Category Archives: psychiatry

Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs

Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs:

  • Duloxetine (Cymbalta)
    • For Depression: Cymbalta should be administered a total dose of 40mg/day (20mg 2x daily) to 60 mg/day (given either 1x daily or 30mg 2x daily). There is no evidence that doses greater than 60mg/day give additional benefits.
    • 20 mg opaque green capsules imprinted with “Lilly 3235 20mg”
    • 30 mg opaque white and blue capsules imprinted with “Lilly 3240 30mg”
    • 60 mg opaque green and blue capsules imprinted with “Lilly 3270 60mg”
cymbalta

Cymbalta 60mg

  • Venlafaxine (Effexor XR)
    • Immediate release:
      Initial dose: 37.5 mg orally twice a day or 25 mg orally 3 times a day
      Maintenance dose: May increase in daily increments of up to 75 mg at intervals of no less than 4 days
      Maximum dose: (moderately depressed outpatients): 225 mg/day
      Maximum dose (severely depressed inpatients): 375 mg/day
      Daily dosage may be divided in 2 or 3 doses/day
      Extended release, or XR:
      Initial dose: 75 mg orally once daily
      Maintenance dose: May increase in daily increments of up to 75 mg at intervals of no less than 4 days
      Maximum dose (moderately depressed outpatients): 225 mg/day
      Maximum dose (severely depressed inpatients): 375 mg/day
    • EffexorXR 75 and 150mg

      EffexorXR 75 and 150mg

  • Desvenlafaxine (Pristiq)
    • 50 mg 1x daily, with or without food.

      pristiq

      Pristiq 50mg

Common Side Effects:

  • Nausea
  • Dry mouth
  • Dizziness
  • Excessive sweating

Other side effects may include:

  • Tiredness
  • Difficulty urinating
  • Agitation or anxiety
  • Constipation
  • Insomnia
  • Sexual problems, such as reduced sexual desire, difficulty reaching orgasm, or the inability to maintain an erection (erectile dysfunction)
  • Headache
  • Loss of appetite

IMPORTANT: Pharmaceutical companies HAVE to list every side effect reported during clinical trails. So, just because a medication lists a certain side effect does not mean YOU will get it. In fact, most people experience very few side effects and with continued use (2 weeks and beyond), most of the initial side effects dissipate, or resolve completely.

Statistics, logistics and ballistics

Most of the time, I hate stats. It’s one of my least favorite subjects. Frankly, I think most people would agree. But, it’s a necessary evil in this field. So, I put together a few points of logistical relevance so you don’t have to go ballistic on this stuff!

5 takeaway points for evaluating statistics and drug studies:

1-Even in a double-blind study, reported side effects can tip off the clinician as to whether the subject has received the placebo, or the actual treatment.
2-The placebo effect-is shown when a sugar pill is given to the control group and can lead to positive (and less likely negative) symptoms just simply by receiving something from a clinician. This speaks to the power of the mind.
3-Our mind can work against us, too, with the nocebo effect-setting someone up for possible negative side effects by telling them that “you may get all these side effects, or symptoms: lupus, scleroderma, blurred vision, dry mouth, and left foot paralysis.” It never fails that someone will report left foot paralysis!! As you may know there is not a single drug That’s the power of suggestion!
4-Here’s a great tip when deciding whether to read a study, or not. If your confidence interval is <1.0 it IS statistically significant!! If it includes 1.0, don’t read the study because it is NOT statistically relevant.
5-Risk ratio-is the point estimate used for cohort studies.

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