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Antidepressants

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General
--Remeron
--Paxil
In High Dose Interferon Patients
--Paxil
In Patients on Tamoxifen
--Effexor

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General
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Remeron (mirtazapine) 15-45 mg/day. Start 15 mg po QD & escalate.
side effect = somnolence, weight gain.

Venlafaxine is the first antidepressant in a new drug class referred to as the serotonin noradrenergic reuptake inhibitors (SNaRIs).

REF= J Clin Psychiatry 62(6):413, 2001. Remeron was found to be an effective treatment for a substantial proportion of patients for whom an SSRI was ineffective &/or poorly tolerated. Remeron was well tolerated, with sedation & appetite increase/weight gain the most commonly reported adverse events. In addition, no difference in efficacy, safety, or tolerability was observed for patients undergoing an immediate switch from an SSRI (after having been tapered to the minimal effective dose) to mirtazapine, compared with those undergoing the imposition of a 4-day drug-free washout. CONCLUSION: These results suggest that an immediate switch to mirtazapine may be a valid therapeutic option among patients who cannot tolerate or do not respond to SSRIs.

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Paxil (paroxetine) 20-40 mg/day


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In High Dose Interferon Patients

Paxil (Paroxetine) 10 mg po QD X 1 week then 20 mg po QD X 1 week. Then start IFN treatment. Can escalate up to 40 mg po QD. Continue during the treatment.

REF= NEJM 344:961, 2001
Paroxetene lowered the chance of developing depression by ~75%.
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In patients on tamoxifen for the relief of hot flashes:

Effexor (venlafaxine) 37.5 mg PO BID

REF=ASCO 2000 abstract
N=229 women with bothersome hot flashes were randomized to one of four groups. The first group received placebo. The second group received 37.5 mg of venlafaxine QD. The 3rd group received 75 mg of venlafaxine QD, & the 4th group received 150 mg QD. All patients were treated for four weeks.
RESULTS. Venlafaxine reduced hot flashes by 61% when delivered in a daily 75-mg dose compared with a 27% reduction with a placebo. Doses of 37.5 mg/day and 150 mg/day were not as effective as the 75-mg dose.
TOXICITIES. The drug was quite well tolerated in most patients. However, it caused significantly more anorexia, nausea & mouth dryness in a minority of patients. This lower dose of effexor might not be enough to trigger the antidepressantís other well known and potentially more severe adverse events, such as dizziness, nervousness or diminished libido.


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