Pearls for Prescribing Antidepressants Flashcards
What are severe signs of suicidal thoughts?
hopelessness, lack of sleep
What are the three things that you should hone in on to determine whether or not to give antidepressants?
- number and severity of symptoms
- duration
- impact on daily functioning
What are the bipolar depression clues?
- personal history of mania
- atypical depression
- family history of mania
- early onset
- multiple poor responses to antidepressants
What is atypical depression?
when you have 2 reverse vegetative signs (i.e sleeping all day, and eating when not sleeping)
What should you prescribe to a patient with depressive symptoms?
if they have done well on something previously that is what we will give them
What should you test before giving someone a psychotropic dug?
pregnancy test
WHat cant you give a pregnant person?
paxil
What are the patient centered factors?
- history
- idosyncratic (what kinds of things have you heard about the different antidepressants)
- Financial
T or F
evidence says all antidepressants are equally effective, regardless of specific depressive symptoms
T
What are the prescriber centered factors?
- prescriber favorites
- primary and recency effects (i recenty gave this drug and it sucked)
- impact of sales and marketing efforts
What education should you provide as you enter her prescription?
- how to take
- when to take
- how long it takes to work
- how long you should take it
- what we will do if it doesnt work
- most common side effects
What are the most common clinical signif side effect of SSRIs?
GI (25%) Sedation (20%) Reslessness/agitation (15%) Insomnia (15%) Decreased libidor and/or delayed orgasm (15%)
Zero benefit at (blank) weeks-predicts poor ultimate response so offer switch
4 weeks
If there is some benefit at 4 weeks what should you do?
wait longer, consider dosage increase
What do you do if treatment fails?
- revisit diagnosis
- check on adherence
- consider comorbidities (medical, substances)
- consider unaddressed situational issues
- Consider switching class of med
- Consider augmentation
