Week 13 - Mood Disorders Wrap Up

Question 1

What are common side effects of antidepressants in patients

Answer 1

o Xerostomia : Most common; SSRIs affect salivary flow less than other antidepressants, but still a concern
o Postural (orthostatic) Hypotension (condition where BP drops when a person stands up): Risk increases if combined with antihypertensives.
o Bleeding and bruising Risks: Possible with antidepressants that influence serotonin activity, SSRIs and SNRIs impair platelet function, increasing bleeding/bruising risk – as serotonin is an important mediator of normal platelet function
o Sedation: Notable with TCAs and TeCAs; enhanced when combined with other CNS depressants (e.g., benzodiazepines, mirtazapine).
o Mirtazapine (type of TeCA): Has dose-dependent sedative and stimulant properties.

Question 2

What type of antidepressant impairs platelet function - increasing bleeding risk

Answer 2

SSRIs and SNRIs

serotonin is an important mediator for normal platelet function

Question 3

What type of antidepressant is known for sedative effects

Answer 3

TCAs and TeCAs (Mirtazapine)

Question 4

What are the interactions of antidepressants with local anesthetics (LAs)

Answer 4

o Risk of hypertensive crisis when using vasoconstrictor-containing LAs. (sudden increase in BP)
o SNRIs, TCAs, TeCAs can potentiate adrenaline/noradrenaline effects.
o Use of adrenaline-containing LAs requires careful dose consideration due to vasoconstriction
o MAOIs: Previously contraindicated, but now adrenaline-containing LAs are not considered a significant risk in dentistry.

Question 5

how do antidepressants affect bone

Answer 5

SSRIs can cause loss of bone density - increasing risk of implant failure

Question 6

what is the interaction between antidepressants and tramadol (opioid used in TMJ disorders and third molar extractions):

Answer 6

Inhibits serotonin/noradrenaline reuptake; increases risk of serotonin syndrome and seizures when combined with serotonergic drugs (SSRIs, SNRIs, TCAs, TeCAs, MAOIs, lithium).

Question 7

What is serotonin syndrome

Answer 7

potentially life threatening condition caused by excess serotonin activity

nearly always caused by interactions between 2 serotonergic drugs

causing neuromuscular excitation, autonomic effects and altered mental status

Question 8

How does anxiety affect patient oral health

Answer 8

o Hypersensitive teeth: Mood influences pain perception. (more sensitive if scared)
o Xerostomia: Linked to anxiolytic medication
o Oral hygiene issues: Can vary from poor hygiene to over-brushing, leading to abrasion.

Question 9

When is sedation used in dentistry

Answer 9

• Useful for:
  o Patients with anxiety, pain intolerance, hard time sitting in a chair, or strong gag reflex.

Question 10

What are the 3 types of sedation in dentistry

Answer 10

1. mild sedation
2. Conscious sedation (twilight sleep)
3. General Anesthesia

Question 11

What is mild sedation

Answer 11

Nitrous oxide or oral benzodiazepines; patient relaxed but conscious.

Question 12

What is conscious sedation (twilight sleep)

Answer 12

often given via IV sedation; although patients will technically be awake they are deeply relaxed, very sleepy and won’t remember much

Question 13

What is general anesthesia

Answer 13

Full unconsciousness and in deep sleep; higher risk, should be done by a trained specialist.

Question 14

What is nitrous oxide in dentistry

Answer 14

• Inhalation of nitrous (N2O-)2 (70%/30%))
• Used for anxiety and sedation
• Properties:
  o Strong analgesic, minimal cardiovascular/muscle effects
  o Quick onset/recovery
  o Titration-friendly
  o Safe in pregnancy with medical advice

Question 15

What is the anxiolytic and sedative used in dentistry

Answer 15

• Benzodiazepines (Benzos)

Question 16

What is Benzodiazepines (Benzos)

Answer 16

o Fast-acting; reduce acute anxiety and induce conscious sedation.
o Enhance GABA activity (inhibitory neurotransmitter).
o Helpful for dental anxiety before and during a procedure
o In traumatic procedures is can cause amnesic effects (helpful)
o Long-term use not preferred: tolerance, dependency concerns.

Question 17

What are the commonly used benzos in dentistry

Answer 17

Diazepam, Temazepam

Question 18

How do you administer benzodiazepine (benzos)

Answer 18

o Oral dose before appointment or night before for sleep
o Used to reduce anxiety, not for full clinical sedation

Question 19

What are the side effects and major concerns of Benzodiazepine

Answer 19

o Drowsiness, confusion, impaired motor coordination, amnesia
o Requires escort post-treatment; no driving

o Drug interactions: Enhances CNS depressants (e.g., TCAs, alcohol)

o Pregnancy Risk: Teratogenic – avoid during pregnancy

Question 20

What is used to treat chronic anxiety in dentistry

Answer 20

o Typically treated with antidepressants (e.g. SSRIs) and beta-blockers, not benzodiazepines.