Antidepressants

Mirtazapine Essentials: What Every Prescriber Should Know

Author: Flavio Guzman, MD Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA), it doesn’t have effects as monoamine reuptake inhibitor. A significant feature is its effect as histamine 1 antagonist. This antihistamine effect is linked to sedation and weight gain. Mirtazapine is commonly used in the elderly population. In this group of patients…

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Fluvoxamine Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Besides being a SERT inhibitor, fluvoxamine is an agonist at sigma 1 receptors. The drug is approved in the US for the treatment of OCD but not depression. This is interesting as this is a widely used antidepressant in other countries. Fluvoxamine has the potential for drug-drug interactions through inhibition of…

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Sertraline Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Sertraline is a moderate inhibitor of CYP2D6. In terms of drug-drug interactions this is not as significant as with fluoxetine or paroxetine. It has a similar side effects profile to other SSRIs. The dosage range goes from 50 to 200 mg/day. Pharmacology and MOA   Sertraline is an inhibitor of the…

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Antidepressant Discontinuation Syndrome: Diagnosis, Prevention and Management

Author: Flavio Guzman, MD Discontinuation symptoms can occur with all antidepressant classes, and you will see many articles referring to SSRI discontinuation syndrome. The reason is that SSRIs are by far the most commonly prescribed antidepressant class. This syndrome consists of usually mild and reversible symptoms that can be grouped into six categories. As a…

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The Psychopharmacology of Fluoxetine: An Illustrated Review for Prescribers

Author: Flavio Guzman, MD Fluoxetine has activating properties that make it a good option for patients with retarded depression or atypical depression. However, we should avoid activation in patients with insomnia and agitation. There is something that makes fluoxetine unique: its long half-life, we will discuss the advantages and disadvantages of this in clinical practice.…

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Reviewing Bupropion for Depression: An Update with Dr. Derek Tracy

In this episode we interview Dr. Derek Tracy on the use of bupropion for depression. Dr. Tracy is a Consultant Psychiatrist and the Associate Clinical Director for Crisis, Inpatient, and Rehabilitation services at Oxleas NHS Foundation Trust, London. He is a BRC research fellow and the neuromodulation lead at the Institute of Psychiatry, Psychology, and Neuroscience, King’s…

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The Psychopharmacology of Paroxetine: An Illustrated Summary for Prescribers

Author: Flavio Guzman, MD Paroxetine (Paxil, Seroxat, Aropax) is an SSRI approved for major depressive disorder and most anxiety disorders. In clinical practice, many clinicians use it for patients with anxious depression. However, this observation hasn’t been specifically studied in randomized controlled trials. Regarding its side effects profile, important features include higher risk for sexual…

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Pharmacotherapy of Treatment-Resistant OCD: Augmentation Strategies

Treatment of obsessive compulsive disorder is often challenging. Treatment resistance is quite common, between 40 to 60% of patients do not show and adequate response to first-line treatments. We invited Dr. David Veale to comment on his meta-analysis published in BMC Psychiatry : “Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review…

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Side Effects of Antidepressants: Interview with Dr. Rajnish Mago

In this expert interview we discuss side effects of antidepressants. Our guest today is Dr. Rajnish Mago. Dr. Mago currently serves as Director of the Mood Disorders Program at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. He is Associate Professor of Psychiatry at the Jefferson Medical College. He recently published the high-yield book “Side…

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Citalopram and Escitalopram: A Summary of Key Differences and Similarities

Author: Flavio Guzman, MD Psychiatrist Pharmacology Department University of Mendoza Argentina Citalopram (Celexa) and escitalopram (Lexapro) are two commonly prescribed SSRIs used for the treatment of depression and anxiety disorders. This brief multimedia tutorial explores the differences and similiarities between these two SSRIs. Introduction: Basic Concepts Let me highlight some useful points before getting into more…

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