What medications are recommended for a 35-year-old female with moderate to severe Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Panic Disorder, who wants to avoid weight gain and sexual side effects?

From the Guidelines

For a 35-year-old female with moderate-severe major depressive disorder, generalized anxiety disorder, and panic disorder who wants to avoid weight gain and sexual side effects, I would recommend bupropion (Wellbutrin) as the first-line treatment option. Bupropion is often prescribed at 150 mg daily for one week, then increased to 300 mg daily, either as a single dose or divided into two doses 1. It's generally weight-neutral and less likely to cause sexual dysfunction compared to SSRIs, as it is associated with a lower rate of sexual adverse events than fluoxetine and sertraline 1.

Key Considerations

• Bupropion works by affecting neurotransmitters like norepinephrine and dopamine, which help regulate mood, anxiety, and panic symptoms.
• Treatment should continue for at least 6-12 months after symptom improvement.
• Regular follow-up appointments are essential to monitor effectiveness and side effects.
• Combining medication with cognitive-behavioral therapy often provides better outcomes than medication alone.

Alternative Options

If bupropion is not effective, alternative options may include:

• Venlafaxine (Effexor) or duloxetine (Cymbalta), which are SNRIs that can help regulate mood, anxiety, and panic symptoms.
• Mirtazapine (Remeron) at bedtime or escitalopram with bupropion, which can be considered as alternatives if first-line options are not effective.

Monitoring and Follow-up

It is essential to monitor the patient's response to treatment and adjust the therapy as needed, as recommended by the American College of Physicians 1. Regular follow-up appointments should be scheduled to assess the patient's symptoms, side effects, and overall response to treatment.

From the Research

Medication Options

For a 35-year-old female with moderate to severe Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Panic Disorder, who wants to avoid weight gain and sexual side effects, several medication options are available:

• Bupropion: a dopamine-norepinephrine reuptake inhibitor with no appreciable activity on serotonin concentrations in the central nervous system 2, 3
• Vilazodone: a selective serotonin reuptake inhibitor and 5-HT1A receptor partial agonist, which may have reduced sexual side effects compared to other SSRIs 2, 4
• Vortioxetine: a novel antidepressant that targets multiple serotonin receptors and may have a lower risk of weight gain and sexual side effects 2

Efficacy and Safety

These medications have been shown to be effective in treating MDD and anxiety disorders:

• Bupropion has been found to be as efficacious as SSRIs and tricyclic antidepressants, with a lower risk of somnolence and weight gain 3
• Vilazodone has been shown to be significantly superior to placebo in treating MDD, but more studies are needed to establish its efficacy and long-term safety 4
• Vortioxetine has been found to be effective in treating MDD, with a rapid onset of action and a low risk of sexual side effects 2

Combination Therapy

Combining bupropion with SSRIs or SNRIs may be effective in treating MDD and reducing sexual side effects:

• Studies have shown that adding bupropion to SSRI or SNRI treatment can enhance antidepressant response and reduce sexual side effects 5
• However, more studies are needed to determine the optimal dose and duration of combination therapy 5