Considerations When Prescribing a Patient’s First Antidepressant
With so many psychopharmacological options, prescribing a patient’s first antidepressant can be a daunting task.
At the inaugural NP Institute In-Person in Boston, Depression Care360 sat down with Andrew Penn, MS, PMHNP, to discuss some of the major takeaways from his session on “How to Choose the Right Antidepressant for Your Patient.”
In this video, Penn offers some considerations that clinicians can keep in mind when surveying antidepressant options for their patients.
For more expert insights on treating depression, visit Depression Care360.
Save the date for NP Institute In-Person 2024, March 20-23 in San Diego, CA! For more information, visit the meeting website.
Read the Transcript:
Andrew Penn, MS, PMHNP: Hi, I'm Andrew Penn. I'm a psychiatric nurse practitioner and a clinical professor at the University of California San Francisco School of Nursing. I'm also a member of the Psych Congress Steering Committee.
DepressionCare 360: What are the primary challenges for clinicians when first choosing an antidepressant for a patient?
Penn: Yeah. So, we have so many antidepressants to choose from, which is kind of a good problem to have. I wouldn't want to try and treat patients with only one medication at my disposal, but it does create a challenge of which ones do we choose? Often the conventional wisdom is to start with what has worked in the past, which I'm certainly a believer in. There's no need to reinvent the wheel. But then given that, or if somebody hasn't been on antidepressants at all, how do we make that decision?
I always think about how do we sort of maximize benefits if we can get a two for one effect. If say somebody wants to quit smoking and has a depression that might respond to a drug like bupropion, then that medication can do both of those things. So, I think about things like that. I think about can we use a side effect to our benefit? A medication that's sedating might be helpful for a patient who's having really bad insomnia and also having depression. Also, I think about cost and access, placement on formularies, and then thinking about what side effects are going to be a deal breaker for a patient. We know that a lot of patients, sexual dysfunction, for example, or weight gain, may result in the person stopping the medication. So, I want to think about choosing a medication that's going to really minimize the side effects that matter most to the patient.
As a Psych Congress Steering Committee member, I really want to encourage you to continue to check back to the Psych Congress Network, which is a fantastic source of information, not only on our conferences, but also on emerging developments in psychiatry and mental health. Thanks.
Andrew Penn, MS, PMHNP, is a clinical professor at the University of California, San Francisco, School of Nursing where his teaching has received the UCSF Academic Senate Distinction in Teaching Award, among other recognitions. He has practiced as a psychiatric/mental health nurse practitioner, treating veterans at the San Francisco Veterans Administration Hospital. As a researcher, he collaborates on psychedelics studies of psilocybin and MDMA in the Translational Psychedelics Research (TrPR) lab at UCSF. A leading voice in nursing, he is a cofounder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses.org), advocating for the perspective of nurses in psychedelic therapy, he has published on psychedelics in the American Journal of Nursing, Frontiers in Psychiatry, and The Journal of Humanistic Psychotherapy. An internationally invited speaker, he has lectured at SXSW, Aspen Health Ideas Festival, the Singapore Ministry of Health, and Oxford University and can be found at Andrewpennnp.com