Presentation on theme: "Psychopharmacology. Incorrect assumptions Patient is triaged as psychiatric, therefore patient is psychiatric. Patient has a history of psychiatric presentations,"— Presentation transcript:
Incorrect assumptions Patient is triaged as psychiatric, therefore patient is psychiatric. Patient has a history of psychiatric presentations, therefore this presentation is psychiatric. Patient is young, therefore this must be a functional disorder. Abnormal vital signs are due to mental/emotional state.
Choice of Initial Antidepressant in Adults Symptom profile Side effect profile in relation to the individual patient Patient preference Cost History of previous response of the patient or family members Comorbid psychiatric or medical illnesses Potential drug-drug interaction
SSRI: Side Effect Profile Headache Anxiety and Agitation Nausea Diarrhea Sexual dysfunction and Sleep disruption or Somnolence
SSRI: Rare but Dangerous Side Effects UGI bleeding (platelet dysfunction), esp. in combo with NSAID’s or other blood-thinning agents SIADH Osteoporosis and fractures in the elderly Serotonin syndrome SSRI discontinuation syndrome (slow taper) Flu-like symptoms Insomnia Nausea Imbalance Sensory disturbances Hyperarousal (agitation/anxiety)
Valproic Acid: longer term side effect monitoring On the surface: –Acne, hair loss Under the surface: –weight gain, edema Systemic: –blood dyscrasias (esp plt dysfn) –liver dysfunction +/- elevated ammonia levels –reproductive changes incl menstrual irregularities, PCOS, teratogenicity