CNS: SSRI counseling points

Question 1

indications

Answer 1

major depressive disorder (MDD)

various anxiety disorders

Question 2

administration

Answer 2

• same time each day (AM/PM determined by patient)

- with or without food (determined by patient)

Question 3

SSRI SEs

Answer 3

Nausea, loss of appette or weight gain, somnolence or
insomnia, sexual dysfuncton, increased risk of bleeding (partcularly with aspirin
or NSAIDs), RARE – slight potental for QTc prolongaton

Question 4

SSRI serious SE

Answer 4

can cause Seratonin Syndrome- life-threatening conditon, increased serotonergic actvity in CNS

Question 5

Seratonin Syndrome symptoms

Answer 5

SHIVERS
• Shivering
• Hyperreflexia (overactve reflexes)
• Increased temperature
• Vital sign instability (tachycardia/tachypnea)
• Encephalopathy (confusion)
• Restlessness
• Sweatng

Question 6

Seratonin Syndrome- how it occurs

Answer 6

Occurs most often when more than one medication that affects serotonin are taken together:
• Increased release of serotonin
• Or the amount of time that serotonin stays in the brain is prolonged

Question 7

Seratonin Withdrawal symptoms

Answer 7

FINISH

• Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
• Insomnia (with vivid dreams or nightmares)
• Nausea (sometimes vomiting)
• Imbalance (dizziness, vertigo, lightheadedness)
• Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations)
• Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)

Question 8

Seratonin Withdrawal

Answer 8

• A result of quickly stopping or rapidly decreasing a dose of a serotonin agent
• Usually begins within 2-5 days after last dose

Question 9

citalopram SE

Answer 9

Insomnia, headache, nausea

Question 10

citalopram unique features

Answer 10

• Consists of two stereoisomers

- Dose limits due to QTc prolongation (20mg/day in at risk patients such as those 60yo+)

Question 11

escitalopram SE

Answer 11

Insomnia, headache, nausea

Question 12

escitalopram unique features

Answer 12

S-enantiomer of citalopram

Question 13

fluoxetine SE

Answer 13

Insomnia, anorexia, nausea, irritability, sexual dysfunction

Question 14

fluoxetine unique features

Answer 14

• Most stimulating agent of SSRIs (dose in AM)
• Appetite suppression common SE
• Long ½ Life

Question 15

paroxetine SE

Answer 15

Sedation, weight gain, increased appetite, sexual dysfunction, diarrhea

Question 16

paroxetine unique features

Answer 16

Potentially assoc. w/ more sexual SE & weight gain than other SSRIs

Question 17

sertraline SE

Answer 17

Nausea, sexual dysfunction

Question 18

sertraline unique features

Answer 18

Initial doses (25-50mg/day), usually must be increased for full therapeutic effects (goal: 100-200mg/day)