Depression Flashcards
what is the different treatment types for depression? and counselling of them
-mild=cognitive behavioural therapy
-moderate-severe= antidepressant
-patient may feel worse at the start first 1-2wks
-should be taken for 4 weeks (6 weeks in elderly)before deemed ineffective
-take for 6 months after remission. 1 year in elderly, 2 years in recurrent
what is the first line for depression?
-SSRI
if doesn’t go away:
-increase dosage
-change SSRI
-mirtazapine
-MAO-I (specialist)
-TCS or venlafaxine (severe)
-if that doesn’t work, add in another class, lithium or antipsychotics
-use electroconvulsive therapy in severe refractory depression
what antidepressant do you use in 17 years and under?
-fluoixtine
what SSRI is best to use if patient has risk of bleeding?
mirtazepine
what is the safest drug to use in depression for someone with cardia events?
sertraline
are SSRI or tricyclic antidepressants more tolerated and safer in overdose?
SSRI are better
what are some side effects of SSRI?
-GI disturbances (diarrhoea and vomiting )
-apretite/weight gain
-Sexual dysfunction
-risk of bleed
-insomnia (take medication in morning )
-QT prolongation (escitalopram and citalopram
what are some SSRI interactions?
-CYP enzyme inhibitors (avoid grapefruit, increase plasma conc)
-CYP enzyme inducers (reduces effectiveness) e.g. St John Wort
-Drugs that cause QT prolongation (amioderone, sotolol, quinolones
-drugs increasing risk of bleed
-hyponatraemia (carbamazepine and diuretics)
-serotonin syndrome
what are the 3 types of effects that come with serotonin syndrome?
-cognitive effects e.g. headaches, agitation, hypomania, coma, confusion
-autonomic effects e.g. sweating, hypothermia, nausea and diarrhoea
-neuromuscular excitation e.g. myoclonus, tremor, teeth grinding
what drugs can cause serotonin syndrome?
-SSRIS, TCA, MAO-I
-triptans
-tramadol
-lithium
what anti-depressant would you use for sedation?
-tricyclic anti-depressants
like amitriptyline, clomipramine, dosulepin and trazodone
what tricyclic anti-depressant are less sedating? what patients are this best?
-better for withdrawn and apathetic patients
-imipramine, lofepramine nortiptyline
what is a very dangerous overdose tricyclic antidepssants?
-amitriptyline and dosulepin are not recommend for the treatment of depression due to overdose
what are the side effects of tricyclic anti-depressants?
-cardia events
-anti-muscarinic (dry mouth, constiptation)
-seizures reduction
-hypotension
-hallucinations
more dangerous in overdose than SSRIs
what are some interactions with TCA?
-CYP enzyme inhibitors (avoid grapefruit, increases plasma conc)
-CYP enzyme inducers (reduces effectiveness)
-Drugs that causes QT prolongation (amiodarone, sotalol, quinolones)
-anti-muscarinic
-antihypertensive drugs
serotonin syndrome
