Anti-Depressants

Question 1

SSRI

Answer 1

• Co-ingestion with serotonegic meds cause Severe SS/ Coma
• Citalopram and Escitolopram ;
  
  • Dose dependent QTp , rarely TDP
  • Risk of seizures
  • AC if within 4 hours

Question 2

SNRI

Answer 2

• Venalafaxine !Lethal! , Des-Venalafaxine good
• Co-ingestion - severe SS
• >7g - cardiac toxicity - low BP, QRS, QTp
• Seizures
  
  • Dose dependent risk of seizures (>4.5g 100%)
  • Late onset (upto 16h)
  • No COMA
• ? place for AC and WBI due to seizures

Question 3

Lithium

• ACUTE
• CHRONIC

Answer 3

Lithium levels to cofirm and monitor progress

1. Acute - GI Symptoms

• Renal failure, dehydration, Hypo Na - risk of Nurotox (TREMOR)
• Place for HD

2. Chronic - Nurological

• Three Grades
  
  • G1 - tremor, hyperreflexia, weakness
  • G2- stupor, hypertonia, rigidity
  • G3- coma , seizures, myclonus
• Contributed by ;
  
  • RF, dehydration, low Na, ACEI, thiazides,NSAIDs
• Complications - DI, hypothyroidism