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Re: Which antidepressants are 'less' activating? linkadge

Posted by SLS on August 27, 2021, at 23:26:46

In reply to Re: Which antidepressants are 'less' activating?, posted by linkadge on August 10, 2021, at 15:14:03

Hi, Linkadge.

Thank you.

We share opinions here. You are spot-on as far as I'm concerned. I like your selections of drugs and the algorithms to place them in order. Choosing antidepressants is no longer blind trial and error.

> >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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poster:SLS thread:1116258
URL: http://www.dr-bob.org/babble/20210723/msgs/1116734.html