The diagnoses of depression has been made for a 57 year of age white male with symptoms of insomnia, anxiety, hoplessness, suicidal ideation and anhedonia for the last 4 weeks. His medical history indicates a myocardial infarcation )"heart attack") 2 yesrs ago and he now takes nitroglycerin (Nitrostat) prn for angina and chest pain and warfarin (Coumadin) for inhibition of platelet aggregation. He has been diagnosed with Hepatitis C. What is your opinion for the safest antidepressant for this patient's treatment?
1) Doxepin (Sinequan)
2) Trazodone (Desyrel)
3) Fluoxetine (Prozac)
4) Nefazodone (Serzone)
5) Citalopram (Celexa)
What is the rationale for your answer?
3) Fluoxetine (Prozac) is the correct answer. This is because sertraline (Zoloft) has not been included in your list.
In addition the patient is not taking any MOAs in addition there is no history of self-harm or suicide.
One of the reasons that SSRIs (including Paxil, Prozac, Luvox, Zoloft, Celexa) are so widely prescribed by doctors and psychiatrists is because they are safer in overdose. This is obviously a good thing because traditionally the most common form of suicide was to overdose on the very antidepressants which were meant to help relieve the depression.
However, there are two very real dangers with Sari: one that has recently been the basis of an historic court battle in the US.
1. SSRIs pose greater risks when taken with other drugs, due to their pharmacokinetic and pharmacodynamic properties. For example, SSRIs can be lethal when taken with MAOIs.
2. While being safer in overdose, SSRIs have actually been proven to increase thoughts of suicide or self harm.
Nausea, diarrhea, headaches. Sexual side effects are also common with SSRIs, such as loss of libido, failure to reach orgasm and erectile problems. Seratonergic syndrome is also a worrying condition associated with the use of SSRIs.
Still for the patient under consideration, this Prozac is relatively safe!
Of the 1 million Americans hospitalized each year for a heart attack, about 20 percent will also suffer from depression that puts them at triple the risk of dying. Yet most of these patients are not treated with antidepressants because older antidepressants were known to be cardiotoxic and the effects of the new antidepressants were unknown.
In the first study of an ...