Master the board step 3

Master the Boards: USMLE Step 3
ECT is safe in pregnancy.
Caution: The biggest complication of ECT is transient memory loss, which
worsens with prolonged therapy and resolves after several weeks. Use of ECT
is cautioned in patients with space-occupying intracranial lesions (e.g., brain
metastasis), as ECT induces transient intracranial pressure.
Antidepressants and Mood Stabilizers
Guidelines for Use of Antidepressants
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SSRIs are first-line therapy.
Basic Science Correlate
SSRIs inhibit the reuptake of serotonin in the synaptic cleft, resulting in more
signaling across the synapses.
In TCA overdose, the
most urgent next step is
to check an EKG for lifethreatening
arrhythmias.
SSRIs are first-line therapy
for many conditions
because of their
therapeutic effect and low
side effect profile. Always
think of SSRIs first in
patients with the following
disorders:
• Major depressive
disorder
• Bipolar disorder
• Anxiety disorders: Panic
disorder, OCD, social
phobia, generalized
anxiety disorder
• Bulimia nervosa
··
TCAs are avoided because of risk of toxicity (think: TCA may be Toxic).
··
MAOIs are more helpful in atypical depressive disorders.
··
Choose an antidepressant based on side effect profile.
··
Switch to another antidepressant if patient does not respond after 8 weeks or
if the patient does not tolerate the side effects.
··
Treat patients for 6 months and attempt to discontinue after tapering.
Consider long-term therapy for multiple episodes of depression.
··
When the question describes a patient concerned about weight gain or sexual
side effects, give bupropion (causes modest weight loss). Note: Bupropion
is associated with seizures.
··
When the question describes a patient who has poor appetite, loss of weight,
or insomnia, give mirtazapine. Mirtazapine is associated with weight gain.
··
Amitriptyline is used to treat chronic pain (especially effective in neuropathic
pain).
··
Imipramine is useful in enuresis.
··
Trazodone is strongly sedating and is often used to treat depressed patients
who have severe insomnia.
··
SSRIs and TCAs are safe in pregnancy except for paroxetine (Paxil).
A young male recently started on antidepressants develops prolonged erection.
What is the antidepressant he was most likely taking?
Answer: Trazodone
510