*When starting someone on an antidepressant, always ask them if they have experienced hypomania or mania- if you prescribe them an antidepressant, it could trigger a manic episode.
SSRIs are good for depression and pathological anxiety (people who “make mountains out of molehills”).
- Common starting side effects: headache, nausea, and “jitters.”
- A patient who experiences sexual side effects on one SSRI will likely experience them on another. It’s best just to switch classes.
- Bupropion is more activating.
- Mirtazapine can cause insomnia, GI distress, anxiety, and weight gain (however, for the same reasons, it’s good for cancer patients).
- Paxil should be your last resort. It is associated with weight gain, sexual side effects are more common, and a strong withdrawal syndrome when compared with other SSRIs. (Effexor also has a strong association with withdrawal syndrome.) When you want a patient to stop Paxil, taper them slowly. You can add Prozac at the end of the taper to protect against withdrawal.
Benzodiazepines are good for anxiety due to external stress (someone who is “going through a tough time and just needs to get over the hump”)
- Most non-addicts don’t abuse benzos
- But you should avoid them in older individuals because they have sedative effects
- Ativan is what I’d consider my “go-to.” If Ativan isn’t lasting long enough, Klonopin and Valium are other options because of their longer half-lives.
- Xanax should be a last option, because its extremely short half-life (about three hours) gives it high addictive potential