Psych CASC / OSCE · Psychopharmacology — SNRIs and NRIs
Starting venlafaxine after SSRI — dual action, BP and discontinuation (CASC)
CASC-style communication station: explain SNRI rationale after SSRI, honest dual-action dose language, BP monitoring, sexual side-effects, discontinuation vs addiction framing, safety-netting and follow-up.
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Station instructions (candidate)
You have 7 minutes. Speak with the patient (and partner if engaged). Explain why a change from escitalopram is reasonable, what an SNRI is in plain language without overselling “always stronger dual action,” propose a venlafaxine XR start and review plan including blood pressure checks, address “addiction/withdrawal” fears accurately, mention sexual side-effects, and safety-net for early worsening mood or rare dangerous combinations. Do not guarantee remission. Do not dismiss online fears — reframe with evidence.[1][2][4][7]
References8ShowHide
- [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]Blier P, Saint-André E, Hébert C, et al. Effects of different doses of venlafaxine on serotonin and norepinephrine reuptake in healthy volunteers Int J Neuropsychopharmacol, 2007.PMID 16690005
- [3]Thase ME Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3744 depressed patients J Clin Psychiatry, 1998.PMID 9818630
- [4]Schatzberg AF, Blier P, Delgado PL, et al. Antidepressant discontinuation syndrome: consensus panel recommendations for clinical management and additional research J Clin Psychiatry, 2006.PMID 16683860
- [5]Montejo AL, Llorca G, Izquierdo JA, et al. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients J Clin Psychiatry, 2001.PMID 11229449
- [6]Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis Lancet, 2018.PMID 29477251
- [7]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
- [8]Boyer EW, Shannon M The serotonin syndrome N Engl J Med, 2005.PMID 15784664