• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Anecdotes From The Field

Anecdotes From The Field

January 1, 2005
Tom Rusk, M.D.
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Tom Rusk, M.D. is Chief of Adult Psychiatry at Community Health & Counseling Services in Winterport, Maine. He shares his approach to minimizing the risk of SSRI-induced agitation. Dr. Rusk has disclosed that he is a member of the speakers bureau of Pfizer, Bristol-Myers Squibb, GlaxoSmithKline, Astra Zeneca, and Eli Lilly.

“Eight or nine years ago I had a couple of young adults become highly agitated and violent in the week after I started an SSRI (paroxetine in both cases). One beat up his girlfriend badly despite the lack of any history of violence previously. (I have since become dissatisfied with paroxetine because it seems to carry the worst risk of every bad side effect of SSRIs -- discontinuation syndrome, sexual side effects, fatigue, etc., with no clear benefits compared with other SSRIs.) But regarding the specific issues of violence and suicidality, I have learned to initiate any SSRI at much lower than recommended dosages in all patients: 12.5 mg sertraline, 5mg fluoxetine, 5 mg escitalopram, and so forth, in order to diminish the tendency of these medications to cause initial agitation. The vast majority of our patients have had psychiatric symptoms for months or more often years, so why not start very low and go very slow in everyone including the young, old, and medically ill? With responsible patients, I often encourage them to increase after several days if they are not experiencing any agitation. I have had almost no problem with initial agitation in adolescents or anyone else since taking this approach.”
General Psychiatry
    Tom Rusk, M.D.

    More from this author
    www.thecarlatreport.com
    Issue Date: January 1, 2005
    SUBSCRIBE NOW
    Table Of Contents
    rTMS: Will It Replace ECT?
    Antidepressant Updates: Generics, VNS, & Serzone
    Dr. Michael J. Gitlin on Using the Newer Antidepressants
    Thinking Outside the Box
    Anecdotes From The Field
    The Dual Reuptake Wars
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.