Page 346 - Learnwell EVS
P. 346
ression
P r e fe r a bly us e a s e r otonin r e up ta ke inhibitor (SR I), p a r tic ula r ly in e ld e r ly p a tie nts :
paroxetine P O : 2 0 m g onc e d a ily in the e v e ning
or fluoxetine P O : 2 0 m g onc e d a ily in th e m or n ing; us e w ith c a ution in p a tie nts w ith
s e v e r e a nxie ty d is or d e r s or w ho a r e im m obilis e d (e .g., w ound e d ).
I f the d e p r e s s ion is a c c om p a nie d by s e v e r e a nxie ty, us e amitriptyline P O
ins te a d : s ta r t
w it h 2 5 m g on c e d a ily a n d gr a d ua lly in c r e a s e ov e r on e w e e k to 7 5 m g on c e
d a ily
(1 5 0 m g/ d a y m a xim um ).
B e c a r e ful w ith tr ic yc lic a ntid e p r e s s a nts , a s the the r a p e utic d os e is c los e to the
le tha l
d os e . I n e ld e r ly p a tie nts , r e d uc e the d os e by ha lf.
D e p r e s s ion is le s s fr e q ue nt in p r e gna nc y tha n in the p os tp a r tum p e r iod . In
s itua tions
w he r e a ntid e p r e s s a nts a r e r e q uir e d , us e p a r oxe tine r a the r tha n fluoxe tine if the
w om a n
p la ns to br e a s tfe e d . I n the e v e nt of p r e gna nc y in a w om a n und e r
a ntid e p r e s s a nts , r e -
e v a lua te the ne e d to c ontinue the tr e a tm e nt. If the tr e a tm e nt is s till ne c e s s a r y,
r e fe r to
t h e t a ble be low . M on itor n e w bor n s for s ign s of t oxic ity or w it h d r a w a l
s ym p t om s
d ur ing the fir s t fe w d a ys of life .
Antidepressant therapy
Fluoxetine (m g/ d a y) Paroxetine (m g/ d a y) Amitriptyline (m g/ d a y)
W e e k/ m onth W1 W2 W3 M1 W1 W2 W3 M1 W1 W2 W3 M1
B r e a s tfe e d ing A v oid C a n be us e d
A d ults 20 20 20 40 20 20 20 40 25 50 75 1
00
> 6 0 ye a r s id e m id e m 25 25 50 75
Inc r e a s e a t M 1 (e nd of the fir s t m onth) only if s till ne c e s s a r y.
C a n be us e d ; m onitor the
infa nt (r is k of d r ow s ine s s ).
P r e gna nc y C a n be us e d C a n be us e d ; r e d uc e the
d os e a t t h e e n d of
pr e gna nc y.
If SR Is a r e un a v a ila ble or p oor ly tole r a te d , clomipramide P O m a y a ls o be us e : s ta r t
w ith
2 5 m g onc e d a ily a t be d tim e , a nd gr a d ua lly inc r e a s e ov e r one w e e k to 7 5 m g
onc e d a ily
(1 5 0 m g/ d a y m a xim um ).
T he r e is a d e la y of 2 to 3 w e e ks be for e a ntid e p r e s s a nt e ffe c t oc c ur s . D ur ing
this p e r iod ,
a nxie ty m a y be e xa c e r ba te d a nd the r is k of s uic id e inc r e a s e d , e s p e c ia lly w ith
fluoxe tine
a nd c lom ip r a m ine . Diazepam P O (5 to 1 0 m g/ d a y in 2 d iv id e d d os e s ) m a y be
giv e n for
the fir s t tw o w e e ks of tr e a tm e nt.
P r e fe r a bly us e a s e r otonin r e up ta ke inhibitor (SR I), p a r tic ula r ly in e ld e r ly p a tie nts :
paroxetine P O : 2 0 m g onc e d a ily in the e v e ning
or fluoxetine P O : 2 0 m g onc e d a ily in th e m or n ing; us e w ith c a ution in p a tie nts w ith
s e v e r e a nxie ty d is or d e r s or w ho a r e im m obilis e d (e .g., w ound e d ).
I f the d e p r e s s ion is a c c om p a nie d by s e v e r e a nxie ty, us e amitriptyline P O
ins te a d : s ta r t
w it h 2 5 m g on c e d a ily a n d gr a d ua lly in c r e a s e ov e r on e w e e k to 7 5 m g on c e
d a ily
(1 5 0 m g/ d a y m a xim um ).
B e c a r e ful w ith tr ic yc lic a ntid e p r e s s a nts , a s the the r a p e utic d os e is c los e to the
le tha l
d os e . I n e ld e r ly p a tie nts , r e d uc e the d os e by ha lf.
D e p r e s s ion is le s s fr e q ue nt in p r e gna nc y tha n in the p os tp a r tum p e r iod . In
s itua tions
w he r e a ntid e p r e s s a nts a r e r e q uir e d , us e p a r oxe tine r a the r tha n fluoxe tine if the
w om a n
p la ns to br e a s tfe e d . I n the e v e nt of p r e gna nc y in a w om a n und e r
a ntid e p r e s s a nts , r e -
e v a lua te the ne e d to c ontinue the tr e a tm e nt. If the tr e a tm e nt is s till ne c e s s a r y,
r e fe r to
t h e t a ble be low . M on itor n e w bor n s for s ign s of t oxic ity or w it h d r a w a l
s ym p t om s
d ur ing the fir s t fe w d a ys of life .
Antidepressant therapy
Fluoxetine (m g/ d a y) Paroxetine (m g/ d a y) Amitriptyline (m g/ d a y)
W e e k/ m onth W1 W2 W3 M1 W1 W2 W3 M1 W1 W2 W3 M1
B r e a s tfe e d ing A v oid C a n be us e d
A d ults 20 20 20 40 20 20 20 40 25 50 75 1
00
> 6 0 ye a r s id e m id e m 25 25 50 75
Inc r e a s e a t M 1 (e nd of the fir s t m onth) only if s till ne c e s s a r y.
C a n be us e d ; m onitor the
infa nt (r is k of d r ow s ine s s ).
P r e gna nc y C a n be us e d C a n be us e d ; r e d uc e the
d os e a t t h e e n d of
pr e gna nc y.
If SR Is a r e un a v a ila ble or p oor ly tole r a te d , clomipramide P O m a y a ls o be us e : s ta r t
w ith
2 5 m g onc e d a ily a t be d tim e , a nd gr a d ua lly inc r e a s e ov e r one w e e k to 7 5 m g
onc e d a ily
(1 5 0 m g/ d a y m a xim um ).
T he r e is a d e la y of 2 to 3 w e e ks be for e a ntid e p r e s s a nt e ffe c t oc c ur s . D ur ing
this p e r iod ,
a nxie ty m a y be e xa c e r ba te d a nd the r is k of s uic id e inc r e a s e d , e s p e c ia lly w ith
fluoxe tine
a nd c lom ip r a m ine . Diazepam P O (5 to 1 0 m g/ d a y in 2 d iv id e d d os e s ) m a y be
giv e n for
the fir s t tw o w e e ks of tr e a tm e nt.
