Anti-Depressants

Question 1

Name 4/5 SSRIs

SE
3 -ve
2

Answer 1

Sertiline 
Fluoxetine 
Citalopram 
Escitalopram 
Peroxetine 

SE
-ve
Increased anxiety and agitation
Sexual Dysfunction 
GI bleed risk from gastric ulcer
Hyponatraemia (Due to inappropriate release of ADH especially in the elderly)

+ve
Not sedative
Safer in overdose and CVD

Question 2

Side effect of (Es)Citalopram

Side effect of Paroxetine

Answer 2

Citalopram causes QT prolongation syndrome

Paroexetine causes withdrawal syndrome

Question 3

Name SNRI

SE
3 -ve

1 +ve

Answer 3

Venlafaxine
Duloxetine

SE

• Increased CVD risk (increased BP at higher doses)
• overdose risk (toxic)
• Sexual dysfunction

+ve
- non sedating

Question 4

When do you NOT use a SSRI (2)

When is it BEST to be used

Answer 4

• when manic
• caution with children/ teens
• If CVD
• First line for depression

Question 5

Name 3/5 TCA

What line are they in depression?
What is there mechanism of action, therefore cause:
5 SE
1 +ve?

extra point?

Answer 5

Amitryptiline 
Trazadone
Lofeprimine 
Chlorimipramine
Dosulepin 

2nd line

They are anti- ACh therefore cause:

• Urinary retenion
• drowsiness
• constipation
• burred vision
• dry mouth

+ve quick onset

Dosulepin is Very cardiotoxic!! (overdose risk)

Question 6

Contraindications of TCAs

7!!

Answer 6

• Heart disease
• Can exacerbate schizophrenia
• exacerbate QT prolongation
• not in preg or breast feeding
• can alter blood sugar in T1DM/ T2DM
• Don’t use in enlarged prostate as can cause urinary retention
• Uses the cytochrome p450 pathway therefore avoid in patients with anti-p450 drugs as can cause liver damage

Question 7

Name 2 MAOI

1 SE

Answer 7

Phenelzine
Tranylcypromine

SE
Interacts with food

Question 8

Key clinical advice when starting any anti-depressant?

Answer 8

Close monitoring is needed as at the start a spike in serotonin can cause impulsive suicide attempt.

Question 9

Other Indications for Anti-Depressants
Anxiety disorders 2

OCD 2

Panic Disorder 1

Eating disorder 1

Neuropathic pain 1

Migraine prophylaxis 1

Nocturnal Enuresis 1

Answer 9

Anxiety disorders- SSRI or Venlafaxine (SNRI)

OCD- SSRI or clomipramine (TCA)

Panic Disorder SSRI

Neuropathic pain- TCA

Migraine prophylaxis- amytriptiline (SNRI)

Nocturnal Enuresis- Imipramine (TCA)