what's my LEAST favorite medication?


I'll tell you.

Paxil, or paroxetine.

Nothing against Paxil, really, it's just that when it comes to antidepressants there are SO MANY GREAT OPTIONS that I don't want to choose a mediocre one if I don't have to.

This week's video starts with how I find the (hopefully) right antidepressant medication for someone based of a few different things including whether I like them or not! (The medications, not the patients. All of my patients are awesome!)

I will also specifically walk through my top 3 SSRIs and Effexor, an SNRI.

It's about to get crazy!

Well, no, kind of the opposite.

I get super excited talking about the meds I like best and why. But that's because these are all fabulous at bringing the calm. The good vibes. The sunshine and cupcakes and sparkly stuff.

Here are the main points:

  • My 1st choice for medication newbies or people that struggle with side effects is Lexapro or escitalopram
  • My 2nd choice for starting something gentle-ish if Lexapro isn't a good option is Zoloft!
  • Prozac is fabulous if Lexapro or Zoloft don't cut it, it can just be a little tough to start people on this because of side effects so I often switch to this if the other 2 aren't doing a great job
  • Effexor XR is great for people who might end up on medications long term

I also give a break down of all 4 of these meds specifically based on FDA data so it can be shared with your clients if they want a little more information

Each of these medications has similar risks that I explain towards the end:

  • Serotonin Syndrome which usually causes a lot of physical symptoms from too much serotonin in the system and should involve a trip to the ER
  • Increased risk of suicidality in younger people which is something we're watching for anyway! This doesn't dissuade me from prescribing because depression is a risk for suicide! But I will make careful choices and changes if this seems like it's medication-induced
  • Chance of switch to mania for a patient with bipolar depression. It's never recommended to treat a bipolar condition with an antidepressant alone! Mania is a medical and mental health emergency!
  • There's a good thing too! These medications are considered weight neutral so they shouldn't cause weight changes. It doesn't mean some people won't have weight changes, but in general this is not a common, expected side effect of these medications. Yay!

I'm thinking about breaking out the medication discussions into separate videos for my own patients since sometimes it's overwhelming to get a bunch of information about different medications at the same time.

Maybe it would be helpful if people could watch me explain the med details when they're ready to take in all that scary side effect stuff.

What do you think, Reader? Seem like a good idea? Do you have clients that would benefit from watching me talk about the details of the medications they take?

Watch the video and reply and let me know!

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly online psychiatrist!

P.S. Watch the video about how I choose antidepressants for my patients!

P.P.S. Thera Blanks awaits your genius. Pick your best words and stick them right here!

P.P.S. Watch more on serotonin HERE and HERE and subscribe to my YouTube Channel while you're there!

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