In this podcast episode, we discuss a case of a 65-year-old patient with first-episode MDD that is treatment-resistant. With the expertise of Dr. Ken Gillman, we unpack how to manage this case with an MAOI.
00:00 Welcome
02:37 Clinical Case: Senior Depression
05:57 Not responding to ECT?
07:19 Serotonin Syndrome/Toxicity
11:10 Titrating Tranylcypromine
13:10 Monitoring Postural Hypotension
14:51 Response to Parnate
16:54 Maximal Parnate Dosing
21:08 Key Points
21:48 Closing, Credits & References
Key Points:
- Stop all serotonergic agents before starting an MAOI. This includes SSRIs, SNRIs, and drugs like ziprasidone.
- Symptoms of serotonin syndrome/toxicity include hyperthermia, tremors, hyperreflexia and clonus.
- Starting doses of tranylcypromine are 10 mg and 20 mg in more severe cases in a controlled setting. Typical doses are between 30 and 50 mg per day.
- Monitor patients for postural hypotension by measuring blood pressure sitting and standing.
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