Antidepressant Drugs Flashcards
(156 cards)
1
Q
Antidepressant drugs are effective for treating moderate to severe depression associated with __________ and ____________ changes such as loss of appetite and sleep disturbance
A
psychomotor
physiological
2
Q
Antidepressant drugs are effective for treating moderate to severe depression associated with psychomotor and physiological changes such as _____________ and ____________
A
loss of appetite
sleep disturbance
3
Q
What is typically the first benefit of antidepressant therapy?
A
Improvement in sleep
4
Q
Ideally, patients with moderate to severe depression should be treated with ____________ in addition to drug therapy.
A
psychological therapy
5
Q
What is dysthymia?
A
lower grade chronic depression; typically of at least 2 years duration
6
Q
Dysthymia is a type of ________ (higher/lower) grade chronic depression that is typically of at least __________ duration
A
Lower
2 years
7
Q
Antidepressant drugs should not be used routinely in _________ depression
A
mild
*psychological therapy should be considered initially
8
Q
When are antidepressants used in the treatment of mild depression?
A
psychological therapy should be considered initially; however, a trial of antidepressant therapy may be considered in cases refractory to psychological treatments or in those associated with psychosocial or medical problem
9
Q
In addition to patients with MILD depression in whom depression is refractory to psychological treatment, which other patients may be considered for antidepressant therapy?
A
Patients with a history of moderate or severe depression
10
Q
What are the major classes of antidepressants? (4)
A
- TCAs
- SSRIs
- MAOIs
- SNRIs
11
Q
Since there may be an interval of ________ before the antidepressant action takes place, electroconvulsive treatment may be required in severe depression when delay is hazardous or intolerable
A
2 weeks
12
Q
Since there may be an interval of 2 weeks before the antidepressant action takes place, ____________ may be required in severe depression when delay is hazardous or intolerable
A
electroconvulsive treatment
13
Q
During the first few weeks of treatment with antidepressants, there is an increased potential for _________, __________, and __________.
A
agitation
anxiety
suicidal ideation
14
Q
__________ are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression.
A
SSRIs
15
Q
In patients with unstable angina or who have had a recent myocardial infarction, ____________ has been shown to be safe in the treatment of depression
A
sertraline
16
Q
______________ have similar efficacy to SSRIs but are more likely to be discontinued because of side-effects; toxicity in overdosage is also a problem
A
Tricyclic antidepressants
17
Q
SSRIs are less __________ and have fewer ________ and ________ effects than tricyclic antidepressants.
A
sedating
antimuscarinic
cardiotoxic
18
Q
__________ (class of antidepressants) have dangerous interactions with some foods and drugs, and should be reserved for use by specialists
A
MAOIs
19
Q
___________ or __________ drugs should be used with caution in depression due to the risk of masking the true diagnosis, but they are useful adjuncts in agitated patients
A
Anxiolytics
antipsychotic
20
Q
Augmenting antidepressants with __________ under specialist supervision may also be necessary in patients who have depression with psychotic symptoms
A
antipsychotics
21
Q
Augmenting antidepressants with antipsychotics under specialist supervision may also be necessary in patients who have depression with ____________ symptoms
A
psychotic
22
Q
Although anxiety is often present in depressive illness (and may be the presenting symptom), the use of an antipsychotic or an anxiolytic may _____________.
A
mask the true diagnosis
23
Q
What is St John’s wort?
A
A popular herbal remedy for treating mild depression
Also a CYP450 inducer
24
Q
St John’s wort can _________ (induce/inhibit) drug metabolising enzymes and a number of important interactions with conventional drugs, including conventional antidepressants, have been identified.
A
Induce
25
If a patient stops taking St John’s wort, the concentration of interacting drugs may _______ (increase/decrease), leading to toxicity.
Increase
26
What are the most commonly prescribed SSRIs? (5)
1. Citalopram
2. Escitalopram
3. Fluoxetine
4. Paroxetine
5. Sertraline
27
What are the most commonly prescribed SNRIs? (2)
1. Venlafaxine
| 2. Duloxetine
28
What are the most commonly prescribed TCAs? (5)
1. Amitriptyline
2. Clomipramine
3. Nortriptyline
4. Imipramine
5. Lofepramine
29
What are the most commonly prescribed MAOIs? (4)
1. Tranylcypromine
2. Phenelzine
3. Isocarboxazid
4. Moclobemide
30
Patients should be reviewed every _________ at the start of antidepressant treatment
1–2 weeks
31
Treatment should be continued for at least __________ (________ in the elderly) before considering whether to switch antidepressant due to lack of efficacy
4 weeks
6 weeks
32
In patients being treated with antidepressants, how should partial response be managed?
In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond)
33
Following remission, antidepressant treatment should be continued at the same dose for at least _________ (about __________ in the elderly), or for at least __________ in patients receiving treatment for generalised anxiety disorder (as the likelihood of relapse is high).
6 months
12 months
12 months
34
Patients with a history of recurrent depression should receive maintenance treatment for at least __________.
2 years
35
Which electrolyte disturbance has been associated with all types of antidepressants?
Hyponatremia, usually in elderly
36
Hyponatremia has been reported more frequently with ________ than with other antidepressants
SSRIs
37
_____________ should be considered in all patients who develop drowsiness, confusion, or convulsions while taking an antidepressant
Hyponatraemia
38
Hyponatraemia should be considered in all patients who develop ___________, ___________, or __________ while taking an antidepressant
drowsiness
confusion
convulsions
39
The use of antidepressants has been linked with suicidal thoughts and behaviour; which patient demographics are particularly at risk? (3)
1. Children
2. Young adults
3. Patients with a history of suicidal behavior
40
Where necessary patients being treated with antidepressants should be monitored for suicidal behaviour, self-harm, or hostility, particularly at the __________ of treatment or if ___________
beginning
the dose is changed
41
What is serotonin syndrome?
a relatively uncommon adverse drug reaction caused by excessive central and peripheral serotonergic activity
42
What are the symptoms of serotonin syndrome? (3)
Range from mild to life-threatening
1. Neuromuscular hyperactivity: tremor, hyperreflexia, clonus, myoclonus, rigidity
2. Autonomic dysfunction: tachycardia, BP changes, hyperthermia, diaphoresis, shivering, diarrhea
3. Altered mental state: agitation, confusion, mania
43
What factors may precipitate serotonin syndrome in a patient? (5)
Can occur within hours or days following:
1. Initiation of treatment
2. Dose escalation
3. Overdose of serotonergic drugs
4. Addition of a new serotonergic drug
5. Replacement of one serotonergic drug by another without allowing a long enough washout period in between (particularly when the forest drug is in irreversible MAOI or a drug with a long half-life)
44
Severe toxicity, which is a medical emergency, usually occurs with a combination of serotonergic drugs, one of which is generally a(n) _________.
MAOI
45
What is the treatment of serotonin syndrome?
1. Withdrawal of serotonergic medication
| 2. Supportive care
46
What are the main classes of serotonergic drugs? (10)
1. SSRIs
2. SNRIs
3. Bupropion
4. TCAs
5. MAOIs
6. Anti-migraine medications eg carbamazepine, valproate, triptans
7. Pain medications eg opioids including over-the-counter cough syrups
8. Lithium
9. Antiemetics including 5-HT antagonists and D2 antagonists
10. St John’s wort
47
What is the mechanism of action of bupropion?
Norepinephrine and dopamine reuptake inhibitor (SNDRI)
48
Failure to respond to initial treatment with an SSRI may require _____________, or ____________.
an increase in the dose
switching to a different SSRI or mirtazapine
49
In which drug class is the antidepressant mirtazapine?
Alpha-2 antagonist
50
____________ and __________ should be considered for more severe forms of depression
tricyclic antidepressants
venlafaxine
51
______________ may be initiated in severe refractory depression
Electroconvulsive therapy
52
Failure to respond to a second antidepressant may require the addition of ____________, or use of an augmenting agent like _________, __________, ____________, __________, or __________ under specialist supervision
another antidepressant of a different class
Lithium
Aripiprazole (unlicensed)
Olanzapine (unlicensed)
Quetiapine
Risperidone (unlicensed)
53
Management of acute anxiety generally involves the use of a ____________ or _____________.
benzodiazepine
buspirone hydrochloride
54
For chronic anxiety (of longer than 4 weeks’ duration) it may be appropriate to use a(n) _____________
antidepressant; particularly SSRI or SNRI
55
For patients with newly diagnosed anxiety, combined therapy with a ____________ may be required until the antidepressant takes effect
benzodiazepine
56
Patients with generalised anxiety disorder, a form of chronic anxiety, should be offered _____________ before initiating an antidepressant.
psychological treatment
57
For patients with chronic anxiety, a(n) ___________ such as ____________, ___________, or __________ [unlicensed], can be used if drug treatment is needed
SSRI
escitalopram
paroxetine
sertraline
58
In addition to SSRIs escitalopram, paroxetine, and sertraline, _____________ and ____________ (SNRIs) are also recommended for the treatment of generalised anxiety disorder
Duloxetine
venlafaxine
59
In patients with chronic anxiety, if SSRIs or SNRIs are not tolerated (or if treatment has failed to control symptoms), ____________ can be considered
pregabalin
60
Panic disorder is treated with _________
SSRIs
61
_______________ or __________ can be used second-line in the treatment of panic disorder. ____________, an SNRI, is also licensed for panic disorder.
clomipramine hydrochloride [unlicensed]
imipramine hydrochloride [unlicensed]
Venlafaxine
62
Obsessive-compulsive disorder, post-traumatic stress disorder, and phobic states such as social anxiety disorder are treated with ______________
SSRIs
63
What is the first line treatment for OCD?
SSRIs
64
What is the first line treatment for PTSD?
SSRIs
65
What is the first line treatment for phobic states eg social anxiety disorder?
SSRIs
66
_______________ can be used second-line for obsessive-compulsive disorder
Clomipramine hydrochloride (TCA)
67
______________ is licensed for the treatment of social anxiety disorder
Moclobemide (MAOI)
68
Moclobemide is licensed for the treatment of ______________
social anxiety disorder
69
What is the mechanism of action of TCAs?
Block re-uptake of both serotonin and noradrenaline
70
Tricyclic and related antidepressant drugs can be roughly divided into those with additional __________ properties and those that are less __________
sedative
sedating
71
Agitated and anxious patients tend to respond best to the TCAs with _____________, whereas withdrawn and apathetic patients will often obtain most benefit from the less _________ ones
Sedative activity
Sedating
72
TCAs with greater sedative activity are better for depressed patients who also have _________ and __________ symptoms
Agitated
Anxious
73
TCAs with less sedative activity are better for depressed patients who also have _________ and __________ symptoms
Withdrawn
Apathetic
74
Which TCAs have sedative properties? (7)
1. Amitriptyline
2. Clomipramine
3. Dosulepin
4. Doxepin
5. Mianserin
6. Trazodone
7. Trimipramine
75
Which TCAs have less sedating properties? (3)
1. Imipramine
2. Lofepramine
3. Nortriptyline
76
____________ (TCA) has a lower incidence of side-effects and is less dangerous in overdosage but is infrequently associated with hepatic toxicity
Lofepramine
77
Imipramine hydrochloride has more marked _________________ side-effects than other tricyclic and related antidepressants
antimuscarinic
78
______________ and ______________ are effective but they are particularly dangerous in overdosage and are not recommended for the treatment of depression
Amitriptyline
dosulepin
79
Amitriptyline hydrochloride and dosulepin hydrochloride are effective but they are particularly dangerous in overdosage and are not recommended for the treatment of _____________
depression
80
Low doses of TCAs should be used for initial treatment in _____________ (patient population).
the elderly
81
In most patients the long half-life of tricyclic antidepressant drugs allows once-daily administration, usually ______________
at night
82
Studies have shown that tricyclic antidepressants are not effective for treating depression in ___________ (patient population).
children
83
The use of tricyclic antidepressants in elderly patients is potentially inappropriate (STOPP criteria):
If prescribed in those with… (5)
1. Dementia
2. Narrow angle glaucoma
3. Cardiac conduction abnormalities
4. Prostatism
5. History of urinary retention
84
Can TCAs be used as first line antidepressant treatment in the elderly?
No; more appropriate to prescribe SSRIs or SNRIs which have a lower risk of adverse drug reactions
85
It is easier to prescribe __________ (MAOIs/TCAs) when ___________ (MAOIs/TCAs) have been unsuccessful than vice versa.
MAOIs
TCAs
86
_______________ has a greater stimulant action than phenelzine or isocarboxazid and is more likely to cause a hypertensive crisis
Tranylcypromine
| all MAOIs
87
Tranylcypromine has a greater stimulant action than phenelzine or isocarboxazid and is more likely to cause a _____________
hypertensive crisis
88
_____________ and ___________ are more likely to cause hepatotoxicity than tranylcypromine.
Isocarboxazid
phenelzine
(All MAOIs)
89
Isocarboxazid and phenelzine are more likely to cause ____________ than tranylcypromine.
hepatotoxicity
90
______________ (MAOI) should be reserved as a second line treatment
Moclobemide
91
Phobic patients and depressed patients with atypical, hypochondriacal, or hysterical features are said to respond best to ___________ (class of antidepressants)
MAOIs
92
____________ patients and depressed patients with ____________, ____________, or ___________ features are said to respond best to MAOIs
Phobic
atypical
hypochondriacal
hysterical
93
__________ should be tried in any patients who are refractory to treatment with other antidepressants as there is occasionally a dramatic response
MAOIs
94
Response to treatment with MAOIs may be delayed for __________ or more and may take an additional 1 or 2 weeks to become maximal.
3 weeks
95
Response to treatment with MAOIs may be delayed for 3 weeks or more and may take an additional ___________ to become maximal.
1 or 2 weeks
96
Other antidepressants should not be started for ___________ after treatment with MAOIs has been stopped (___________ if starting clomipramine or imipramine)
2 weeks
3 weeks
97
An MAOI should not be started until at least ___________ after a previous MAOI has been stopped (then started at a reduced dose)
2 weeks
98
An MAOI should not be started until at least ___________ after a TCA (___________ in the case of clomipramine or imipramine) has been stopped
7-14 days
3 weeks
99
An MAOI should not be started until at least ___________ after an SSRI (at least ___________ in the case of fluoxetine) has been stopped
1 week
5 weeks
100
An MAOI should not be started until at least 2 weeks after a ___________ has been stopped (then started at a reduced dose)
previous MAOI
101
An MAOI should not be started until at least 7–14 days after a __________ (3 weeks in the case of _____________ or __________) has been stopped
TCA
clomipramine
imipramine
102
An MAOI should not be started until at least a week after a(n) ____________ (at least 5 weeks in the case of ____________) has been stopped
Fluoxetine
103
_____________, an antidepressant thought to directly modulate serotonergic receptor activity and inhibit the re-uptake of serotonin, is recommended in patients whose condition has responded inadequately to 2 antidepressants within the current episode
Vortioxetine
104
_____________ is licensed for use in treatment-resistant depression, used as monotherapy and as an adjunct to other antidepressant drugs
Tryptophan
Should be initiated by hospital specialists
105
SSRIs and SNRIs are correlated with a small increased risk of __________ when used in the month before delivery
Postpartum hemorrhage
*SSRIs are known to increase the risk of bleeding due to their effect on platelet function; this may be significant in patients with other risk factors for bleeding disorders
** Anticoagulant medication in women at high risk of thrombotic events should not be stopped, however, prescribers should be aware of the risk identified.
106
What are the contraindications to use of SSRIs? (2)
1. Poorly controlled epilepsy
| 2. Mania
107
SSRIs should be prescribed with caution in which patients? (7)
1. Cardiac disease
2. Concurrent ECT
3. DM
4. Epilepsy (discontinue if convulsions develop)
5. History of bleeding disorders, esp. GI bleeding
6. History of mania
7. Susceptibility to angle-closure glaucoma
108
What are the side effects associated with SSRIs? (5)
1. Neuro/Psych: anxiety, impaired concentration, confusion, depersonalization, drowsiness, headache, mydriasis, paresthesias, visual impairment, sleep disorders, tinnitus
2. GI: change in appetite and taste, constipation, diarrhea, discomfort, nausea, vomiting, weight changes, hemorrhage, dry mouth
3. MSK: arthralgia, myalgia, tremor, skin reactions, hyperhydrosis
5. Other: arrhythmias/QT interval prolongation, fever, urinary disorders, sexual dysfunction
109
Sexual dysfunction is most commonly associated with which class of antidepressant?
SSRIs
May persist after treatment has stopped
110
Symptoms of poisoning by ____________ include nausea, vomiting, agitation, tremor, nystagmus, drowsiness, and sinus tachycardia; convulsions may occur.
selective serotonin re-uptake inhibitors
111
Rarely, severe poisoning with ________ results in ___________, with marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop.
SSRIs
serotonin syndrome
112
Which common or very common side effects are specifically associated with the SSRI, sertraline? (6)
1. Chest pain
2. Depression
3. GI disorders
4. Increased risk of infection
5. NM dysfunction
6. Vasodilation
113
What serious side effects have been associated with sertraline? (4)
1. Cerebrovascular insufficiency
2. Leukopenia
3. NMS
4. Pancreatitis
114
Are SSRIs safe to use in pregnancy and breastfeeding?
Avoid in pregnancy unless benefit outweighs risk
Not known to be harmful but consider is continuing breastfeeding
115
If SSRIs are used during the third trimester there is a risk of _____________, and _____________ has been reported.
neonatal withdrawal symptoms
persistent pulmonary hypertension in the newborn
116
Does dosing of SSRIs in hepatic and/or renal dysfunction need to be adjusted?
Prolonged half-life in hepatic impairment; caution
Avoid sertraline in severe impairment and reduce dose in mild to moderate disease
117
What are the symptoms of abrupt withdrawal of SSRIs? (13)
1. GI disturbance
2. Headache
3. Anxiety
4. Dizziness
5. Paresthesias
6. Electric shock sensation in the head, neck, and spine
7. Tinnitus
8. Sleep disturbances
9. Fatigue
10. Flu-like symptoms
11. Sweating
12. Visual disturbances
13. Palpitations
118
The dose of SSRIs should be tapered over at least _____________ to avoid the effects of rapid withdrawal
a few weeks
*longer if sertraline
119
Withdrawal effects may occur within __________ of stopping treatment with SSRIs; they are usually mild and self-limiting, but in some cases may be severe
5 days
120
Sertraline should preferably be reduced gradually over about ___________, or longer if withdrawal symptoms emerge (_________ in patients who have been on long-term maintenance treatment).
4 weeks
6 months
121
Patients and carers should be advised that patients taking SSRIs may have impaired ability to ___________
Drive and perform skilled tasks eg operating machinery
122
____________, __________ and _______________ increase the risk of bleeding when used in combination with SSRIs
NSAIDs
Anticoagulants
Antiplatelets
123
Escitalopram is the active enantiomer of __________.
citalopram (both SSRIs)
124
What is the main contraindication specific to escitalopram?
QT-prolongation
125
What is a common side effects associated with paroxetine (SSRI)?
Blurred vision
126
Paroxetine is associated with a __________ (higher/lower) risk of withdrawal reactions compared to other SSRIs
Higher
127
Which antidepressants are LEAST likely to cause sexual side effects? (4)
1. Bupropion
2. Mirtazapine
3. Vortioxetine
4. Vilazodone
128
Which antidepressants are MOST likely to cause sexual side effects? (4)
1. SSRIs
2. SNRIs
3. TCAs
4. MAOIs
129
What are the contraindications to the use of TCAs? (5)
1. Acute porphyrias
2. Arrhythmias
3. Mania
4. Heart block
5. Immediate recovery period after MI
130
TCAs should be prescribed with caution in which patients? (13)
1. CVD
2. Chronic constipation
3. Epilepsy
4. History of bipolar disorder
5. History of psychosis
6. Hyperthyroidism (risk of arrhythmia)
7. Increased IOP
8. Significant suicide risk
9. Phaeochromocytoma (risk of arrhythmias)
10. Prostatic hypertrophy
11. Risk of QT prolongation (correct hypokalemia before initiating treatment)
12. Susceptibility to angle closure glaucoma
13. Urinary retention
131
For patients taking TCAs, treatment should be stopped or dose reduced if the patient enters a _____________
Manic phase
132
____________ patients are particularly susceptible to many of the side-effects of tricyclic antidepressants
Elderly
*low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects
133
What are the common or very common side effects of TCAs? (5)
1. Neuropsychiatric: aggression, anxiety, impaired concentration, confusion, delirium, depersonalization, exacerbation of depression, drowsiness, fatigue, hallucinations, headache, hot flushes, hyperhydrosis, memory loss, altered mood, movement disorders, mydriasis, sexual dysfunction, sleep disorders, altered taste, tinnitus, vision disorders, speech disorder
2. CV: arrhythmias, hypotension, palpitations
3. GI/GU: constipation, diarrhea, dry mouth, nausea, urinary disorders
4. Endocrine: breast enlargement, galactorrhea, weight increased
5. MSK: muscle tone increased, muscle weakness, skin reactions
134
What are the dangerous side effects associated with TCAs? (6)
1. Agranulocytosis
2. NMS
3. Vaginal hemorrhage
4. Rhabdomyolysis
5. Serotonin syndrome
6. Suicidal behaviors
135
Patient taking TCAs should be encouraged to ____________ treatment if side-effects develop
Continue
*some tolerance to side-effects seems to develop; the risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days)
136
Overdose of _____________ cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur
TCAs
| Antimuscarinic effects among other symptoms of autonomic dysregulation
137
____________ have been reported when TCAs are used during the third trimester of pregnancy
Neonatal withdrawal symptoms
138
Are TCAs safe to use in breastfeeding?
Yes
139
Can TCAs be used in hepatic impairment?
Use caution; avoid in severe impairment due to risk of hypertensive crisis
140
Is monitoring required with TCA use?
Monitoring of cardiac and hepatic function during long-term use
141
Manufacturer advises monitoring of __________ and ___________ function during long-term use of TCAs
Cardiac
Hepatic
142
The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for __________ or more.
8 weeks
143
Limited quantities of ___________ should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage.
TCAs
144
Limited quantities of tricyclic antidepressants should be prescribed at any one time because their ___________ and _________ effects are dangerous in overdosage.
cardiovascular
epileptogenic
145
Effects of alcohol are enhanced when patients are taking _____________ (class of antidepressant)
TCAs
146
Overdosage with _____________ (antidepressant) is associated with a relatively high rate of fatality.
Amitriptyline
*Symptoms of overdosage may include dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias; Dilated pupils and urinary retention also occur
147
What are the symptoms of NMS? (6)
1. Muscle rigidity (diffuse “lead pipe”)
2. Fever
3. Tachycardia
4. Diaphoresis
5. Hyporeflexia
6. Hypertension
*gradual onset
(VS serotonin syndrome which is characterized by hyperreflexia, myoclonus, nausea, diarrhea)
148
What is the mechanism of action of MAOIs?
MAOIs inhibit monoamine oxidase, thereby causing an accumulation of amine neurotransmitters.
149
What are the contraindications to MAOIs? (4)
1. Cerebrovascular disease
2. Mania
3. Phaeochromocytoma
4. Severe CVD
150
What are the side effects associated with MAOIs?
Akathisia; anxiety; appetite increased; arrhythmia; asthenia; behaviour abnormal; blood disorder; confusion; constipation; dizziness; drowsiness; dry mouth; dysuria; hallucination; headache; hyperhidrosis; insomnia; jaundice; nausea; paraesthesia; peripheral neuritis; postural hypotension (more common in elderly); reflexes increased; skin reactions; suicidal behaviours; tremor; vision blurred; vomiting; weight increased
151
Discontinue MAOIs if __________ or __________ occur
Palpitations
Frequent headaches
152
Are MAOIs safe in pregnancy?
Increased risk of neonatal malformations; avoid unless compelling reasons
153
Are MAOIs safe to use in hepatic and/or renal impairment?
Avoid in hepatic impairment
154
What monitoring is advised for patients taking MAOIs?
Monitor BP due to risk of hypotension and hypertensive responses
155
What are the symptoms of abrupt MAOI withdrawal? (10)
1. agitation
2. irritability
3. ataxia
4. movement disorders
5. insomnia
6. drowsiness
7. vivid dreams
8. cognitive impairment
9. slowed speech
10. Hallucinations and paranoid delusions
156
What additional information should be given to patients and carers regarding MAOIs?
1. Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or ‘going off’. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued.
2. Patients should also be advised to avoid alcoholic drinks or de-alcoholised (low alcohol) drinks.
3. Drowsiness may affect performance of skilled tasks (e.g. driving).
