pick your anti depressant

Question 1

which drug?

pt w/lmost benefit: Elderly patient; a patient with **agitated depression or **patient with GI distress

pt w/lease benefit: Elderly patient with excessivesleep and apathy. Note: 20% excreted by kidney.

sexual dysfunction: common

Answer 1

citalopram

Question 2

pt w/most benefit: noncompliant or forgetful pt + excessive fatigue:

pt w/least benefit: pt on several meds/and or frequent med chagnes

common sexual dysfunctio

Answer 2

fluoxetine

Question 3

benefits: Less likely to produce initial
anxiety and/or insomnia.

least benefit: Patients who may require high
doses or elderly (who are more
susceptible) are more prone to
anticholinergic effects (e.g.
delirium). Half-life increased by 170% in elderly

sexual dysfunction common:

Answer 3

paroxetine

Question 4

**pt w/most benefit **The medical/surgical patient on one or more medical drugs. Initial activation and increased alertness desired.

**pt w/least benefit: **Patient sensitive to any of the

typical SSRI side-effects (e.g.
increased arousal).

**sex ade common **

Answer 4

sertlaline

Question 5

most benefit: Patients with menopausal
symptoms or failing an SSRI
trial. At higher doses (e.g.,
225 mg or higher), patients
with chronic pain.

least benefit: Patients with unstable BP andperhaps, those who are GI sensitive. A clinically significant withdrawal syndrome requires slow down-taper.

sex ADE: less common

Answer 5

VENLAFAXINE P

Question 6

most benefit: Patient with depression and chronic pain (effects on painare dose-dependent).Patient failing an SSRI trial.

least benefit: Patient with significant anorexia,

constipation, or other GI
symptoms.

sex ADE not common

Answer 6

DULOXETINE

Question 7

most benefit: The medically ill patient with

weight loss, insomnia and
nausea.

least benefit: The obese patient with fatigue

and hypersomnia. Patients with

neutropenia

unlikely sex ades

Answer 7

MIRTAZAPINE

Question 8

most benefit: The now depressed, actually
or potentially, bipolar patient.
The apathetic, low energy
patient. Patients motivated
to stop smoking. Helpful for
ADHD

least benefit: Patients who are agitated, very

anxious and/or panicky. Patients
at risk for seizures and/or with
history of head trauma,
substance abuse, eating
disorder, or electrolyte
disturbance

sex ade: rare

Answer 8

buproprion