Strategies to Switch Antidepressants Brittany Parmentier, PharmD PGY2 Behavioral Care Resident Butler University/Community Health Network This speaker.

Slides:



Advertisements
Similar presentations
Overview of Mental Health Medications for Children and Adolescents Module 2 Depressive Disorders 1.
Advertisements

Pharmaceutical Care of People with Depression
Psychopharmacology. Incorrect assumptions Patient is triaged as psychiatric, therefore patient is psychiatric. Patient has a history of psychiatric presentations,
Pharmacologic Considerations in the Treatment of Major Depressive Disorder Presented by: Ann M. Hamer, PharmD, BCPP Date: 10/30/2014.
GENERALIZED ANXIETY DISORDER IN PRIMARY CARE Curley Bonds, MD Medical Director Didi Hirsch Mental Health Services Professor & Chair Charles R. Drew University.
Drug Discontinuation Syndrome Sarah Quick, PharmD 2015 IPA Spring Meeting April 15, 2015.
Discontinuation Syndrome Sue Henderson. Definition Cluster of symptoms that may occur in response to the reduction or cessation of any antidepressant,
STAR*D Changed Our Working Definition of Treatment Resistance People who are intolerant to drugs regardless of dosage OR People who receive vigorous dosing.
Treating Depression in the Primary Care Setting Pharmacologic Interventions Presented by: Jonathan Betlinski, MD Date: 09/25/2014.
Real-World Pharmacologic Treatment of Depression B. Anthony Lindsey, MD Professor and Vice Chair UNC Department of Psychiatry.
Treatment Resistant Depression: Current Concepts & Treatment Applications Bradley N. Gaynes, M.D., M.P.H. Associate Professor Department of Psychiatry.
1 Neonatal Adverse Events Associated with in utero SSRI/SNRI Exposure Robert Levin, M.D. Medical Reviewer DNDP FDA.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 32 Antidepressants.
Depression Ibrahim Sales, Pharm.D. Associate Professor of Clinical Pharmacy King Saud University
Depression A Pathopharmacological Approach. Depression is a serious medical disorder characterized by sadness and despondent behavior. It isn’t something.
Second-Generation Antidepressants for Treating Adult Depression—An Update Prepared for: Agency for Healthcare Research and Quality (AHRQ)
SSRIs & Antidepressants
Julie Kennedy. Symptoms Anhedonia- loss of interest in everyday activites Despondent mood Altered sleep patterns Changes in weight/appetite Persistent.
for the Psychiatry Clerkship is proud to present And Now Here Is The Host... Insert Name Here.
Major Depressive Episode:  loss of interest and pleasure for at least 2 weeks Manic Episode:  elevated an expansive mood for at least 1 week Mixed Episode:
Antidepressants & Neuroleptics Lesson 20. Unipolar Depression n Major Depressive Disorder n Extreme sadness & despair l extent & duration important n.
Management Of Depressive Disorders Pharmacologic Treatments For Depression Copyright © World Psychiatric Association.
PIPC ® Psychiatry In Primary Care Medications Robert K. Schneider, MD Departments of Psychiatry, Internal Medicine and Family Practice The Medical College.
Serotonin Syndrome (Toxicity) Sue Henderson
Maryam Tabatabaee M.D Assistant professor of psychiatry.
By S.Bohlooli, Ph.D..  “An affective disorder characterized by loss of interest or pleasure in almost all a person’s usual activities or pastimes.”
Depression Dr. Alan Ng Behavioural Medicine. Reference Psychiatry in Primary Care Editors: Goldbloom, Davine CAMH, Toronto 2011.
Mood Disorders Lesson 24.
Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 24 Antidepressant Drugs.
Review of Antidepressants & a look at the newest agent Vortioxetine
Isahel N. Alfonso, R.N.  Selective Serotonin Reuptake Inhibitor (SSRI) Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram  Tricyclic Compound (TCA)
Psychopharmacology in Psychiatry
Drugs used in Depression- New groups By Prof. Yieldez Bassiouni.
Anxiolytics and Other Agents Used to Treat Psychiatric Conditions
Antidepressant Classes 1.Selective Serotonin Reuptake Inhibitor (SSRI) Sertraline (Zoloft) Fluoxetine (Prozac) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram.
for MHD & Therapeutics is proud to present And Now Here Is The Host... Insert Name Here.
Case study Which antidepressant Dr. Matthew Miller.
PHARMACOLOGY TUTORING FOR ANTIDEPRESSANTS By Alaina Darby.
Antidepressants and Benzodiazepines February 2015.
Anti-depressants Dr. Sanjita Das Range Tricyclics Tetracyclics Selective serotonin reuptake inhibitorsSelective serotonin reuptake inhibitors SSRI Serotonin.
Date of download: 6/6/2016 From: Psychopharmacologic Treatment Strategies for Depression, Bipolar Disorder, and Schizophrenia Ann Intern Med. 2001;134(1):47-60.
Treating generalised anxiety disorder in primary care – an example of a treatment pathway Step 3: review and consideration of alternative treatments Step.
Drugs used in the treatment of affective disorders Dr. Vidumini De Silva.
Management of Anxiety Throughout Life’s Stages
By dr.safeyya alchalabi
Management of Depression
Antidepressant-Induced Sexual Dysfunction
Drugs used in Depression- Prof. Yieldez Bassiouni
Predictors of good and poor response in GAD
Drugs used in Depression- Prof. Yieldez Bassiouni
Pharmacologic Considerations in the Treatment of Major Depressive Disorder—Part II Presented by: Ann M. Wheeler, PharmD, BCPP Date: 10/13/
PHARMACOTHERAPY - I PHCY 310
Депресивни состојби во тек на бременост и постнаталниот период
Copyright Notice This presentation is copyrighted by the Psychopharmacology Institute. Subscribers can download it and use it for professional use. The.
School of Pharmacy, University of Nizwa
Duloxetine Flavio Guzman, MD.
Tricyclic and Tetracyclic Antidepressants Pharmacology and Indications
School of Pharmacy, University of Nizwa
Depression in Older Adults Depression is common in older adults, and especially prevalent in older adults with chronic illnesses EPIDEMIOLOGY OF DEPRESSION.
PHARMACOTHERAPY - I PHCY 310
Figure legend Serum cholesterol concentration (mg/dL)
Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction.
Predictors of good and poor response in GAD
Antidepressant Discontinuation Syndrome
Drugs used in Depression- Prof. Yieldez Bassiouni
Drugs used in Depression-
W. Victor R. Vieweg, MD, James R. Levy, MD, Sonja K
Dr James Ovens Consultant Psychiatrist Tandridge CMHRS
Drugs Used in Depression (New group)
Criteri di scelta dell’antidepressivo
Presentation transcript:

Strategies to Switch Antidepressants Brittany Parmentier, PharmD PGY2 Behavioral Care Resident Butler University/Community Health Network This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.

AD – antidepressant SSRI – selective serotonin reuptake inhibitor SNRI – serotonin norepinephrine reuptake inhibitor TCA – tricyclic antidepressant MAOI – monoamine oxidase inhibitor Abbreviations

27.5% of STAR*D patients achieved remission with 1 st treatment 50% of depression patients respond to 1 st treatment 35-50% of responders still have residual symptoms Intolerance to side effects Need for Switch Trivedi MH e al. Am J Psychiatry. 2006;163: Fava M et al. Psychiatr Clin N Am. 2003;26:

Optimize dose Adequate duration Key Points before Switching American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (3 rd ed). Oct Available at: Accessed July 30, 2015.

Individualized therapy for each patient Variations in acute and ambulatory practice Limited data comparing one strategy to another General Considerations Jefferson JW. J Clin Psychiatry. 2008;69(Suppl E1):14-18.

Switching Effects Serotonin Syndrome Sweating Insomnia Tremor Akathisia Antidepressant Discontinuation Zerumsky K et al. P&T. 2005;30(12): Flu-like symptoms Insomnia Nausea Imbalance Sensory disturbances Hyperarousal (anxiety/agitation)

Between SSRIs SSRI (except fluoxetine)  SSRI Direct switch to equivalent dose Direct switch to lower new dose of new SSRI Fluoxetine  Other SSRI Stop fluoxetine, 4-7 day washout with no antidepressant, start new SSRI at low dose Marangell. J Clin Psychiatry. 2001;62(Suppl 18):12-7. Zerumsky K et al. P&T. 2005;30(12):

SSRIDose Fluoxetine20 mg Paroxetine20 mg Citalopram20 mg Escitalopram10 mg Sertraline50 mg Fluvoxamine50 mg SSRI Dose Equivalency Hayasaka Y et al. J Affect Disord. 2015;180:

SSRI  duloxetine Direct switch to duloxetine 60mg daily Start duloxetine 60mg and taper SSRI down SSRI  venlafaxine Direct switch to low dose venlafaxine (37.5 mg – 75mg) Cross-taper SSRI to SNRI Marangell. J Clin Psychiatry. 2001;62(Suppl 18):12-7. Jefferson JW. J Clin Psychiatry. 2008;69(Suppl E1):14-18.

Venlafaxine  SSRI Direct switch to therapeutic SSRI dose Cross-taper Duloxetine  SSRI Direct switch to therapeutic SSRI dose Cross-taper SNRI to SSRI Marangell. J Clin Psychiatry. 2001;62(Suppl 18):12-7. Jefferson JW. J Clin Psychiatry. 2008;69(Suppl E1):14-18.

To/from another agent Cross-taper Bupropion, Mirtazapine, and TCAs Marangell. J Clin Psychiatry. 2001;62(Suppl 18):12-7. Jefferson JW. J Clin Psychiatry. 2008;69(Suppl E1):14-18.

MAOI  MAOI MAOI  Other antidepressant Other antidepressant (except fluoxetine)  MAOI Stop medication, 2 week washout with no AD, start new AD Fluoxetine  MAOI Stop fluoxetine, 5 week washout with no AD, start MAOI MAOIs – High Risk for Toxicity Marangell. J Clin Psychiatry. 2001;62(Suppl 18):12-7. Jefferson JW. J Clin Psychiatry. 2008;69(Suppl E1):14-18.

When would it be most appropriate to do a direct switch from a therapeutic dose of old AD to a therapeutic dose of new AD? A. Imipramine  tranylcypromine B. Escitalopram  nortriptyline C. Citalopram  sertraline D. Venlafaxine  phenelzine Assessment Question

When would it be most appropriate to do a direct switch from a therapeutic dose of old AD to a therapeutic dose of new AD? A. Imipramine  tranylcypromine B. Escitalopram  nortriptyline C. Citalopram  sertraline D. Venlafaxine  phenelzine Assessment Question

Strategies to Switch Antidepressants Brittany Parmentier, PharmD PGY2 Behavioral Care Resident Butler University/Community Health Network