Depression: Choosing, changing, and tweaking antidepressants – Your questions answered

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The questions answered in this podcast are listed below. They were compiled by GPs and health professionals around Australia.

  1. There seems to be a lack of use of Magogalite inhibitors or MAO inhibitors. Why are we not using this class of drugs much these days?
  2. How do we know we’ve reached their maximum doses? When do we combine? And when do we switch?
  3. What is a good guide to choose the next drug? And how would you choose between groups or classes and within classes?
  4. What are some of the more common adverse reactions from common combinations, and which combinations are probably not so good together?
  5. Are there age groups in which you worry about increasing suicidal ideation and particularly which class of patients?
  6. Questions to ask to keep an eye on patients for suicidal ideas:
  7. – Ask people about depression and how bad it is on a scale from zero to 10
    – Are things so bad, you wish you did not wake up in the morning?
    – If they say yes, you would then say, do you really wish you were not alive?
    – Are they mild, medium, or strong?
    – Have you actually thought of doing something to yourself?
    – On a zero to 10 scale, how strong are such ideas?

  8. Do they often wake up feeling much less at risk to themselves?
  9. What do we tell patients when they wake up having appetite for benzodiazepines to ease the emotional pain? What would be the advice for these patients? Whom did they reach out to? And what would they say to GPs/healthcare professionals.
  10. Tell us more about serotonin syndrome, what we shouldn’t do, and is there anything we can do to help to reduce the risk?
  11. What do you do with a young woman on escitalopram who has a low libido as a result of the drug?
  12. We seem to have a world with less smiling people and more depression as compared to children in Africa or the first and second world war. Can you comment? 


Guest: Clinical A/Prof David Horgan, Psychiatrist

Host: Dr David Lim, GP and Medical Educator

Total time: 47 mins


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Last Updated: 21 Nov, 2023

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Clinical A/Prof David Horgan


Clinical A/Prof David Horgan

Psychiatrist; Australian Suicide Prevention Foundation; Clinical Associate Professor, Department of Psychiatry, University of Melbourne; Previous Senior Psychiatrist, Royal Melbourne Hospital

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