69. How to Switch SSRIs with Dr. Jeffrey Strawn

Send us Fan Mail3 Ways to Switch SSRIs in Kids: Direct Switch vs Taper vs Cross-Titration Dr. Elise Fallucco continues a conversation with child psychiatrist and anxiety GURU Dr. Jeffrey Strawn about evidence-informed ways to switch SSRIs in pediatric patients when an adequate trial hasn’t led to remission. They review 3 strategies:1.    direct stop/starta.    Stop SSRI#1 then start SSRI#2: best for patients with side effects on the 1st SSRI, but creates a gap in antidepressant coverage during the transition2.    taper-then-switcha.    Taper SSRI#1 off then start SSRI#2: best for patients who are highly sensitive to medication changes, but leaves a LONG time without effective antidepressant/SSRI coverage 3.    cross-titrationa.    Continue SSRI#1 while adding SSRI#2 with the plan to later taper down on SSRI#1: best for patients without side effects on 1st SSRI as it allows for optimal SSRI coverage in the transition between meds; watch out with SEROTONERGIC SIDE EFFECTS (nausea, vomiting, diarrhea, flushing) while 2 SSRIs on boardClinical Pearl: Dr. Strawn emphasizes that higher starting doses don’t speed time to steady state, so start the new medication at LOW dosesClinical Case: Teen on sertraline 150 mg switches to fluoxetine·      How to cross-titrate·      How to monitor for serotonergic side effects ·      How to taper sertralineBonus Psychopharm: They receptor pharmacology considerations and the need to distinguish withdrawal effects from new-medication side effects, illustrated by an atomoxetine (Strattera) -to- fluvoxamine (LUVOX) switch affecting ADHD symptoms. Check out our website PsychEd4Peds.com for more resources!Follow us on Instagram @psyched4pedsCheck out our NEW CME Audio-based, on-demand CME Course online at:Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1