Question

1. You are spending the day with a family practitioner to brush up on your family medicine skills. Your next patient is a 33-year-old woman who is being seen for depressive symptoms with mixed agitation. She was first diagnosed with depression 5 years ago and was treated with paroxetine 20mg daily. She took the medication for a year, but stopped taking the medication after claiming that she felt better. That was two years ago. Today she appears agitated and distraught. Her speech is rapid and she seems distractible and disorganized. She denies suicidal tendencies and substance abuse. The family practice physician decides to prescribe venlafaxine ER 75mg daily.
   1. Knowing what you learned about mood disorders and antidepressants, why would venlafaxine not be the best choice of antidepressants?
   2. List two other antidepressants that might represent better treatment options in this patient and explain why?

Answer 1

Venlafaxine is a serotonergic and noradrenergic antidepressant. It shares the same serotonergic adverse effects as the "selective" serotonin reuptake inhibitor (SSRI) antidepressants while in addition provoking noradrenergic adverse effects, in particular cardiovascular disorders ,that's why it is not the best of antidepressants .

Two other antidepressants that might represent better treatment options in this patient are :-

- SSRIs

- MAOIs

1. The SSRIs are preferable for the older adult because of their low risk for cardiovascular as well as anticholinergic effects. The SSRIs are also tolerated well in clients taking other medications metabolized in the liver, such as digoxin.

2. MAOIs work by inhibiting the enzyme monoamine oxidase (MAO), which is responsible for inactivating many of the important neurotransmitters in the nervous system. This results in an increased availability of the neurotransmitters which will help to decrease the depression and agitation .