1. Management of Non-Response to Two SSRI Trials (Node 5)
David N. Osser, MD,
Associate Professor of Psychiatry
Harvard Medical School
Brockton Division of the VA Boston Healthcare System

2. 1st line 2nd line No response to 1st line options
No response to 2nd line options
Options
SSRI
SNRI (venlafaxine)
Mirtazapine

3. NEF 1st line 2nd line No response to 1st line options
No response to 2nd line options
Nefazodone
Options
SSRI
SNRI (venlafaxine)
Mirtazapine

4. Nefazodone Hepatotoxicity Withdrawn by the manufacturer
Available as generic
Hepatotoxicity incidence: 1/250,000
To be considered after trying two other ADs
Hepatotoxicity

5. Nefazodone Hepatotoxicity Withdrawn by the manufacturer
Available as generic
Hepatotoxicity incidence: 1/250,000
To be considered after trying two other ADs
Hepatotoxicity
Gelenberg AJ. Nefazedone hepatotoxicity: black box warning. Biol Ther Psychiatry 2002;25:2

6. Nefazodone Hepatotoxicity Withdrawn by the manufacturer
Available as generic
Hepatotoxicity incidence: 1/250,000
To be considered after trying two other ADs
Hepatotoxicity

7. Nefazodone Hepatotoxicity No significant weight gain
No sexual side effects
Less priapism than trazodone
Less sedation than trazodone
Hepatotoxicity

8. Nefazodone – Efficacy Nefazodone Placebo Effect size: 0.6
Davis LL, Jewell ME, Ambrose S, et al. A placebo-controlled study of nefazodone for the treatment of chronic posttraumatic stress disorder: a preliminary study. J Clin Psychopharmacol 2004;24:291–7.

9. No difference on any outcome measure
Nefazodone – Efficacy
Nefazodone
Placebo
Nefazodone
Sertraline
Effect size: 0.6
No difference on any outcome measure
McRae AL, Brady KT, Mellman TA, et al. Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Depress Anxiety 2004;19:190–6

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