Posted by linkadge on August 10, 2021, at 15:14:03
In reply to Re: Which antidepressants are 'less' activating?, posted by SLS on August 9, 2021, at 13:30:46
>I think psychomotor retardation is a hallmark >symptom that leaves TCAs to be a better choice >than SSRIs. I am thinking that Prozac
>(fluoxetine) might be a better choice of SSRI >after one failed trial of another SSRI.That makes sense.
>I would gravitate towards Lexapro or Zoloft as >the first choice, but that is more of a >subjective impression than a statistical >appraisal.
I think this was the conclusion too of some meta-analysis looking at dropout rates and overall efficacy. These are safe first choices for garden variety depression.
>Which drug - of any class - would be your first >pick for the average case of Major Depressive >Disorder (atypical)?
Zoloft may be worth a try too as a first agent. After that maybe effexor or imipramine. Failing that I might try an MAOI (if the patient is willing).
>2. What would be your first choice of a pro->serotoninergic drug for treating "atypical" >depression presenting WITHOUT psychomotor >retardation?
It's hard to say. I'd have to dig into the symptoms a bit more. If the patient was mostly anhedonic (perhaps with overeating and oversleeping) than sertaline, effexor or prozac might be worth a try.
>3. Which drug - of any class - would be your >first choice for treating "endogenous" or >"melancholic" depression presenting WITH >psychomotor retardation?
Imipramine or amitriptyline. Effexor may be a good option too.
>4. How would you characterize Prozac >*clinically*, and what place would it have in >your treatment algorithm?
I tend to think that prozac is a bit better with energy and apathy than other SSRIs. I would probably put it as a second option if escitalopram or zoloft didn't work. If low energy or apathy were prominent, or if the patient was not a candidate for NE boosting meds, then it might be a good first option.
It's really hard to tell for some of these as the categories are pretty broad. I would probably first rate the patient on a scale of 1-10 on interest, anxiety, insomnia, energy, low self esteem, hopelessness etc. and then go from there.
Linkadge
poster:linkadge
thread:1116258
URL: http://www.dr-bob.org/babble/20210723/msgs/1116345.html