SSRIs and SNRIs

Question 1

List the SSRIs

Answer 1

EFFective for Sadness Panic and Compulsion

Escitalopram
Fluoxetine
Fluvoxamine
Sertraline
Paroxitine
Citalopram

Question 2

SSNRIs

Answer 2

Velafaxine above 200mg
Desvenlafaxine

Duloxetine

Milnacipram
Levomilnacipram

Question 3

What is the NRI

what is its indication

Answer 3

Reboxetine

Not approved in US,

Used in eruope for MDD, Panic disorder, and ADHD.

Question 4

Indications for the SSRIs

Answer 4

1st line:

• major depressive disorder
• panic disorders
• OCD
• PTSD
• GAD and Social anxiety disorders
• Bulemia
• Premature ejaculation - fluoxetine.

Question 5

Indications for the SNRIs

Answer 5

• major depressive disorder, esp if patients also have sedation
• Fibromyalgia - Duloxetine and Levomilnaciprame
• Neuropathic pain and chronic pain syndromes
• Osteoarthritis chronic pain
  Duloxetine and Venlafaxine

Question 6

SSRI side effects

Answer 6

Have both onset and discontinuation side effects:
Initial phase, lasts a few days:
- CNS stimulation, anxiety agitation, increased chance of suicide from increased energy but unchanged depression

Discontinuation reaction:
Flu-like syndrome lasting a few days if abruptly stopping the medication

• Headache
• GI irritation, nausea, and weight loss or gain
• Sexual dysfunction – major problem and cause for discontinuation.
• CNS stimulant, agitation
• Sleep disturbances, insomnia and/or drowsiness

Serious side effects:

• SIADH, and dilutional hypervolemic hyponatremia
• Serotonin syndrome

Question 7

What is the treatment for Serotonin syndrome

Answer 7

Cyproheptadine

first-generation antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties.

Question 8

SSRI drug interactions

Answer 8

Are CYP inhibitors,
Increase the amount of

TCAs
Lithium
Warfarin
Theophylline

Fluoxetine inhibits both 2D6 and 3A4

Paroxetine 2D6