Drug Classes

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…

Read More

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…

Read More

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…

Read More

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…

Read More

Lithium’s Mechanism of Action: An Illustrated Review

Author: Flavio Guzman, MD Lithium’s mechanism involves multiple levels of action, from macroscopic neuroprotective effects to intracellular changes. This tutorial discusses: Brain abnormalities found in patients suffering from bipolar disorder How lithium modulates dopamine, glutamate and GABA Intracellular changes associated with lithium use (effects on proteins such as PKC, MARCKS, GSK-3, IPPase and IMPase) Download…

Read More

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.…

Read More

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…

Read More

Bipolar Disorder Treatment Guidelines: A 2017 Update

By Flavio Guzman, MD This page offers direct links to the most recent guidelines for the treatment of bipolar disorder. You may notice that we have not included the guidelines published by the American Psychiatric Asssociation, this is because the document has not been updated since 2005. – 2016 – British Association for Psychopharmacology Evidence-based…

Read More

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…

Read More

Long-Acting Injectable Antipsychotics: A Practical Guide for Prescribers

Author: Flavio Guzman, MD Competing interests: none This article summarizes the most clinically relevant features of long-acting injectable antipsychotics (LAIs, previously known as depot antipsychotics). We discuss general concepts as well as key prescribing facts of individual agents. The guide also includes two new formulations: aripiprazole lauroxil (Aristada) and 3-month paliperidone palmitate (Invega Trinza). Advantages and disadvantages of long-acting antipsychotics…

Read More