Anti-depressants Flashcards
Recall the symptoms of suddenly stopping antidepressant medication
FIRM STOP
Flu-like Sx
Insomnia
Restlesness
Mood swings
Sweating
Tummy problems
Off-balance (ataxia)
Paraesthesia
Recall 4 examples of SSRIs
For Sadness, Panic, Compulsion:
Fluoxetine
Sertraline
Paroxetine
Citalopram
Recall one important risk of SSRIs
May increase suicidal thoughts/ self-harm risk
Depression can stop people performing ADLs due to extreme lethargy/ apathy: when antidepressant begins to work + enable people to do things again, they are also more able to act on thoughts of self-harm
Give 2 drugs that SSRIs interact with and the result
Triptans (ask about migraines)
Monoamine oxidase inhibitors
Interaction can cause serotonin syndrome
When prescribing an SSRI for anxiety, how long should you advise the patient it may take to work?
Anxiety may initially worsen (1-2w)
Will need 4-6w to work
How long should SSRI medications be continued for?
6m after remission of 1st episode
2y after remission if it’s a recurrence
Gradually stop over 4w
Recall one important side effect of citalopram
QT prolongation
What is the first line antidepressant used in children?
Fluoxetine
What should be prescriped if a patient on SSRIs needs NSAIDs?
Proton pump inhibitor
As increased risk GI bleeding with SSRI
When should patients be reviewed after starting an SSRI?
2w
1w if <25/ increased risk of suicide
What are the risks of SSRI use in pregnancy?
1st trim: small increased risk of congenital heart defects
3rd trim: can result in persistent pulmonary HTN of the newborn
Which SSRI is associated with congenital malformations if used in the first trimester?
Paroxetine
Recall 5 SE’s of SSRIs
The 5 ‘S’s:
Stomach (DNV= most common SE)
Suicidal idealisation
Sexual dysfunction
Sleep (insomnia)
Serotonin syndrome
What electrolyte abnormality can be caused by SSRIs?
Hyponatraemia
When switching anti-depressant, what does the term withdraw mean?
Gradually reduce dose, then stop + start new anti-depressant next day
Describe the switching from citalopram, escitalopram, sertraline or paroxetine to another SSRI
1st should be withdrawn before other is started
Describe the switching from fluoxetine to another SSRI
Withdraw, then leave 4-7d (long half life) before starting a low dose of the new SSRI
Describe the switching from SSRI to TCA
Cross tapering is recommended
Exception: Fluoxetine should be withdrawn before starting 4-7d later
Describe the switching from citalopram, escitalopram, sertraline or paroxetine to venlafaxine
Cross taper cautiously + start low dose venlafaxine
Describe the switching from fluoxetine to venlafaxine
Withdraw then start venlafaxine low + slow 4-7d later
If a patient takes warfarin/ heparin, what antidepressant should be advised instead of an SSRI?
Mirtazipine
What does SNRI stand for?
Serotonin noradrenaline reuptake inhibitor
What is the main side effect of SNRIs?
Headache
Recall 2 examples of SNRIs
Venlafaxine
Duloxetine
Give 7 side effects of SNRIs
Headaches
Nausea
Constipation
HTN
Sweating
Insomnia
Sexual dysfunction
What is the mechanism of action of TCAs?
Block serotonin + NA re-uptake
What can TCAs be used for at low vs high doses?
Low dose: blocks H1 + 5HT + aids sleep
Higher doses: blocks all receptors- used in depression
Why are TCAs not given if there is risk of suicide?
Can be fatal in OD
What is one key contraindication for TCAs?
If patient also taking a monoamine oxidase inhibitor
Recall the side effects of TCAs
TCA:
Thrombocytopaenia
Cardiac (QT prolongation, ST elevation, heart block, arrhythmias)
Anticholinergic (urinary retention, dry mouth, blurry vision, constipation)
Also:
Weight gain + sedation from histaminergic receptor blockade
Postural hypotension from alpha-adrenergic receptor blockade
What are the anticholinergic side effects that are possible with all types of antidepressant?
“Can’t see, can’t pee, can’t spit, can’t shit”
Give 2 examples of TCAs
Amitriptyline
Clomipramine
What type of antidepressant is mirtazapine?
Noradrenergic and specific serotonin antidepressant (NaSsA)
When is mirtazapine indicated?
Triad of depression + insomnia + loss of appetite
What does MAOI stand for? Give 2 examples of MAOIs
MonoAmine Oxidase Inhibitor
Phenelzine
Selegiline
What is the main risk of MAOI use?
Hypertensive cheese reaction
What type of antidepressant is moclobemide?
Reversible Inhibitor of Monoamine oxidase A (RIMA)
What is the MOA of benzodiazepines?
Enhance inhibitory GABA transmission at GABA-A receptor
MOA: Increase frequency of chloride channels
What is the MOA of Barbituates?
Enhance inhibitory GABA transmission at GABA-A receptor
MOA: increase duration of cl- channel opening
