Criteri di scelta dell’antidepressivo

Which is the best antidepressant? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Venlafaxine Duloxetine Mirtazapine Reboxetine Bupropion

Specific features for paroxetine: Elderly Females Long duration of the episode

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Which are ADs most commonly associated with weight gain in the short term period? Paroxetine Duloxetine Nortriptyline Escitalopram

SHORT TERM 10

Long term 11

Fluoxetine 12

Escitalopram escitalopram 13

Evidence from literature Twenty eight studies investigating treatment emergent sexual dysfunction in samples with no previous dysfunction which reported measures as dichotomous outcomes were entered in a meta-analitic analysis 14

Which antidepressants (ADs) are more likely associated with SD? Paroxetine Duloxetine Venlafaxine Escitalopram

The shocking truth 16

Evidence from literature 17

SSRI: total sexual dysfunction 18

SSRI: desire dysfunction 19

SSRI: arousal dysfunction 20

SSRI: orgasm dysfunction 21

Sex differences Few data available DESIRE DYSFUNCTION: more frequent in men (males: 80%; females:70%) AROUSAL DYSFUNCTION: more frequent in women (males: 65%; females 75%) ORGASM DYSFUNCTION: more frequent in men (males 70%; females 40%)

Which are the best strategies to manage with AD-induced SD? Wait for a reasonable amount of time Drug holyday Stop and switch to a different AD Add some remedies

Other Criteria for choosing? Sedation/Insomnia Gastrointestinal QTc Apathy inducing Anamnestic and family positive response Symptomatology profile Psychiatric comorbidities Residual symptoms Cost Interactions/medical comorb. (lecture afternoon)