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Showing posts with the label Guidelines

Treatment Guidelines for Panic Disorder

Treatment Guidelines for Panic Disorder Drug of choice SSRIs Sertraline is recommended first-line per NICE Stepped Care Model Second-line MAOIs, Mirtazapine, Imipramine, Clomipramine, Venlafaxine Experimental Gabapentin, Inositol, Pindolol as augmentation Psychotherapy      CBT, Anxiety management

Treatment Guidelines for Generalized Anxiety Disorder

Psychotherapy      Reassurance Self-help and psychoeducation à Pure self-help, guided self-help, group psychoeducation Relaxation therapy à applied relaxation, progressive muscle relaxation, deep breathing exercises Cognitive behavior therapy Exercise Pharmacotherapies Indications of pharmacotherapy While on psychotherapy, short-term Psychotherapy ineffective, Psychotherapies not available First-line         Selective Serotonin Reuptake Inhibitors à These and SNRIs may initially exacerbate symptoms; a lower starting dose is often required.   Fluoxetine and sertraline are preferred options.   Sertraline is the most tolerable and cost effective, recommended as first choice by NICE. Fluoxetine is most effective choice. Effexor (venlafaxine) SR up to 225 mg/day Dulan/Duron (duloxetine) up to 60 mg/day pregabalin 150–600 mg/day Second-line choices             Agoviz (agomelatine) 25 mg                2 x nocte Agoviz (agomelatine) 25 mg    

Treatment Options for Refractory Depression

Treatment of Refractory Depression When depression does not improve with three sequential trials of antidepressants, we call it treatment-refractory depression. the following is the list of choices for treatment-refractory depression.  First-line Treatment Options Bupropion 400 mg/d + SSRI Olanzapine + fluoxetine 25/50 mg/d Venlafaxine + mirtazapine 30-45 mg/d Add lithium, aim up to 1.0 mmol/L concentration.  Add aripiprazole 2-20 mg/d Add quetiapine 150-300 mg/d  Second-line Choices Ketamine-IV (0.5 mg/kg IV over 40 minutes),   à rapidly effective, by the anesthetist High-dose venlafaxine à 200 mg/d,    à NICE recommended, monitor BP Electroconvulsive therapy à effective, stigmatized Add risperidone 0.5-3 mg/d,   à weak evidence, hypotension Add Triiodothyronine 20–50 μ g/d, à reasonable evidence, monitor TFTs Lamotrigine, 100, 200, 400 mg/d, à best tolerated, risk of rash SSRI+ buspirone 60 mg/d, à research-supported, dizzi

Guidelines for the Pharmacotherapy of Major Depressive Disorder

Guidelines for the Pharmacotherapy of Major Depressive Disorder I have summarised the following recommendations from the Maudsley prescribing guidelines in Psychiatry, 13th Ed. Psychotherapies Supportive psychotherapy, CBT, interpersonal therapy, marital/couple therapy, dynamic psychotherapy, behavioral activation Depressive episode Step-1 SRI/ Mirtazapine à A generic SRI; use mirtazapine if sleep needed Step-2 SSRI/non-SRI   à Most evidence is for a switch to vortioxetine Step 3 Mirtazapine, vortioxetine, agomelatine   à if not already trialed

WHO 2012 Guidelines for the Treatment of Alcohol Withdrawal

WHO 2012 Guidelines to treat Alcohol Withdrawal Clinicians should advise supported withdrawal in patients before beginning treatment. The World Health Organization recommends benzodiazepines as front-line medication for the management of alcohol withdrawal.  Long-acting benzodiazepines are superior to shorter-acting ones, except in cases of impaired hepatic metabolism.  Clinicians should determine the dose and duration individually.  The duration of benzodiazepine treatment should be 3 to 7 days. Clinicians should not use antipsychotic medications as stand-alone medications for the management of alcohol withdrawal.  Advise Benzodiazepines , and not anticonvulsants, following an alcohol withdrawal seizure. Clinicians should dispense psychoactive medication in small doses.   Patients at risk of severe withdrawal, or who have concurrent serious physical or psychiatric disorders, or who lack adequate support, should preferably remain in an inpatient setting.  As part of withdrawal manag

WHO Alcohol Withdrawal Treatment Guidelines

What interventions are safe and effective for the management of alcohol withdrawal, including treatment for alcohol withdrawal seizures and prevention and treatment for acute Wernicke's encephalopathy? Alcohol withdrawal can be uncomfortable and occasionally life-threatening. Pharmacological management of alcohol withdrawal is an essential component of alcohol dependence. Benzodiazepines (BZDs), non-sedating anticonvulsants, and antipsychotics are commonly used in the treatment of alcohol withdrawal.  Given that they are all potentially toxic medications, what is the evidence that the benefits of their use justify the risks? Which is more effective? Below, I summarize the  WHO 2012 Guidelines to treat Alcohol Withdrawal that explains the answers to these questions.