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 insomnia, anxiety  



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Author16 Posts
  #1

A 72-year-old woman enters the hospital having lost 7 kg and saying she has no interest in eating. Her physical examination and laboratory findings are normal. She has been awakening at 5 a.m. for several months and cannot fall back to sleep. She says she has been feeling anxious and helpless since her husband died 3 years ago. Which one of the following is a reasonable medication to prescribe for her?

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1) olanzapine (Zyprexa®)



2) venlafaxine (Effexor®)



3) clonazepam (Rivotril®)



4) quetiapine (Seroquel®)



5) risperidone (Risperdol®)





  #2

2) venlafaxine


  #3

2


  #4

but 2 has insomnia side effect?



  #5

2
venlafaxine is serotonergic ,so should not cause insomnia.
other three are antiphychotic .cionazepam will produce excessive sedation.


  #6

2 is the only reasonable choice.rest r not first line antidepressants


  #7

determine, are you sure?

'Venlafaxine has generally been reported to be well tolerated. The most common adverse reactions are nausea, somnolence, dry mouth...'
from 'Kaplan & Sadock's Concise Textbook of Clinical Psychiatry', 2nd ed. 2003, page 499.


  #8

Effexor is a good choice because it's the only antidepressant among meds mentioned, and she might be depressed. But I would go with Clonazepam coz she says she 's anxious, and Clonazepam would make her sleep and be less anxious.
What's the right answer, determine?



  #9

Effexor


  #10

I thought as a SNRI, Venf. has also insomnia side effect. But I double checked, it has only %3 insomnia side eff.



  #11

I don`t have the right answer. I can`t decide between 2 AND 3?


  #12

I checked out- Effexor XR has been approved for both depression and Anxiety Disorder. I was choosing Clonazepam because of anxiety, Effexor has stimulating activity, so I thought prescribing it to smb with anxiety wouldn't be right. Apparently, I'm wrong-Effexor is the right choice-treats both depression and anxiety.


  #13

thanks rasul. i did'nt know the answer to this one.


  #14

thanks a lot friends smiling face





  #15

Effexor is an excellent choice for depression, pain control .





  #16

velaxafine





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