DEPRESSION: SSRIs Flashcards
(58 cards)
Why are SSRIs first line in depression?
Better tolerated and safer in overdose
MoA
Selectively inhibit the reuptake of 5-HT from the synaptic cleft
Commonly used SSRIs
Sertraline
Fluoxetine
Fluoxetine
citalopram
escitalopram
fluvoxamine
Side effects - SSRIs
- GI
- Hyponatraemia
- QT prolongation
- Suicidal tendencies
- Seizures
- SS
Interactions - increased risk of hyponatraemia
Diuretics - loop/thiazides
Desmopressin
Carbamazepine
NSAIDs
initial dose of sertraline in depression, OCD and panic disorder/PTSD/social anxiety disorder
depression and OCD: 50mg
panic disorder, PTSD, social anxiety disorder: 25mg
max dose sertraline per day
200mg
Which SSRI is safe in stable angina + MI
Sertraline
is chest pain a common symptom of sertraline
Yes
Which antidepressant in licensed for children?
Under 17
Fluoxetine
Which SSRIs cause QT prolongation
Citalopram
Escitalopram
Which SSRI has higher risk of withdrawal reactions?
Paroxetine
Other SSRIs
Escitalopram
Fluvoxamine
Paroxetine
Benefit of SSRIs over TCAs
o less cardiotoxic
o less sedating
o less antimuscarinic than TCAs
o SSRis safer in unstable angina and myocardial infarction and in overdose
T or F - symptoms of sexual dysfunction will stop on treatment discontinuation
false. they can persist even after treatment has stopped
SSRIs interactions
o CYP enzyme inhibitors (Avoid grapefruit, increases plasma conc)
o CYP enzyme inducers e.g. St John’s Wart (reducers effectiveness)
o Drugs that cause QT prolongation
o Drugs increasing risk of bleed
o Hyponatraemia (carbamazepine and diuretics)
o Serotonin syndrome
SSRIs in pregnancy
Risk vs benefits
Use lowest effective dose
Small increased risk of persistent pulmonary hypertension in newborns with use beyond 20 weeks
Use in later stages = neonatal withdrawal symptoms
Small increased risk of PP haemorrhage when used in month before delivery
Using SSRIs in later stages of pregnancy may result in neonatal withdrawal symptoms. What do we monitor?
Associated CNS, motor, respiratory, and GI symptoms
You know that a patient is due to give birth in a couple of weeks. You see that she has just had an rx for sertraline 50mg OD come in. You know there was recent MHRA safety info published about the use of SSRIs in the month before delivery having a possible increased risk of PP haemorrhage. What do you do?
- contact prescriber and tell them this is contraindicated
- dispense it
dispense it. there MIGHT be a small increased risk of PP haemorrhage when used in month before delivery. but specialist sources indicate SSRIs may be suitable for use in pregnancy, but risks and benefits of use may be considered, and lowest effective dose to be used
SSRIs in BF
- sertraline and paroxetine preferred
- however all can be used with caution
- risks with switching SSRIs so may be more clinically appropriate to continue treatment with SSRI that has been effective, or restart with one that has previously been effective
What should you monitor the infant for when BF?
Monitor infant for drowsiness, poor feeding, adequate weight gain, GI disturbances, irritability, restlessness
Although all SSRIs can be used in BF women with caution, the following two are preferred based on passage into milk, half-life, published evidence of safety
paroxetine
sertraline
use of sertraline in BF
can be used (preferred in BF, along with paroxetine)
long half life increase risk of accumulation in infant
monitor infant for drowsiness, poor feeding, irritability, GI disturbance, restlessness, adequate weight gain
important safety info for all SSRIs - small increased risk of PP haemorrhage when used in month before delivery
increased bleeding risk due to effect on platelet function
using in last month before delivery may increase risk of PP haemorrhage
consider benefits and risks of AD during pregnancy, and risks of untreated depression in pregnancy
