Antidepressants

Question 1

What drugs are first line for depression?

Answer 1

SSRIs

Question 2

What is the mechanism of action of SSRIs?

Answer 2

selectively inhibits reuptake of 5HT from postsynaptic cleft

Question 3

What does SSRI stand for?

Answer 3

selective serotonin reuptake inhibitors

Question 4

What are some examples of SSRIs?

Answer 4

sertraline
citalopram
fluoxetine

Question 5

What SSRI is licensed in children?

Answer 5

fluoxetine

Question 6

What SSRIs are safe in pregnancy?

Answer 6

sertraline and fluoxetine

Question 7

What SSRI is good for use in patients with epilepsy?

Answer 7

citalopram

Question 8

What SSRI can prolong the QTc interval?

Answer 8

citalopram

Question 9

What SSRI is good for use in patients with cardiac problems?

Answer 9

sertraline

Question 10

What are some discontinuation side effects of SSRIs? How can these be avoided?

Answer 10

diarrhoea
sweating
postural hypotension

gradually decrease dose over 4 weeks instead of coming off all at once

Question 11

What are the side effects of SSRIs?

Answer 11

sexual dysfunction 
vivid dreams 
headache 
nausea 
sweating

Question 12

SSRIs are safe in overdose - true or false.

Answer 12

True

Question 13

When should you take SSRIs?

Answer 13

in the morning

Question 14

How long should an antidepressant be trialled before trying something else?

Answer 14

4-6 weeks

Question 15

Which antidepressant can cause an increase in suicidal idealisation in under 25s?

Answer 15

SSRIs

Question 16

What antidepressant class should you try if SSRIs aren’t working?

Answer 16

SNRIs

Question 17

What does SNRI stand for?

Answer 17

serotonin and noradrenaline reuptake inhibitors

Question 18

What is the mechanism of action of SNRIs?

Answer 18

block reuptake of NA and 5HT into presynaptic cleft

Question 19

What are some examples of SNRIs?

Answer 19

duloxetine

venlafloxine

Question 20

When should you take SNRIs?

Answer 20

IN the morning

Question 21

What are some examples of tricyclic antidepressants?

Answer 21

amitryptilline
lifepramine
imipramine

Question 22

Are tricyclics toxic in overdose?

Answer 22

Yes - cardiotoxic

don’t give to people with a history of suicide attempt by overdose

Question 23

What is the mechanism of action of tricyclic antidepressants?

Answer 23

block reuptake of NA and 5HT

Question 24

When do you take tricyclic antidepressants? Why?

Answer 24

At night - sedation

Question 25

What are the side effects of tricyclic antidepressants?

Answer 25

weight gain anticholinergic effects - dry mouth, constipation, urinary retention arrhythmias postural hypotension

Question 26

What is the mechanism of action of monoamine oxidase inhibitors?

Answer 26

inhibit MAO A and B enzymes

Question 27

What are some examples of MAO inhibitors?

Answer 27

phenylzine | mobeclomide

Question 28

When are MAO inhibitors used? Why?

Answer 28

IN resistant depression - due to side effects and diet restriction

Question 29

Why is diet restricted with MAO inhibitors?

Answer 29

Can cause hypertensive crisis Build up of tyramine (usually broken down by MAO enzymes) - in certain foods e.g. cheese, chocolate Potent releasor of NA --> hypertension

Question 30

What are some symptoms of hypertensive crisis?

Answer 30

nose bleeds anxiety SOB headache

Question 31

How is a hypertensive crisis treated?

Answer 31

phentolamine infusion

Question 32

What are some side effects of MAO inhibitors?

Answer 32

``` insomnia postural hypotension jaundice oedema rare - liver damage ```

Question 33

What does NaSSA stand for?

Answer 33

noradrenergic and specific serotonergic antidepressant

Question 34

What is an example of NaSSA?

Answer 34

mirtazapine

Question 35

When is mirtazapine used?

Answer 35

If SSRI/SNRIs haven't worked

Question 36

What is the mechanism of action of mirtazapine?

Answer 36

blocks alpha 2 and 5-HT 2 and 3

Question 37

What can you give with mirtazapine to stop the seratonergic side effects?

Answer 37

SSRI

Question 38

What are side effects of mirtazapine?

Answer 38

weight gain | sedation - good in insomnia

Question 39

What happens if you take mirtazapine with alcohol?

Answer 39

GI upset