SSRI Initiation How long before increasing dose? • 4 wks. Initial response in 2-4 wks, max response at 4-6 weeks. Side effects? (Initial and subsequent improvement) • Initial: transient Gl upset (nausea, vomiting, diarrhea). Subsequent: decreased libido, sexual side effects. PHQ-9 improvement expected? • Depression: 50% reduction in PHQ-9 • Anxiety: 25-50% reduction in GAD-7 Longest half life? • Fluoxetine: for cross-titration need to wait 3-4 days before starting new med. Can be useful in patients with intermittent adherence (less discontinuation sx). Least preferred? • Paroxetine: Weight gain. Shortest half life. Sedating. Most QTc-prolonging? • Citalopram, Escitalopram - BWH Medicine Chiefs @BrighamChiefs #SSRI #Initiation #depression #psychiatry #treatment #management
