SLIDE 5 10/5/2017 5
Antide pre ssa nts: SNRI vs SSRI
In a po o le d a na lysis, SNRIs sho we d hig he r re missio n ra te s tha n SSRIs (E ntsua h e t a l. J Clin Psyc hia try 2001)
Go o d e vid e nc e o f impro ve me nt in sympto ms with c ita lo pra m, e sc ita lo pra m, pa ro xe tine , ve nla fa xine a s mo no the ra py
Go o d e vid e nc e fo r using c ita lo pra m a nd mirta za pine a s a d junc t to e stro g e n whe n e stro g e n a lo ne is insuffic ie nt in a id ing mo o d (Jo ffe e t a l. J Wo me ns He a lth Ge nd Ba se d Me d. 2001, So a re s e t a l. J Clin Psyc hia try. 2003)
If a wo ma n ha s ha d suc c e ss in the pa st with a c e rta in a ntid e pre ssa nt sho uld sta rt with tha t a ntid e pre ssa nt a s 1st line re g a rd le ss o f c la ss
If a wo ma n is ta king ta mo xife n sho uld use SNRI inste a d o f SSRI d ue to c o nc e rn a b o ut inte rfe re nc e with me ta b o lism o f ta mo xife n with SSRI (Stub b s e t a l. J Okla Sta te Me d Asso c . 2017)
CYP2D6 inhib ito rs- pa ro xe tine , fluo xe tine
Ro le o f E stro g e n in T re a tme nt o f Mo o d Diso rde rs in Midlife Wo me n
E stro g e n a s tre a tme nt
Pe rime no pa usa lwo me n with MDD tre a te d with e stra dio l mo no the ra py ha ve
impro ve me nt in mo o d similar to tha t with a ntide pre ssa nts
T
ra nsde rma l e stra dio l (50-100 mic ro g ra m/ da y) re sulte d in 60-75% o f sub je c ts no ting pa rtia l o r to ta l re missio n in de pre ssive e piso de s c o mpa re d to 20-30% o f sub je c ts re c e iving pla c e b o (So a re s e t a l. Arc h Ge n Psyc hia try. 2001, Sc hmidt e t a l. Am J Ob ste t Gyne c o l. 2000)
Po stme no pa usa l wo me n do no t ha ve the sa me impro ve me nt in de pre ssive
sympto ms with e stra dio l mo no the ra py
Da ta sho ws e stra dio l ma y b e use d a s a ug me nta tio n fo r wo me n with
ina de q ua te re spo nse to a ntide pre ssa nts a lo ne
E
stro g e n tre a tme nt sho uld sho w impro ve me nt within the 1st mo nth o f use
Ro le o f Pro g e stins in T re a tme nt o f Mo o d Diso rde rs in Midlife Wo me n
Adding a pro g e stin to e stro g e n the ra py ma y a tte nua te the b e ne fic ia l e ffe c ts o f e stro g e n o n mo o d (So a re s. Me no pa use . 2014)
I
nc re a se s c o nc e ntra tio n o f MAO c a using d e c re a se in se ro to nin c o nc e ntra tio n (Ste ine r e t a l. J Affe c tive Diso rde rs. 2003)
Oppo site e ffe c t fro m e stro g e n
F
- r wo me n with inta c t ute rus
Cyc lic use o f pro g e ste ro ne ma y b e le ss ha rmful to mo o d in wo me n who
re spo nd we ll to e stro g e n (Co he n e t a l. Ame r J Me d 2005)
L
e vo no rg e stre l I UD ma y b e a no the r o ptio n
T re a tme nt Stra te g ie s
Ho w to de c ide whic h tre a tme nt
Mo o d sympto ms a nd va so mo to r sympto ms fre q ue ntly c o inc ide Prima ry mo o d sympto ms- SNRI , SSRI Prima ry va so mo to r sympto ms-E stro g e n
Ora l vs T ra nsd e rma l fo rmula tio ns If ute rus pre se nt must still use pro g e ste ro ne Bo th sympto ms e q ua lly b o the rso me - c o nsid e r d ua l the ra py with a ntid e pre ssa nt a nd
e stro g e n
