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Criteri di scelta dell’antidepressivo
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Which is the best antidepressant?
Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Venlafaxine Duloxetine Mirtazapine Reboxetine Bupropion
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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
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SHORT TERM 10
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Long term 11
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Fluoxetine 12
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Escitalopram escitalopram 13
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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
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Which antidepressants (ADs) are more likely associated with SD?
Paroxetine Duloxetine Venlafaxine Escitalopram
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The shocking truth 16
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Evidence from literature
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SSRI: total sexual dysfunction
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SSRI: desire dysfunction
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SSRI: arousal dysfunction
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SSRI: orgasm dysfunction
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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%)
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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
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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)
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