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Desvenlafaxine is an antidepressant that is an FDA-approved drug to treat major depressive disorder in adults. For healthy women who have contraindications to estrogen, desvenlafaxine can be used off-label to treat hot flashes during menopause. Although not FDA approved in adolescents, the TORDIA studies have shown that serotonin and norepinephrine reuptake inhibitors like venlafaxine have efficacy in treating major depressive disorder in treatment-resistant depression in adolescents. This activity will highlight the mechanism of action, adverse event profile, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions of desvenlafaxine, pertinent for interprofessional team members during desvenlafaxine therapy. Objectives: Summarize the mechanism of action of desvenlafaxine. Identify the indications for using desvenlafaxine therapy. Outline the potential adverse events when using desvenlafaxine. Review the importance of interprofessional communication and improving care coordination among the interprofessional team when initiating desvenlafaxine therapy. Access free multiple choice questions on this topic.

Desvenlafaxine is rarely lethal when used as a standalone agent. There is a risk of serotonin syndrome when combined with other serotonin augmenting medications, triptans, tricyclic antidepressants, over-the-counter agents, and monoamine oxidase inhibitors. The treatment for overdose is symptomatic and supportive. There is no specific treatment for desvenlafaxine toxicity.

The interprofessional healthcare team, including clinicians, mid-level practitioners, nurses, mental health specialists, and pharmacists, should keep major depressive disorder in their differential when dealing with patients who may present with depressed mood, anhedonia, feelings of guilt, worthlessness, insomnia, and suicidality. Endocrine abnormalities, along with substance abuse, may also cause these symptoms. After ruling out substance misuse and other factors, only then should a psychiatric diagnosis of MDD should be made. It is now common to treat this disease with selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Providers need to assess all the medications being taken by the patient to prevent drug interactions with desvenlafaxine, especially those with decreased glomerular filtration rate (GFR) or hepatic impairment. With interprofessional care coordination and open information sharing, treating MDD with an SNRI like desvenlafaxine (or other agents in the antidepressant class) can be accomplished with greater therapeutic effectiveness and fewer adverse events and drug interactions. [Level 5]