Depression QA Flashcards
(26 cards)
Three treatment options in depression
- SSR1s (safe
- TCA (problems with sedation and addiction)
- MOAIs (interact with a lot of drugs)
Why are SSRis first line + length of treatment
- They are better tolerated in overdose and have less side effects
- TCA’s have more side effects such as sedation
- MOAis interact with a lot of food
- Length of treatment = 2wks
When do you review pt on SSRis
1) 1-2 start of treatment
2) After 4 wks in (6wks in elderly)
If SSR1s don’t work there are second line options which include
- Increase SSRI dose
- Choose another SSR1
- Mirtazapine
- Other TCA (consider venlafaxine in more serious depression)
- Irreversible MOAis = only under specialist supervision
Third line treatment options if SSR1s don’t work
1) Add another antidepressant class
2) Add am augmenting agent e.g lithium / antipsychotics
3) Electroconvulsive therapy In server refractory depression
Side effect of antidepressant medication (4)
- Hyponatremia (in SSR1s are most common)
- Suicidal ideation (monitor)
- Serotonin syndrome
- Drowsiness (driving)
What are the three effect of Serotonin syndrome
o Neuromuscular (drowsiness , confusion , convulsion o Altered mental state (confusion, agitation, mania) o Autonomic dysfunction (liable BP, Urination , Diarrhoea , Hyperthermia
When switching between antidepressants how long is the waiting time + exception
MOAIs :
SSR1s:
TCAs:
- MOAIs : 2 weeks before switching
- SSR1s: One week before switching
o 2 wks If sertraline
o 5 wks if fluoxetine - TCAs: Wait 1-2 weeks before switching
How long should depression medication be withdrawn over
Reduced over 4 wks
6 months if long term use
Risk of withdraw increased with medication treatment over how long?
8 weeks
When do withdrawal symptoms of antidepressant occur
After 5 days
Which antidepressants have the highest risk of withdrawal
- Paroxetine
- Venlafaxine
SSRIs MOA
Inhibit the reuptake of 5-HT from synaptic cleft
Examples of SSR1s
Citalopram
Esocitalopram (QT prolongation)
Fluoxetine (only one licensed in children)
Paroxetine (high risk of withdrawal)
Sertraline (safest and can be used in MI)
Side effects of SSRIs GASH
G = GI A = Appetite or weight disturbances S = Serotonin syndrome H = Hypersensitivity reaction - Bleeding risk - QT prolongation - Seizure - Movement disorder (dyskinesia)
Overdose symptoms of SSRIs
Nausea + Vomiting , Agitation , tremor, Nystagmas , Drowsiness , Sinus tachycardia, Convulsions
Interaction of SSRIs
- Grapefruit juice
- Increase risk of bleeding (NSAIDs/Anticoagulants/ Antiplatelet)
- Increase risk of QT prolongation
- Hyponatermia (Loop / thiazide diuretics / Desmopressin )
- Serotonin syndrome (st johns wart / Sumatriptan / Tramadol / TCA / MOAis)
Tricyclic antidepressants
- Which one is sedating
Amitriptyline
Tricyclic antidepressants
- Which one is NOT sedating
Nortriptyline
Side effects (TCAs)
T= Toxic in overdose C= Cardiac side effects (QT prolongation / Arrhythmias / Heart Block / Hypertension) A = Antimuscarinic side effects S = Seizures
- Can cause hallucinations and mania
Interaction which with drug classes of TCA
Increase plasma concentration Decrease plasma concentration Antimuscarinic Serotonin syndrome Hyponatremia QT prolongation Hypotension
MOAIs MOA
Block monoamine oxidase enzyme which leads to accumulation of monoamines.
Examples of MOA’s
Irreversible MOAs
- Phenelazine
- Isocarboxazid
- Tranycypromine
Reversible MOAIs
- Moclobemide (short acting / no washout period)
Side effects of MOA’s
Hepatotoxic
Hypertensive crisis
Postural hypertension
