blue_ocean

Treatment of mood disorder

6 posts in this topic

 The patient suffers from recurrent depression, which being treated by his GP with venlafaxine. He has not made much improvement. Choose the best option - 

A. Citalopram

B. Haloperidol

C. Olanzapine

D. Lithium

E. Mirtazapine 

Edited by blue_ocean
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I thought it should be mirtazapine. Venlafaxine + Mirtazapine ->>> Californian rocket fuel.

But the answer is given Lithium. 

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actually i did go through maudsley as well but they didn't mention which showed the best choice.. the article in the link above mentions venlafaxine + mirtazapine but they also mentioned in another section that venlafaxine + lithium is pretty good as well.. so to be honest, i don't know exactly which the MRCPysch exam would want... 

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Hey

I'm not able to grasp why either Mirtazipine or Lithium would be correct, but here's my thinking:

1. This is a case of non-response, not partial response. hence, the decision ought to be to switch, not augment. Meaning that it's a second single agent that would be tried.
2. There's no information to suggest that the patient has received any treatment before being put on Venlafaxine
3. In the absence of contraindications, and without any information to suggest that the patient is resistant, why is the first line treatment (in this case, Citalopram) not the correct option?
 

Both Vfx with Lithium and Mirtazipine would be reserved for augmentation/failure of two trials (at least that's what STAR*D did)

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