depression and anxiety 12 16 note

related: Psychiatry

Antidepressant dosing and brand name:

Algorithm for depression treatment:

CT: cognitive behavior therapy
No huge difference after failing first SSRI
Paroxetine is most anxiolytic. Citalopram better tolerated and also has anxiolytic. Zoloft also has anxiolytic

Switching antidepressants

Cross titrate 2 different medications over 2 weeks

Pharmacologic treatment options for patients with treatment-resistant depression include switching to another antidepressant or augmenting with a second agent. This patient has failed to respond to an adequate trial (>6 weeks) of high-dose fluoxetine. Patients with little to no improvement (nonresponders) or unacceptable tolerability generally benefit from switching to another antidepressant rather than augmentation. Discontinuing fluoxetine and starting venlafaxine, a serotonin-norepinephrine reuptake inhibitor, would be the most appropriate next step.

Partial responders, in contrast, can consider augmentation as a first-line option as switching carries a risk of losing the partial therapeutic benefit from the original drug. Augmentation strategies include adding a second-generation antipsychotic, an antidepressant with a different mechanism of action, or occasionally lithium or triiodothyronine.

The second-generation antipsychotic aripiprazole is an effective augmentation strategy for treatment-resistant major depression. However, it is not used as monotherapy.