Antidepressants

Question 1

How long do they take to start working?

Answer 1

4-6 weeks to start working

Question 2

how do we monitor them?
how often?

Answer 2

baseline monitor weekly for 4 weeks, then after, 2 weekly

Question 3

what is a common side effect of starting antidepressants and in which age group?

Answer 3

30 and under
high suicidality risk when first starting

Question 4

How long do they need to be taken for and when can they be stopped and how?

Answer 4

need to take for 6 months after Sx improve and wean over 4 weeks

Question 5

why do we wean Px off antidepressants?

Answer 5

To prevent SSRI/Serotonin discontinuation syndrome

Sx = Flu Sx, N+V, Agitation, insomnia, parasthesia

Question 6

name some antidepressant classes?

Answer 6

SSRI
SNRI
MAOI
TCA
MIRTAZIPINE

Question 7

What does SSRI stand for?
what is it?

Answer 7

selective serotonin reuptake inhibitor

5HT (Serotonin) presynaptic reuptake inhibitor

Question 8

what are 4 examples of SSRIs?

Answer 8

sertraline
fluoxetine
paroxetine
citalopram

Question 9

Sertraline
good in which conditions?

Fluoxetine
used in which age group and good in what group?

Answer 9

good for generalised anxiety disorder and depression

CAMHS + breast feeding

Question 10

paroxetine
good in what group? high risk of what?

Citalopram
can cause?

Answer 10

good for breastfeeding
high discontinuation Sx

QTc prolongation

Question 11

Side effects for SSRIs?

Answer 11

GI (enteric NS) - N+V, pain, High GI bleed risk, if lots of NSAID use

Impotence + low libido

Serotonin syndrome

QTc prolongation (>450 ms)

HyPO natremia (low Na)

Question 12

what interactions can SSRIs have with which 2 meds?

Answer 12

triptans
reduces efficacy of triptans and low seizure threshold

NSAIDS
co prescribe PPI

Question 13

What is paroxetine associated with?

Answer 13

high associated congenital defects

Question 14

what cong defects in 1/3 and 3/3?

Answer 14

1/3 = CHD + Cleft palate

3/3 = persistent pul htn of newborn (PPHN)

Question 15

which 2 SSRIs are good for breast feeding?

Answer 15

sertraline and paroxetine

Question 16

What are SNRI’s?
what are they also used in?

Answer 16

Serotonin + norepinephrine reuptake inhibitor
NA reuptake-i presynaptically (+ 5HT Reuptake inhibitor)

used in stress incontinence

Question 17

what are 2 examples of SNRI’s?

Answer 17

venlafaxine
Duloxetine

Question 18

SE of SNRI’s?

Answer 18

N+V
Dry mouth
Rhabdomyolysis
SIADH

Question 19

What is MAOI?
how do they work?

Answer 19

Monoamine oxidase inhibitor

Prevent NAd, Adr, serotonin breakdown in CNS

Question 20

examples of MAOI?

Answer 20

Isocaboxaid
phenoxybenzamine
sellegilline

Question 21

What are TCA?
how do they word?
what is it also used for?

Answer 21

tricyclic antidepressants

serotonin + NAd reuptake inhibitor
+ Antagonises Ach + alpha 1+2 + histamine

neuropathic pain

Question 22

what are 2 examples of TCAs and types?

Answer 22

amitryptiline (sedative)
Imipramine (non sedative)

Question 23

SE of TCAs?

Answer 23

Ach (can’t see, pee, spit and shit), impotence, sedation

Question 24

what symptoms do you get in a TCA overdose?

Answer 24

confused, dry hot skin, high Ach Sx

Question 25

Dx and Tx of TCA overdose?

Answer 25

Wide QRS >100ms QTx prolongation >480ms IV Bicarb

Question 26

what is mirtazipine?

Answer 26

NaSSA Noradrenergic + specific serotonin antidepressant

Question 27

SE of mirtazipine?

Answer 27

Weight gain and sedation

Question 28

what does NICE recommend mirtazipine for?

Answer 28

a Px on warfarin or lmwh

Question 29

what is a major SE of antidepressants?

Answer 29

Serotonin syndrome

Question 30

what is serotonin syndrome? what drugs cause it?

Answer 30

high serotonin SSRI, MAOI, Tramadol, metoclopramide, ondansetron, MDMA, amphetamines, LSD, Cocaine, st Jons wort

Question 31

Sx of serotonin syndrome? How long it occurs for?

Answer 31

Over hours hypER reflexia, clonus, DILATED pupils, autonomic Sx (htn, tachy, flushing eg) + AMS May have high CK (Do u+e, toxicology)

Question 32

Tx for serotonin syndrome?

Answer 32

ABCDE Supportive stop SSRI + Give chlorpromazine (typical antipsychotic which reduces serotonin)

Question 33

what toxicity criteria is used for serotonin syndrome?

Answer 33

Hunter serotonin toxicity criteria used in serotonin syndrome diagnosis (severity)