#33 Antidepressant Efficacy Part 3: The Case for Antidepressants

So we had two episodes on the efficacy of antidepressants and I think I may have been a little hard on them, so I decided to make a part 3 where I instill some hope in these medications. They work great for so many people, yet so many people hate them as well. How can that be? And why do their effectiveness numbers look so abysmal? Find out on this episode!

#32 Medication Treatment Course

We've gone over all the antidepressants. We've talked about how to pick one. But what do you do when you find the right one? How long should the patient take it? Is it ok to come off? How do you take them off? How likely is it that they will get worse again and how do you respond to that? Well that's what I'll be discussing today, so tune in!

#31 Psychogenomic Testing

I bet a lot of you have heard of psychogenomic testing or at least seen one. Maybe you are a patient and you got one or are thinking about getting one. Are these things worse the time and money? Listen to this episode to learn about them and get my 2 cents on the topic!

#30 Improving Efficacy of Medications

On the last episode on antidepressant efficacy we discussed effect size and placebo. On today's episode I will cover a topic called psychodynamic prescribing. I'll be giving you tips on how to become a prescriber that gets max effect from medications. There's a lot of things that you can to maximize the effect, so tune in to find out what they are.

#29 Efficacy of Antidepressants

OK, so we've learned about the antidepressants, how to pick one, and how to dose. Well, how well do they work? I'll be discussing the efficacy of antidepressants on this episode, and I will be exploring the idea of placebo as it relates to these medications. It's more than what you would like, so tune in to find out all about it!

#28 Selecting an Antidepressant

So we've talked about all the FDA approved medications for depression. How to you choose which one to use? Have no fear, I have my break down where I go over all the factors that I take into consideration. Let's not be lazy and pick 5 SSRIs before moving on to other options. Learn about my algorithm that will help you pick the best 1st, 2nd, 3rd, 4th, and 5th choice. And also find out my tier list of these medications. What will be S and A tier? What will be F tier? Tune in to find out!

#27 Investigational Antidepressants

In this episode I will be discussing the different mechanisms of action that are being looked at as the next phase of antidepressant medications. I will also talk about drugs that are in Phase 1, 2, and 3 trials, and how those trials are going. These medications are the likely future of antidepressants. We haven't had many new medications until recently, and they may be followed by several more. Hopefully they will help patients that have yet to benefit from what is out there, but only time will tell. Listen to find out more!

#26 Antidepressant Dosing

On this episode I will be going over all the nuances of dosing the most common antidepressants. I'll talk about the optimal ranges for dosing for most patients, the max doses, and when we can go above the max dose and how high we can go. I will also talk about what doses I start with and how I titrate. I will also discuss a little about why some patients may need doses much lower and much higher than the average patient, and I will touch on hepatic and renal dosing as well. There's a lot more in here than you will find in the prescribing guidelines. I think you will find this detailed information on how to maximize effect and minimize adverse effects with dosing to be really helpful. Enjoy!

#25 5-HT1A Partial Agonist: Gepirone ER

Today I will be talking all about the most recently approved antidepressant, gepirone ER. I'm really not a fan of this one, and there are several reasons why. I honestly cannot think of a reason ever to use it. So tune in to find out all about it!

#24 NMDA Receptor Antagonists: Ketamine, Esketamine, and Dextromethorphan+Bupropion

Today we have an interesting episode. We are covering the first of a very new class of antidepressants, the NMDA receptor antagonists. These are the first antidepressants approved for use for depression which do not interact with the monoamine system, and many more may be coming out in the future. We will talk about ketamine, its sister, esketamine, and the only oral form, a combination of the cough suppressant dextromethorphan and bupropion. Find out how this new class of antidepressant works for depression and what my opinion is of these new medications!

#23 Serotonin Modulators and Stimulators: Vilazodone and Vortioxetine

We are making our way through the atypical antidepressants and up next are the so called serotonin modulators and stimulators, vilazodone and vortioxetine. To me these are more similar to the SSRIs and like the SSRIs they do a little extra on top of serotonin reuptake inhibition, but for these two medications these effects are touted to be better tolerated than the SSRIs. Is that the case? Find out.

#22 Noradrenergic and Specific Serotonergic Antidepressant  (NaSSA): Mirtazapine

Today I'm talking about mirtazapine, which is in a class of its own as both a noradrenergic and selective serotonergic antidepressant and a tetracyclic antidepressant. It has some very unique qualities that make it a great pick for some patients, and its the only option when you need this unique combination of characteristics. I use this one from time to time but not too frequently because of the weight gain adverse effect. But mirtazapine is more than just an antidepressant that causes weight gain and sedation. Tune in to find out.

#21 Norepinephrin and Dopamine Reuptake Inhibitor (NDRI): Bupropion

For today's antidepressant category of norepinephrine and dopamine reuptake inhibitor, we just have one medication, bupropion, but it is a very special antidepressant because its adverse effect profile is so much different than all of the other antidepressants we have talked about, and it is this adverse effect profile that makes bupropion often my first choice for patients not only for depression but also anxiety. Listen and find out why!

#20 Serotonin Antagonist and Reuptake Inhibitors (SARIs)

Merry Christmas. I have a special song for you today as we start the atypical antidepressants. We've finished with the typical antidepressants and now it's time to learn about the so-called atypical antidepressants, and going in chronological order, first up are the serotonin antagonist and reuptake inhibitors. We have two drugs in this class. First, the very commonly prescribed trazodone, and second, the rarely if ever prescribed nefazodone. Find out why that is and learn several things that you probably didn't know about them. My guess is there's more than you thought!