Antidepressants

Question 1

How are mood disorders classified?

Answer 1

Bipolar disorders

Depressive disorders

Impairs activity, cognition and emotion

Question 2

What 4 drug classes are used to treat depression?
Which is used in first-line treatment?

Answer 2

Selective serotonin reuptake inhibitors (SSRI) - first line

Serotonin noradrenaline reuptake inhibitors (SNRI)

Tricyclic antidepressants (TCA)

Monoamine oxidase inhibitors (MOI)

Question 3

SNRI examples, indications, AE, RPI

Answer 3

fluoxetine, paroxetine, dapoxetine, citalopram

• MAJOR DEPRESSION
• nausea, vomiting, dizziness, tremor, headache
• RARE - serotonin toxicity/syndrome
• RPI - increased SI when treatment first started

Question 4

SSRI - examples, indications, AE, RPI

Answer 4

Duloxetine, desvenlafaxine

• MAJOR DEPRESSION
• nausea, dry mouth, constipation, sweating
• risks of serotonin toxicity
  RPI - BP monitoring, slow tapering

Question 5

TCA - examples, indications, AE, RPI

Answer 5

amitriptyline, doxepin, trimipramine, imipramine

indications - depression, urge incontinence, ADHD

AE - anticholinergic effects (sedation, dry mouth, urinary retention, constipation)
- cardiotoxicity
- postural HT
- arrythmia

Question 6

Symptoms of major depression

Answer 6

fatigue
insomnia
diminished interest or pleasure for 2 or more weeks
depressed mood
etc.

Question 7

Rationale for drug use

Answer 7

1. relieve psychological and physical symptoms,
2. improve functional capacity,
3. reduce the liklihood of self-harm or suicide

Question 8

monoamine oxidase inhibitors - EG, indications, AE, RPP

Answer 8

e.g. phenelzine

indications - major depression, anxiety disorders

AE - orthastatic HT, sleep disturbances, agitation, fatigue

RPP - tyramine free/reduced diet (eat fresh or fresh frozen foods)

Question 9

minimisation of discontinuation effects

Answer 9

• continue treatment for 6-9 months after resolution of symptoms
• do not cease abruptly