Pearls for Prescribing Antidepressants Flashcards
What are some bipolar depression clues?
personal history of mania
family history of mania
atypical depression (2 reverse vegetative signs - ex: too much sleep and weight gain)
early onset
multiple poor responses to antidepressants
What things would make you consider prescribing an antidepressant?
hopelessness (suicidal)
lack of sleep
impairs functioning
What is the best predictor of the future response to antidepressants?
If a patient has done well on a certain antidepressant, then prescribe that! The best predictor of the future response is that patient’s past response to that medication.
How to decide which antidepressant is best?
personal history (past response to antidepressant)
co-morbidities (ex: don’t give an obese pt a med that will cause weight gain)
pregnancy
other current meds
family history of mania
antidepressant response in family members (positive expectation)
Is one antidepressant superior to the others?
no, evidence says that all antidepressants are equally effective
**side effects differ, however
What are some prescriber centered factors?
your favorites
primacy and recency bias (the first 3 times you used this med, it worked great so you keep prescribing)
sales and marketing
Most common side effects of SSRIs?
GI sedation restlessness insomnia sexual dysfunction
What do you tell the patient when prescribing antidepressants?
use the "reasonable patient" standard - what would the patient want to know most common/serious side effects how to take it how long until it starts working how long to stay on the medication
What time period should you give to see if a medication is going to be effective or not?
If zero benefit from medication at 4-6 weeks, probably not going to be effective –> make a switch
If some benefit at 4 weeks, might be OK to wait it out
If treatment fails, what can you do?
change class of drug or change w/i class
check on adherence
consider comorbidity
consider unaddressed issues
