SSRIs

Question 1

Citalopram indication

Answer 1

MDD

Question 2

Citalopram serious side effects

Answer 2

QTc prolongation, Torsades (these are dose-dependent)

Question 3

Escitalopram indications

Answer 3

MDD, GAD

Question 4

Can escitalopram be used in peds patients?

Answer 4

Yes

Question 5

Is escitalopram labeled with the same QTc warning as citalopram?

Answer 5

No

Question 6

Fluvoxamine indication

Answer 6

OCD

Question 7

Fluvoxamine and the elderly

Answer 7

Use with caution because it’s one of the most sedating and can be anticholinergic

Question 8

Fluoxetine indications

Answer 8

MDD, OCD, panic disorder, PMDD, bulimia, BPD depressive episodes

Question 9

Fluoxetine side effects

Answer 9

Anorexia, anxiety, insomnia

Question 10

Can fluoxetine be used in peds patients?

Answer 10

Yes

Question 11

What enzymes does fluoxetine inhibit?

Answer 11

2D6, 3A4

Question 12

Paroxetine indications

Answer 12

MDD, GAD, OCD, panic disorder, PTSD, PMDD, SAD

Question 13

What population should you avoid using paroxetine in?

Answer 13

PREGNANCY

Question 14

Paroxetine side effects to watch out for in the elderly

Answer 14

Sedating and anticholinergic effects

Question 15

Other paroxetine side effects

Answer 15

Akathisia, bone fracture

Question 16

Paroxetine has a ___half-life.

Answer 16

Short

Question 17

Sertraline indications

Answer 17

MDD, OCD, panic disorder, PTSD, PMDD, SAD

Question 18

Are SSRIs more likely to be energy-boosting or sedating?

Answer 18

Energy-boosting

Question 19

What should you watch out for in all SSRIs?

Answer 19

Discontinuation syndrome, abnormal bleeding, SIADH, serotonin syndrome, potential cognitive and motor impairment

Question 20

Discontinuation syndrome symptoms

Answer 20

FINISH:

flu-like symptoms
insomnia
nausea
imbalance
sensory disturbances
hyperarousal

Question 21

Exception to discontinuation syndrome

Answer 21

Fluoxetine, because it has a long half-life

Question 22

What happens when D/C’ing an SSRI

Answer 22

Taper the dose!

Question 23

Patient education on SSRIs

Answer 23

Treat first depressive episode for 6-12 months minimum, but it takes about 2-4 weeks minimum to see symptom resolution

Insomnia, HA, initial anxiety also possible when starting- use lower doses and titrate slowly

Question 24

What happens if a patient experiences insomnia or sedation on an SSRI?

Answer 24

have them take the dose in the morning or at night or switch to a med that doesn’t cause as much insomnia

Question 25

What happens if a patient experience sexual dysfunction on an SSRI?

Answer 25

Switch to bupropion or another agent

Question 26

Serotonin syndrome symptoms

Answer 26

mental status changes, autonomic instability, neuromuscular abnormality, GI symptoms

Question 27

How to avoid serotonin syndrome

Answer 27

Avoid serotonergic drugs, triptan migraine agents, pain meds (fentanyl and tramadol), nausea products (Zofran and Reglan), buspirone, linezolid, ritonavir, any drugs that impair serotonin metabolism

Question 28

Patients on SSRI and NSAID, antiplatelet, and/or anticoagulant

Answer 28

Increased risk of bleeding

Question 29

SSRIs and hepatic impairment

Answer 29

Use with caution or modify the dose