Psych CASC / OSCE · Psychopharmacology — atypical and multimodal antidepressants
Choosing bupropion after SSRI sexual dysfunction (CASC)
CASC-style station: explain NaSSA vs NDRI trade-offs, accurate seizure risk counselling, sexual side-effect management, smoking opportunity, and avoid casual combination starts.
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Target exams
Station instructions (candidate)
You have 7 minutes. Explore goals: mood recovery, sexual function, smoking, weight concerns. Explain that sertraline-related sexual dysfunction is common and treatable by strategy, not shame. Offer a collaborative plan that may include switching to or adding bupropion after screening for seizure risk factors, with a clear oral dose plan and early review. Contrast honestly with mirtazapine (helpful for sleep/appetite; sedation and weight gain trade-offs). Do not claim zero seizure risk. Do not start venlafaxine+mirtazapine tonight as casual "rocket fuel." Do not dismiss online fears.[1][3][4][6][7]
You have read the opening of this CASC / OSCE. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Rush AJ, Trivedi MH, Wisniewski SR, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression N Engl J Med, 2006.PMID 16554525
- [2]Trivedi MH, Fava M, Wisniewski SR, et al. Medication augmentation after the failure of SSRIs for depression N Engl J Med, 2006.PMID 16554526
- [3]Thase ME, Clayton AH, Haight BR, et al. A double-blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability J Clin Psychopharmacol, 2006.PMID 16974189
- [4]Davidson J Seizures and bupropion: a review J Clin Psychiatry, 1989.PMID 2500425
- [5]Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation N Engl J Med, 1999.PMID 10053177
- [6]de Boer T The pharmacologic profile of mirtazapine J Clin Psychiatry, 1996.PMID 8636062
- [7]Rush AJ, Trivedi MH, Stewart JW, et al. Combining medications to enhance depression outcomes (CO-MED): acute and long-term outcomes of a single-blind randomized study Am J Psychiatry, 2011.PMID 21536692
- [8]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391