Antidepressants: What You Need to Know to Best Serve Your Clients

In case you missed it, here are the highlights from my recent national webinar entitled: Antidepressants. What You Need to Know to Best Serve Your Clients.

  • No one antidepressant or antidepressant class consistently outperforms another from an efficacy standpoint. There are no shining stars, just lights in the sky. With antidepressants treatment, there is no right way or wrong way, only possibilities. Just get the client started on a regimen.
  • Actions among antidepressants are different. Typically, for the depressed, agitated, irritable client with concomitant insomnia, less activating agents like Celexa, Zoloft or Paxil should be considered. Prozac or Wellbutrin are likely better choices for the client with low energy, little motivation and hypersomnia.
  • The different actions of antidepressants are not reliable predictors of overall treatment response.
  • The most reliable predictors of antidepressant response are someone’s previous history with a particular agent (positive or negative) and family history regarding antidepressants. For example, if a first-degree biological relative of a client (mother/father, brother/sister) has benefited from Lexapro, starting the client on Lexapro is wise.
  • If there’s no discernable symptom improvement within two weeks of a client beginning a particular antidepressant – most notably increased energy levels – future response is unlikely. A switch to another agent is warranted.
  • Clients should be actively involved in their initial antidepressant choice. Since all antidepressants have equal efficacy but different side effects, the first selection should be based on what adverse effects the client is willing to accept or tolerate. Most physicians, particularly those in family practice, are willing to go along with a patient’s choice of antidepressant, assuming there is a clear rationale for its use and no obvious contraindications. However, if the patient needs to be switched to another drug or requires augmentation strategies, the physician should take the lead.
  • Most antidepressant users will achieve partial remission of symptoms at best, so folks shouldn’t pin their hopes for improvement solely on these medications.
  • Antidepressants will not do the heavy lifting when it comes to treating or managing depression, only an integrated, multimodal approach that incorporates competent psychotherapy, diet modification, regular exercise and other beneficial lifestyle changes will work. Depressed people have to want to get better, and the more moving parts the treatment plan possesses, the more positive the outcome.
  • Clients may need us to cheer lead them when it comes to antidepressant compliance.
Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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