in mania Li, DVP, Lamotrigine

PTSD 1st line

- Sertraline, Paroxetine, Fluoxetine - Venlafaxine

OCD 2nd line

- Citalopram - Clomipramine - Mirtazapine - Venlafaxine

OCD adjuncts

Abilify, Risperidone

PTSD 2nd line

- Fluvoxamine - Mirtazapine - Phenelzine