Mercy Managed Behavioral Health Adult Depression Medication Guideline Category Dosage [Adult] Comments Color changed re: generic status Celexa® (citalopram)
Possible side effects: diarrhea, dizziness, nausea, sexual.
Paxil® (paroxetine)
Possible side effects: diarrhea, dizziness, nausea, sexual.
Discontinuation Syndrome. Possible side effects: diarrhea, dizziness, nausea, sexual.
Paxil CR® Zoloft® (sertaline)
Possible side effects: diarrhea, dizziness, nausea, sexual.
Discontinuation Syndrome. Possible side effects: diarrhea, dizziness, nausea, sexual.
Prozac® (fluoxetine)
Discontinuation Syndrome (less of one). Prozac Weekly®
Reserved for patients stable on 20mg/day. Possible side effects: diarrhea, dizziness, nausea, sexual.
Lexapro® (escitalopram)
Discontinuation Syndrome (less of one). Possible side effects: diarrhea, dizziness, nausea, sexual.
Pexeva® (paroxetine) Vibryd (vilazodone
Possible side effects: diarrhea, dizziness, nausea, sexual.
Initial: 10 mg/day for 7 days Usual: 40 mg QD
Cymbalta® (duloxitine)
Nausea, Monitor BP, Possible sexual side effects. Monitor BP. Withdrawal Syndrome due to short half life. 10%
Effexor® (venlafaxine)
Initial: 37.5mg BID Usual: 75 - 375mg/day
have ↑ BP at > 300mg/day. Sexual side effects. Effexor XR® Pristiq (desvenlafaxine)
Less discontinuation and possibly less sexual side effects.
Titrate at intervals > 1 wk. Decreased sedation if > 15mg/day.
Remeron® (mirtazapine) Reports of: Liver failure in 1/250,000 to 1/300,000 patients / year. Caution with cardiac meds. Anxiolytic effect. Titrate at Serzone® (nefazodone)
Initial: 100mg BID Usual: 300 - 600mg/day
intervals > 1 wk. Take with food. Titrate at intervals > 3 days. Caution with cardiac
Desyrel® (trazodone)
meds (calcium channel blockers). ↑ Priapism.
Titrate at intervals > 3 days. Divide doses by 6 hours to manage
Wellbutrin® (bupropion)
Initial: 100mg BID Usual: 100 - 450mg/day
risk of seizure. Avoid with Zyban. Divide doses by 8 hours to manage risk of seizure. Avoid with
Wellbutrin SR® Wellbutrin XL® Aplenzin (bupropion
Lethal in OD due to cardiac toxicity. Weight gain possible. Sexual
Norpramin® (desipramine) Pamelor® (nortriptyline) Vivactil® (protriptyline)
Lethal in OD (2000mg) due to cardiac toxicity. Weight gain.
Elavil® (amitriptyline)
Initial: 25 - 100mg QHS Usual: 50 - 300mg/day
Monitor BP/P during initial therapy. Ascendin® (Amoxipine)
Same as above. Risk of T-D. Ludiomil® (maprotoline) Sinequan® (doxepin) Tofranil® (imipramine) Tofranil PM® Surmontil® (trimipramine) = Generic Available SSRIs or Buproprion SR are generally preferred first-line pharmacotherapy treatments. * Reduce dose in renal and hepatic dysfunction. ** Consult the Product Insert for a complete list of drug interactions and other warnings. *** MAOI's are available - Consider referral to psychiatry to assess. **** Abilify is approved for MDD's as an adjunct medication in conjuction with another antidepressant.
Case Reports From Medistem Given the rationale that autologous SVF cells have a reasonable safety profile, and contain both immune modulatory and regenerative cell populations, a physician-initiated compassionate-use treatment was explored in 3 patients. Here we describe their treatments and histories. #CR-231 In 2005, a 50-year-old man was diagnosed with Relapsing-remitting MS, present
Gu Y, Nieves JW, Stern Y, Luchsinger JA, Scarmeas N. Food combination and Alzheimer Disease risk: A protective diet. Archives of Neurology . 2010; 67(6):699-706. Nafstad P, Nystad W, Magnus P, JJK J. Asthma and allergic rhinitis at 4 years of age in relation to fish consumption in infancy. Journal of Asthma . 2003; 40(4):343-348. Bodnar LM, Wisner KL. Nutrition and depression: Implications for