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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Feb 18, 2019

Dive deep into the psychopharmacology of depression with Dr Patrick Finley, PharmD at UCSF. Learn practical tips including how to switch from one antidepressant to another, what to expect with SSRI and SNRI withdrawal, and how to choose a second (or third) antidepressant for refractory depression. We also summarize the safety around antidepressants in the peripartum period. ACP members can visit to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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Written and produced by: Molly Heublein, MD

CME questions by: Molly Heublein, MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein, MD

Edited by: Matthew Watto MD

Guest Presenter: Patrick Finley, PharmD BCPP


Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

  • 00:00 Sponsor ACP’s MKSAP 18
  • 00:25 Disclaimer, intro and guest bio
  • 04:33 Guest one-liner, book recommendation, and first patient complaint
  • 08:04 Picks of the week
  • 12:10 Sponsor ACP’s MKSAP 18
  • 14:03 Clinical case of depression; assessing target symtpoms to characterize depression; choice of initial SSRI
  • 17:49 Discussion of iron, ferritin, folate and L methylfolate as they relate to treatment refractory depression
  • 20:12 Postpartum depression, iron, genetics and environmental factors
  • 22:35 How to switch from one SSRI to another; Cross-titration from SNRI to SSRI or from SSRI to SNRI
  • 26:05 Withdrawal symptoms from SSRIs or SNRIs and a bit more on switching and cross titration
  • 31:33 Is paroxetine ever a good idea?
  • 33:03 Ultra-rapid metabolizers of SSRIs and pharmacogenomics
  • 34:43 Postpartum depression and treatment with antidepressants during pregnancy and lactation
  • 39:25 Monitoring response to therapy with antidepressants ie PHQ-9
  • 40:53 Augmentation for partial response; bupropion for augmentation and sexual side effects;
  • 43:58 Counseling patients about discontinuation of therapy
  • 47:00 How to choose an agent for augmentation of antidepressant therapy
  • 51:02 Mirtazapine
  • 52:41 Vortioxetine
  • 53:24 Atypical antipsychotics for augmentation
  • 55:37 Pregabalin and gabapentin for augmentation
  • 57:42 Dr Finley’s take home points
  • 60:48 Outro