2 - PSY - Antidepressants Flashcards
AD indications that you wouldn’t think of
insomnia bulimia nervosa impulsivity migraines chronic fatigue IBS narcolepsy
time taken from intiation to response in depressive illness for SSRIs
between one and six weeks
common SSRIS
fluoxetine paroxetine citalopram sertraline fluvoxamine escitalopram
Transient SE’s from SSRI intiation
nausea, anxiety exacerbation, increased suicidal ideation
Other SEof SSRIs
nausea, insomnia, apathy and fatigue, diarrhoea, dizziness, sweating, restlessness, sexual dysfunction
SNRIs - common ones
- how do SE differ from SSRIs
venlafaxine
duloxetine
comparable - pts may notice more sedation and greater discontinuation Sx
When should TCA’s definitely not be used? and when may they be preferred?
if risk of suicide is apparent - toxic in OD
not ass w teratogenic effects - often 1st line in pregnancy
Common TCAs and the majority of SE
amitriptyline, imipramine, dosulepin
majority of SE are from antimuscarinic effects
-dry mouth, blurred vision, constipation, urinary retention
Why have MAOIs become used less and less
cheese reaction (tyramine containing food)
Name the one and only NaSSA
Mirtazapine
Common SE of mirtazapine
weight gain and increased appetite
drowsiness
dizziness
headache
Mirtazapine uses?
maybe superior to SSRIS in depression
can be combo with other AD in Tx res dep
useful anxiolytic
St Johns Wort - leads to loss of therapeutic effect of …. and why?
induces cyt P450 - metabolism of drugs
COC digoxin warfarin HIV protease inhibitor Anticonvulsants
Following resolution of Sx, how long is advised to continue drug of that dose
6 months
How long to decide whether Tx has failed - what if partial improvement ??
at least 3-4 weeks (12 in elderly) at effective dose
partial improvement at 4 weeks - advisable to continue for 2-4 wks before alternatives
