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Topics:
Psychiatry • General Outpatient Psychiatry • Women's Mental Health • Major Depressive Disorder • Psychopharmacology
How do you view the risk of tardive dysinesia and other side effects in your female patients with treatment-resistant depression who are stable on an atypical antipsychotic?
Given the concern about potential TD in female patients treated with second-generation atypical antipsychotics as an adjunct to antidepressants, are you pulling stable patients off them, after they have benefited from them?
I wonder if there is reassuring longitudinal data about the use of atypicals in treatment-resistant depression. I am trying to quantify the ratio of a slightly higher risk of developing TD over time, against the risk of emotional, relational, and vocational stress of pulling stable patients off atypicals after improvement.
Answer from: at Community Practice
Superb question, and it also applies to bipolar disorder, which is even more challenging in this patient population. I like Dr. @Berger's answer, always a risk/benefit analysis. Probably what you are already doing is my guess, since you are asking this question. Make sure you are doing consistent AI...
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Answer from: at Academic Institution
Document that the risks (side effects) and benefits (quality of life) were discussed with the patient, have the patient sign the document that says the patient wishes to take the risks, and then treat the patient with the meds that successfully reduce the symptoms.
Answer from: at Community Practice
Discuss all effects at the start of the medication.
Keep documenting AIMS every month or less frequently at every visit.
Reduce the dose as soon as you can and keeping alternate meds in mind, and replace as soon as you can.
Answer from: at Community Practice
There is always a risk/benefit balance. Fortunately, the risk with newer agents is way lower than with first-generation ones. Stick to the lowest dose that works and watch for abnormal movements.