Antidepressants Flashcards by Unknown Unknown

What do SSRIs stand for?

Selective serotonin reuptake inhibitors

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What are some examples of SSRIs?

Sertraline
Fluoxetine
Paroxetine
Citalopram
Escitalopram
Fluvoxamine

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How do SSRIs work?

They inhibit the re-uptake of serotonin meaning more serotonin is available to pass their messages between nearby nerve cells.

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How long does it take for SSRIs to be effective?

2-4 weeks

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Which SSRI is preferred post MI?

Sertraline- more evidence for being safer than other antidepressants

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Which SSRI is the choice of drug when antidepressants are indicated in children/ adolescents?

Fluoxetine

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Which SSRIs have a higher propensity for drug interactions?

Fluoxetine
Paroxetine

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What is the most common side effect of SSRIs?

GI symptoms

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What should be prescribed to patients on an SSRI and NSAID?

And why?

A PPI should be prescribed

Due to increased risk of GI bleeding

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What is a side effect of using citalopram?

Prolonged QT interval

Therefore shouldn’t be used in those with long QT syndrome, now pre-existing QT interval prolongation or in combination with other medications that prolong QT interval

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What are some common drugs that interact with SSRIs?

NSAIDS: co-prescribe PPI
Warfarin/heparin/aspirin : consider using mirtazapine instead
Triptans: Increased risk of serotonin syndrome
Monoamine oxidase inhibitors (MAOIs): Increased risk of serotonin syndrome

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Following initiation of antidepressant therapy , when should patients be reviewed?

Normally: after 2 weeks
<25 years/ increased risk of suicide: after 1 week

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For how long should patients continue antidepressant therapy?

For at least 6 months after remission as it reduces risk of relapse

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How should SSRIs be stopped?

Reduced gradually over a 4 week period

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What discontinuation symptoms can SSRIs cause?

MAIN ONES:
- GI problems: Diarrhoea, vomiting, cramping, pain

OTHER:
- Increased mood change
- Restlessness
- Difficulty sleeping
- Unsteadiness
- Sweating
- Paraesthesia

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What is a potential risk of using SSRIs in the first trimester of pregnancy?

Small increased risk of congenital heart defects

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What is a potential risk of using SSRIs in the third trimester of pregnancy?

Can result in persistent pulmonary hypertension of the newborn

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Which SSRI is associated with the most risk in pregnancy?

Paroxetine- increased risk of congenital malformation particularly in the first trimester

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What electrolyte imbalance can SSRIs cause?

Hyponatraemia

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What are SNRIs?

Serotonin and noradrenaline re-uptake inhibitors

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How do SNRIs work?

They inhibit the re-uptake of serotonin and noradrenaline= increased concentrations in synaptic cleft = happy vibes

What are some examples of SNRIs?

Venlafaxine
Duloxetine

What may need to be monitored at high doses of SNRIs?

Blood pressure - can cause HTN

What type of antidepressant is Mirtazepine?

Norepinephrine and specific serotonergic antidepressant (NaSSA)

What are some side effects of Mirtazepine?

COMMON: - Sedation - Increased appetite/ weight gain {Can be good for patients who are struggling with sleep and eating} LESS COMMON: - Jaundice/ LFT changes - Postural hypotension - Blood dyscrasias

What are some examples of tricyclic antidepressants (TCAs)

- Amitriptyline - Clomipramine - Dothiepin - Imipramine - Lofepramine

What are TCAs most commonly used for?

Less commonly used for depression due to side-effects and toxicity in overdose Widely used in the treatment of neuropathic pain where smaller doses are typically required

What are come common side effects of TCAs?

- Drowsiness - Dry mouth - Blurred vision - Constipation - Urinary retention - Lengthening of QT interval

Which TCAs are considered most dangerous in overdose?

Amitriptyline and Dosulepin (Dothiepin)

What is the most common use of low dose amitriptyline?

Management of neuropathic pain Prophylaxis of headache (tension and migraine)

Which TCAs are sedative?

MORE SEDATIVE: - Amitriptyline - Clomipramine - Dosulepin - Trazodone (technically a tricyclic related antidepressant) LESS SEDATIVE: - Imipramine - Lofepramine - Nortriptyline

What are some early features associated with TCA overdose?

Anticholinergic properties: - Dry mouth - Dilated pupils - Agitation - Sinus tachycardia - Blurred vision

What are some features of severe TCA poisioning?

- Arrhythmias - Seizures - Metabolic acidosis - Coma

What are some ECG changes seen in TCA overdose?

- Sinus tachycardia - Widening of QRS - Prolongation of QT interval

QRS widening in TCA overdose can cause what?

Widening of QRS > 100ms = increased risk of seizures Widening of QRS > 160ms = increased risk of ventricular arrhythmias

What is the treatment for TCA overdose?

IV bicarbonate: - first line therapy for hypotension or arrhythmias - indications include widening of QRS interval >100ms / ventricular arrhythmias IV liquid emulsion is increasingly used to bind free drug and reduce toxicity

What are some examples of monoamine oxidase inhibitors (MAOIs)?

- tranylcypromine - phenelzine - moclobemide - isocarboxazid

What does monoamine oxidase do?

Serotonin and noradrenaline are metabolised by monoamine oxidase in the presynaptic cell

What are MAOIs used for?

In the treatment of atypical depression (e.g. hyperphagia) and other psychiatric disorder

What are some side effects of non-selective MAOIs?

- Hypertensive reactions - Anticholinergic effects

What foods should be avoided when on MAOIs?

Tyramine containing foods e.g: - Cheese - Pickled herring - Bovril - Oxo - Marmite - Broad beans {Can cause hypertensive crisis}

What is the first line treatment for depression?

SSRIs

What is the first line SSRI for anxiety?

Sertraline

What should be offered if the first line treatment for anxiety is ineffective?

If sertraline is ineffective: - offer an alternative SSRI or SNRI (e.g. duloxetine and venlafaxine) If SSRIs/ SNRIs not tolerated: - offer pregabalin

What should be trialled for panic disorder if first line treatment contraindicated/ ineffective?

If SSRI are contraindicated/ no response after 12 weeks try: imipramine or clomipramine

What medication can be used in OCD with moderate/ severe functional impairment?

- SSRI - Clomipraine if :preference/ previous good response/ if SSRI contraindiated

What can cause serotonin syndrome?

- MAOIs - SSRIs: * St John's Wort can interact with SSRI to cause serotonin syndrome *Tramadol may also interact with SSRIs - Ecstasy - Amphetamines

What are the symptoms of serotonin syndrome?

Neuromuscular excitation: - Hyperreflexia (* increased reflexes*) - Myoclonus - Rigidity Autonomic nervous system excitation: - Hyperthermia - Sweating Altered mental state: - Confusion

What is the management for serotonin syndrome?

- Withdrawal of medication - IV fluids - Benzodiazepines In more severe cases: - Cyproheptadine - Chlorpromazine {serotonin antagonists}

What are the first line drugs in PTSD?

Venlafaxine/ SSRI