Prescribing pearls: sertraline (Zoloft) - also treats social anxiety and hypersomnolence
Prescribing pearls: bupropion (Wellbutrin) - NDRI may improve energy, alertness, and motivation; not
first line treatment for anxiety; contraindicated in clients with a history of seizures
Prescribing pearls: duloxetine (Cymbalta) - effective for atypical pain at higher doses; appropriate for
clients who present with somatic symptoms of depression; effective for atypical pain, such as
fibromyalgia and diabetic neuropathy
Prescribing pearls: venlafaxine (Effexor) - treats both depression and anxiety disorders, ensure trial of
higher dose before switching to a different medication
Prescribing pearls: desvenlafaxine (Pristiq) - effective for perimenopausal vasomotor symptoms
, considered when selecting a medication: - -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
if a medication is not achieving efficacy: - -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
Use to protect against suicide - lithium
MDD and BPD genetics - genetic factors contribute 31-42% of the disease risk in MDD and 59-85% in
BPD
monoamine hypothesis of depression - -posits that depression occurs as a result of a deficiency of one
or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
*Emphasis is now shifted from the monoamines to their receptors and other downstream events such
as the regulation of gene expression, growth factors, environmental factors, and epigenetic changes
- Three principal neurotransmitters
-norepinephrine (NE), dopamine (DA), and serotonin 5HT
• comprise the monoamine neurotransmitter system
• implications for the pathophysiology and treatment of mood disorders
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