E14 - Liver and Let Die: Navigating Antidepressant Use in Cirrhosis

The Y in Psychiatry

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In this enlightening episode, the squad unravels the intricate tango between the liver and psychiatric medications, focusing on patients with cirrhosis. Discussing 1st-pass metabolism, phase 1 and 2 metabolisms, plasma protein binding, fluid overload, and the implications of these processes on medication efficacy and toxicity. We know you liver this stuff.
Our hopes and dreams by the end of this episode for you:
Understand the significance of 1st-pass metabolism in the context of liver disease, particularly cirrhosis.
Analyze the role of phase 1 and phase 2 metabolisms, and how they influence the efficacy of medications like antidepressants.
Discover how plasma protein binding and fluid overload can affect the concentration of medications in the system and potentially cause toxicity.
Learn about the specific antidepressants that go through 1st-pass metabolism, have high plasma protein binding, are broken down by cytochrome, and are affected by fluid overload.
Discuss safer antidepressant options for patients with cirrhosis and the importance of monitoring and adjusting dosage.

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