Please enable JavaScript.
Coggle requires JavaScript to display documents.
Depression (Goals of Therapy (Prevent relapse/recurrence, Minimize…
Depression
-
Monitoring and Follow-Up
-
Efficacy
if SSRI isn't adequately treating symptoms, next strategy is to increase dose (up to max tolerated dose)
If increasing dose doesn't work or pt is experiencing side effects (risk outweighs benefit); switch to another therapy (Switch within the same class first)
If on max dose and not improving, can augment with another therapy -- this decision is made based on whether someone is a non responder or partial responder to the initial therapy
-
-
-
-
-
-
-
Treatment Options
Pharmacologic
First Line
SSRI
Fluoxetine
t1/2: 1 - 3 days; long t1/2 warrants 5 - 6 week washout period before use of MAOI; less D/C withdrawal symptoms seen due to long ~9 day 1/2 life of metabolite
-
-
strong inhibitor of CYP2D6, CYP2C9; moderate inhibitor of CYP2C19
initial reduction in weight, normalizes with continued treatment
most common SEs: nausea, diarrhea, insomnia, decreased libido
Paroxetine
-
-
-
DDI: NSAIDs, antiplatelets, mod/strong CYP2D6 inhibitors, beta blockers, MAOIs, QTC prolonging agents
dose reduce with severe hepatic impairment, monitor with renal impairment (CrCl 30-60 or < 30)
Common side effects: Weight gain, sedation, Greater anti-cholinergic effects
Escitalopram
-
-
T1/2: 19 hours in adolescents, 27-30 hours in adults (increased by ~50% in elderly/hepatically impaired)
-
DDI: NSAIDs, antiplatelets, other SSRIs, CYP2C19/3A4 inducers and inhibitors (moderate/strong), MAOIs, Concerta/methylphenidate, QTc prolonging drugs
Major Side effects: Nausea/Diarrhea, Headache, Insomnia
Sertraline
-
-
Contraindicated with MAOI due to CNS toxicity or serotonin syndrome, QT interval prolonging drugs, and linezolid.
-
Dose reduce (50%) with mild hepatic impairment, not indicated for moderate to
severe hepatic impairment.
-
Citalopram
-
-
-
Hepatic metabolism (3A4, 2C19), weak 2D6 inhibitor
DDI: CYP3A4 inducers/inhibitors, CYP2C19 inducers
-
-
Vilazodone
-
-
-
CYP3A4 (major) and CYP2D6/CYP2C19 (minor) metabolism - do not use with strong CYP3A4 inhibitors like ketoconazole)
No dose adjustments for renal, hepatic, or geriatric
Fluvoxamine
-
hepatic metabolism (oxidative demethylation, deamination)
inhibits CYP1A2 (strong), 2C19 (moderate), 2C9 (weak), and 3A4 (weak)
used mainly for OCD, not depression
-
DDI: antiplatelets/anticoag, antipsychotics, some ABX
Generic available, still costs ~$25/month
-
-