QuestionSBA
QuestionChoice
Up-titrating doses of SSRIs should be done where there has been an inadequate response to the initial starting dose
34022
c
Maintain his current fluoxetine dose and review after 2 weeks
QuestionChoice
Combination therapy with SSRIs is not routinely recommended due to the increased risk of developing serotonin syndrome
34021
b
Add sertraline 50mg PO OD to his current prescription
QuestionChoice
Switching to a non-SSRI antidepressant may be done in the primary care setting by experienced clinicians, but it is recommended to attempt to elicit a beneficial response with at least two SSRIs beforehand
34024
e
Switch his prescription to mirtazapine 15mg PO OD
QuestionChoice
Up-titrating doses of SSRIs should be done where there has been an inadequate response to the initial starting dose. The highest dose of fluoxetine that can be prescribed is 60mg
34020
a
Increase the dose of fluoxetine to 40mg PO OD and review after 1 week
QuestionChoice
SSRIs may be switched where there has been an inadequate response to previously tried SSRIs after up-titration
34023
d
Switch his prescription to citalopram 20mg PO OD
QuestionComment
SSRIs can take 6 weeks to have an effect so why would we be uptitrating after 4 weeks?
17541
QuestionComment
The BNF says: Patients should be reviewed every 1–2 weeks at the start of antidepressant treatment. Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond).

So i guess it depends on how you interpret the question as to whether you think it was a partial response or not. Hope this helps!

17582
User
subscriber
Myotonia Hypertension
User
subscriber
Anterior Compartment
QuestionComment
If there is limited or no improvement with antidepressant medication alone, options include:
Augmenting with group exercise.
Switching to a psychological intervention.
See the section on Initial management for more information on choices of psychological intervention.
Increasing the antidepressant dose or switching the antidepressant to a drug in the same class or different class.

can do either?
36688
User
subscriber
Serotonin Dorsal
QuestionComment
I thought the SSRI was causing thoughts of suicide which is why I stopped it
61788
User
subscriber
Juice Defibrillator
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2748
Depression Therapy Titration
Topic
90
Psychiatry
6815
Case Presentation: A 27 year old man attends a follow-up appointment with his GP. He initially presented one month ago with markedly low mood, loss of interest in his usual activities and feeling tired all the time. His GP diagnosed him with major depressive disorder and prescribed fluoxetine 20mg PO OD.


**O/E**

When asked about any improvement in his symptoms, the patient reports only a very slight lift to his mood that ‘may as well be the same as before’. He still experiences difficulty sleeping and only leaves the house to work his part-time job as a landscaper, but is finding that increasingly challenging. He says he has infrequent suicidal thoughts, and while he is adamant that he would never act on them in reality, he feels that he really ‘can’t go on like this for much longer’.

Question: Select the most appropriate management at this stage.
a