Hopefully with this scenario, I’m going to teach you how half-life may affect antidepressant selection. Adherence to antidepressant therapy is a huge issue for our patients. It is often very challenging in the early stages of treatment to convince patients to continue to take their antidepressant because there usually isn’t an immediate effect. It can take weeks to months for antidepressants to have the full/desired effect.
Selecting an antidepressant is also a difficult decision and is often done based upon the adverse effect profile, characteristics of the medication, patient perceptions and/or provider familiarity.
A 48 year old female has new onset depression and has been placed on sertraline 50 mg daily. She has a well known medication history and has been notoriously difficult as far as medication adherence. She is also on multiple antihypertensives which she has not been consistent about refilling or has historically filled them late.
She is about 1 month in to the sertraline and does not feel that it is helping. So, what should we do? If we could predict the future, this would be easy. That’s the “art” of the battle.
There are a ton of different options to consider. We could increase sertraline. We could ask her to take it for another couple weeks or up to another month or two.
Looking at her history and understanding that adherence might be at play here, especially if she feels it isn’t working, it would very important to try to decipher how much she actually took. In a scenario like this, it might actually make sense to try switching antidepressants. The one that I might think about is fluoxetine, which has a longer half life. The longer half life would potentially be advantageous for a patient who isn’t the most reliable about taking their medications. Missed doses may not have as large of an impact with the fluoxetine.
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