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Re: Which antidepressants are 'less' activating?

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.





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