She also is someone who has a long history of anxiety manifested by “worrying”, “catastrophizing” and ruminating.She denies any history of drug or alcohol use, and “mood swings.” There is a family history of depression in her mother and sister which has responded well to a serotonin reuptake inhibitor (SRI) but she does not remember the name.She has no medical problems and does not take any other medications.She is very active physically and tries to manage her stress through exercise and thus stays very fit.Most common - sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexparo).These allow a low starting dose (12.5mg of Zoloft, 5mg of Celexa) and slow titration (anxiety patients are very vulnerable to initial activation and worsening of symptoms).The choice of antidepressant drug depends on the agent's pharmacologic profile, secondary actions, and tolerability.Sexual dysfunction related to the use of antidepressants may be addressed by reducing the dosage, switching to another agent, or adding another drug to overcome the sexual side effects.
Flu-like symptoms are common in patients who stop sertraline abruptly.
Deborah is a 40-year-old mother of 2 children, ages 8 and 5.
She has been seeing her therapist for several months for marital problems.
Augmentation with lithium or triiodothyronine may be useful in patients who are partially or totally resistant to antidepressant treatment.
Finally, tapering anti-depressant medication may help to avoid discontinuation syndrome or antidepressant withdrawal.