Anti-depressants

Question 0

What is the maximum dose of Sertraline?

Answer 0

200mg

Question 1

What is the starting dose of Sertraline?

What is the maximum?

Answer 1

50mg

200mg

Question 2

Which SSRI cannot be used in pregnancy?

Answer 2

Paroxetine

Question 3

Name all of the SSRIs

Answer 3

Citalopram, Fluoxetine, Sertraline and Paroxetine

Question 4

What is the starting dose of Fluoxetine, Citalopram and Paroxetine?
what are their therapeutic doses?

Answer 4

20mg

60mg, 40mg, max 60mg but no evidence of efficacy past 20mg.

Question 5

What are the side-effects of SSRIs

Answer 5

Nausea, diarrhoea, dry mouth, low sex drive, blurred vision.

Question 6

Name the SNRIs used.

Answer 6

Duloxetine and Venlafaxine.

Question 7

What is the dosage of Venlafaxine and which dose would you use for depression? What dose would you use for anxiety?

Answer 7

75mg - 375mg.

75mg - 150mg for depression.

150mg - 375 for anxiety.

Question 8

Name all of the TCAs. Which are most sedative?

Which is most risky in overdose and therefore not recommended for depression.

Which is the lowest risk in overdose?

Answer 8

Amitriptyline, Nortryptyline, Lofepramine, Clomipramine and Imipramine.

Clomipramine and Imipramine most sedative so good if agitated.
Amitriptyline
Lofepramine

Question 9

What class of antidepressant is Phenelzine?

What foods do you need to avoid?

What may happen if you do not avoid them?

Answer 9

MAOI

Cheese, Marmite, Tyramine.

Increased blood pressure.

Question 10

What are the side effects of TCAs?

What should you do before prescribing TCAs?

Who should not take them?

Answer 10

Cardiotoxicity, depression of respiratory system. Anticholinergic effects such as dry mouth, blurred vision, constipation.

ECG
Cardiovascular disease-chronic constipation-suicidality.

Question 11

What is the first line, second line and third line antidepressant?

What might you prescribe after SSRI that is not in these classes?

Answer 11

1st - SSRI
2nd - SNRI
3rd - TCA

Mirtazepine.

Question 12

Which antidepressant may cause sedation and weight gain and can be used if the client is on NSAIDS (risk of bleed).

Answer 12

Mirtazepine.

Question 13

What are the symptoms of serotonin syndrome?

What should you not take along with antidepressants?

Answer 13

Restlessness, Tremor, Temperature, Lack of coordination.

St Johns Wort, Tryptophan.

Question 14

What are the symptoms of depression?

What is the treatment if symptoms are severe?

Answer 14

Loss of libido, loss of motivation, hopelessness, helplessness, poor sleep, poor appetite, suicidality, psychotic symptoms.

ECT

Question 15

When can you switch drugs with a short half-life?

Answer 15

After one week.

Question 16

What is the therapeutic dose of Duloxetine? What is the trade name?

Answer 16

60mg.

cymbalta

Question 17

What is the therapeutic dose of Mirtazepine?

Answer 17

45mg Nocte. Initially 15-30mg.

Question 18

failure to respond after second antidepressant. What can a doctor consider

Answer 18

Augmenting with lithium, Aripiprazole, Olanzapine, quetiapine, or Risperidone.

Question 19

How long should you continue antidepressants after remissions?

Answer 19

At least six months. 12 months for GAD and 2 years for recurrent depression.

Question 20

Which two antidepressants have a short half-life and therefore an increased risk of withdrawals?

Answer 20

Venlafaxine and Paroxetine.

Question 21

What class of antidepressants can be used for anxiety disorders apart from SSRI.

What would you prescribe if both cannot be tolerated.

Answer 21

SNRI.

Pregabalin.

Question 22

Dose of Amitriptyline

Clomipramine

Answer 22

75-150-200

10-30-150-250

Question 23

Dose of imipramine

Nortryptyline

Answer 23

75-150-300 in hospital

75-100-150

Question 24

Dose of Lofepramine

Answer 24

140-210mg

Question 25

What neurotransmitters do TCAs block re-uptake of?

Answer 25

Serotonin and noradrenaline

Question 26

How do TCAs work?

Answer 26

Block re-uptake of serotonin and noradrenaline.