Top Treatments for Major depressive disorder | Clinical Practice guidelines

In this video, we discuss medications used as treatment for Major Depressive Disorder and what the recent treatment guidelines suggest as first-line treatments which include second-generation antidepressants such as SSRIs, SNRIs, NDRI's, and Multi-modal antidepressants. Top medications from each of these classes are discussed including potential side effects.
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Intro 0:00
Considerations 00:33
SSRIs 01:26
SNRIs 05:29
Atypical antidepressants:
Bupropion 08:29
Vortioxetine 09:45
Mirtazapine 10:55
Rare and Dangerous side effects 12:41
Takeaways 16:52
Resources:
Deprescribing Guide: amzn.to/4dZEUMk
Stahl's Prescribing Guide: amzn.to/3UXj8QL
Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice, or substituted for diagnosis and treatment of any conditions discussed herein. Furthermore, watching these videos or getting answers to comments/questions, does not establish a provider-patient relationship. Please consult with your own health care provider for proper diagnosis and treatment.
References:
American Psychological Association (APA). (2019). Clinical practice guideline for the treatment of depression across three age cohorts. APA.org. Retrieved from www.apa.org/depression-guideline
Bjarnadottir, A. (2018, December 4). A guide to common antidepressant side effects. Healthline. Retrieved from www.healthline.com/health/ant...
Hirsch, M., & Birnbaum, R. J. (2019) Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management. Up To Date. Retrieved from www-uptodate-com.libproxy.eku...
Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., Hasnain, M., Jollant, F., Levitt, A. J., MacQueen, G. M., McInerney, S. J., McIntosh, D., Milev, R. V., Müller, D. J., Parikh, S. V., Pearson, N. L., Ravindran, A. V., Uher, R., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments. Canadian Journal of Psychiatry, 61(9), 540-560. doi-org.libproxy.eku.edu/10.1...
Rush, J.A (2020). Unipolar major depression in adults: Choosing initial treatment. Up to Date. Retrieved from www-uptodate-com.libproxy.eku...
Stahl, S. (2017). Stahl’s essential psychopharmacology: prescribers guide (6th ed.). New York,
N.Y.: Cambridge University Press.
This video was created using the following:
Doodly v2.6.3
Pixabay.com
Adobe Premiere- editing software

[@AbdullahZubair1]

Oh my god, you are one of the greatest in how to explain all meds information 🙏🏻

[@amberstevenson1072]

Thank you for this information. Very glad I found this channel

[@taajutube8885]

thanks for your lecture

[@LevelheadedMind]

It's my pleasure, thank you for watching!

[@ashleyevans7497]

Excellent educational video as always, my friend!

[@LevelheadedMind]

Thank you! ❤️

[@mwalengwahillebrecht4144]

This is a complicated topic and you did a great job breaking it down into such easily accesible concepts. Thank you so much. This is amazing.

[@LevelheadedMind]

Thank you, that means a lot ❤️

[@karmaline]

Great video again! Would love to see a video on bipolar meds and explaining what each one differs and why sometimes people have to take more than 1 med.

[@LevelheadedMind]

Thanks for the video idea, I will consider it.

[@jakdaxter641]

The audio in this video is a lot better than the other ones I've seen. Now all you need is something for the reverb and the quality will be superb. Thanks for the high quality straight to the point content!

[@LevelheadedMind]

Thanks for the tip. Audio is something I've been struggling with. Just got a fancy mic too... but suppose I need to learn how to use it. Lol. Anyhow, thanks for your support.

[@LevelheadedMind]

The last 2 videos are with my new microphone and camera, so I believe the audio is better now. Thanks for the advice.

[@vladkhvan1326]

Great video! How would Auvelity compare tobthese more established medicines?

[@Syncere20]

I wish you can be my psych doctor. I love to watch your videos.

[@LevelheadedMind]

Thank you.

[@nicoleboie3794]

I'm trying vraylar & trintellex & weekly therapy. High hopes

[@stevewilliams9672]

I want to switch antidepressant im on Paxil but want to try Zoloft do need to taper off Paxil ....? Before Zoloft or can I do a direct switch .

[@marieb9961]

It is imposible not to quit an antidepressant when you don’t tolerate it and your doctor is reluctant to talk before your appointment

[@LevelheadedMind]

I am sorry to hear that you have an uncooperative doctor, that certainly makes things difficult. Have you considered finding another doctor, one who will listen to your needs?

[@marieb9961]

@@LevelheadedMind thank you for your answer , Maybe the problem is that here in Mexico City, where I live, and was born, doctors are like that , specially psychiatrics . They were not like that before the COVID pandemic. I had a beautiful old doctor very nice and cooperative , nowadays I can’t find one so I only stay on sertraline and escitalopram. I take Sometimes Tafil and metilfenidato in low dosages but I will certainly like to ask a doctor because of this difficult depression By the way, you are beautiful 😊and I like the way you give the information 🤗

[@garysimone4977]

​@MarieB ever think of gkve a call to this lady to get further help ?

[@stevewilliams9672]

Hi I'm thinking of switching antidepressants I've been on Paxil for 5yrs I take 20mg per day . Wanting to switch to Zoloft can I do a direct switch or need to taper off Paxil ....? Will the side effects be an issue first month😊

[@MichelleRenaeNesmith-fp9vt]

May I ask of you whichare better adderall or ritalin

[@hermidalc]

Could you do a video on antidepressant augmentation approaches (eg bupropion, aripiprazole, brexpiprazole, etc) and how they compare to each other and to monotherapy?

[@LevelheadedMind]

Thanks for the video idea.

[@hermidalc]

@@LevelheadedMind Btw while there are many psychs on KZbin giving decent info, just wanted to tell you your delivery, style, way you structure the talk, deeper dive into pharmacology, clever use of graphics, editing, etc I find really good! Sets you apart from the rest

[@johnmclawrence4676]

Great videos, I want to go on an anxiety medication and the reason why is because I had a bad experience by trying marijuanna just once and from that point I started to get excessive worry and anxiety and depression and became ver traumatized by this event and since then I worry excessively about the negative experience with the weed, now I have 2 questions the 1st question is did I permanently mess up by brain chemistry and the next question is should I go back on an anxiety medication for example paroxetine since it have help me in the past to think less of the the negative weed event.

[@LevelheadedMind]

It is hard to predict whether or not a single experience of smoking marijuana caused your anxiety or even damaged your brain. Most likely you had a predisposition to anxiety, perhaps a gene that was not expressed and then smoking the THC made that gene express? This could also be the case if you experienced trauma. As for what medication to start, that is a personal decision and one to discuss with your doctor, there are many variables to consider. As for paroxetine, that medication is one of the worst antidepressants to come off of, the withdrawal tends to be very difficult so keep that in mind.

[@hermit6044]

I am taking paroxytene 37.5 + D Venlor 100 for the past 6 years. For the past one year, I am having a lot of negative thoughts and feel lethargic the whole day. I sleep a lot. Is it that I have developed a resistance to these drugs and need to change them? Please help.

[@sandan2358]

Why do so many meds only work a short time?

[@richardstennis5400]

Can you do one on lexapro? Thanks

[@LevelheadedMind]

Check out this video kzbin.info/www/bejne/eZCUfp2wpK96Z8k

[@michaelthau1007]

Thank you for a wonderful video!! My Dr suggested Mirtazapine 7.5 mg for sleep, just worried abt side effects. Also was suggested to start Buspar 30mg. Question can Buspar help with sleep anxiety? God Bless you

[@LevelheadedMind]

Hi Michael! Buspirone can help with general anxiety, try not to take it at night though as it may cause insomnia. I have my patients take it at 7am and 3pm, or a schedule similar to that. If your having sleep anxiety, I'd recommend a sleep meditation or body scan meditation, these are very useful. God bless you and I wish you the best! Also... please comment on the community post to enter our drawing Friday for a $50 Gift Card for purchases on psychlifeteeco.com/

[@michaelthau1007]

@@LevelheadedMind thank you !!#

[@sfsakirsky]

Just curious, why would you consider celexa as first line treatment? I hear that it prolongs QT interval

[@LevelheadedMind]

Yes it can at doses above 40mg. With elderly patients beign more prone to this. Guidelines still consider it a first line agent. But I will not for elderly patients in particular. I made a video on lexapro and Celexa where I discuss this issue in this video here if you are interested kzbin.info/www/bejne/eZCUfp2wpK96Z8ksi=nKYjCNfUyXXk9orT

[@qasimkhan2558]

Great video. I am using mirtazapine 30 mg for GAD from last 6 months but my symptoms are not gone.should I stay on it or leave it.kindly reply thanks

[@LevelheadedMind]

Have a discussion with your provider, you may need to increase to 45mg.

[@conchitaharper4723]

Doe these meds affect liver function¡

[@nicoleboie3794]

Is vraylar good for mdd

[@LevelheadedMind]

It can be used as an adjunct to antidepressants. Talk with your doctor about it.

[@myohome1]

I am taking 5 mg of Buspar twice a day and 37.5 mg of Effexor...just started 4 days ago...very agitated...I am 79 years old and had a stroke one year ago...i am very agitated and wired...is this common?

[@LevelheadedMind]

You are sensitive to the norepinephrine and dopamine increases of these medications. Talk to your provider about it. I hope they did thorough lab testing for root causes of your symptoms before putting you on these medications as they can back fire and cause these types of symptoms.

[@myohome1]

@@LevelheadedMind i stopped both...4 days should have no issues...ty

[@mihoubmehdi3776]

There is other side effects

[@tamimoroz4655]

None have ever helped me