Antidepressant drugs

Question 1

What are they effective for treating?

Answer 1

Moderate to severe depression associated with psychomotor and physiological changes such as loss of appetite and sleep disturbance

Question 2

Antidepressants are also effective for treating dysthymia. What is this?

Answer 2

Lower grade chronic depression - typically of at least 2 years duration.

Question 3

When might it be appropriate to use antidepressants for treatment of mild depression?

Answer 3

Alongside psychological treatments or in those associated with psychosocial or medical problems.
Patients with a history of moderate or severe depression

Question 4

What are the main classes of antidepressents?

Answer 4

Tricyclic and associated
Monoamine Oxidase Inhibitors (MAOIs)
SSRIs
Newer drugs that can’t be accommodated into the above

Question 5

According to the BNF which herbal remedy should not be prescribed for depression and why?

Answer 5

St Johns Wort

Can induce drug metabolising enzymes

Question 6

What signs might indicate hyponatraemia in a patient on antidepressant therapy?

Answer 6

Drowsiness, Confusion or Convulsions.

Question 7

Which group on antidepressant therapy are particularly vulnerable to hyponatraemia?

Answer 7

Elderly

Question 8

What is the possible cause of hyponatraemia in antidepressant therapy?

Answer 8

Possible over secretion of ADH (anti-diuretic hormone)

Question 9

Which patients are at higher risk of suicidal thoughts/behaviour whilst on antidepressant therapy?

Answer 9

Children
Young people
Patients with a history or suicidal behaviour

Question 10

What is serotonin syndrome?

Answer 10

Serotonin toxicity

Question 11

What causes serotonin syndrome?

Answer 11

Adverse drug reaction caused by excessive central and peripheral serotonergic activity.

Question 12

When can serotonin syndrome arise during antidepressant therapy?

Answer 12

Within hours or days following initiation, dose escalation or overdose of serotonergic medications, the addition of a new serotonergic drug, or the replacement of one drug by another without allowing a sufficient washout period.

Question 13

When is there an increased risk of severe serotonin toxicity (medical emergency)?

Answer 13

When a combination of serotonergic drugs are involved, particularly if one is an MAOI

Question 14

What are the characteristic symptoms of Serotonin Syndrome

Answer 14

Neuromuscular hyperactivity
Autonomic Dysfunction
Altered mental state

Question 15

What types of neuromuscular hyperactivity may be present in someone with serotonin syndrome?

Answer 15

Tremor
Hyperreflexia
Clonus 
Myoclonus
Rigidity

Question 16

Clonus is greek for what?

Answer 16

“violent, confused motion” is a series of involuntary, rhythmic, muscular contractions and relaxations.

Question 17

What is myoclonus?

Answer 17

spasmodic jerky contraction of groups of muscles.

Question 18

What is Hyperreflexia?

Answer 18

A condition in which your involuntary nervous system overreacts to external or bodily stimuli.

Question 19

What autonomic dysfunction can occur as a result of serotonin toxicity (serotonin syndrome)?

Answer 19

Tachycardia
blood pressure changes
Hyperthermia
Diaphoresis
Shivering
Diarrhoea

Question 20

What altered mental states can occur as a result of serotonin toxicity (serotonin syndrome)?

Answer 20

Agitation
Confusion
Mania

Question 21

On average how long after remission should antidepressant therapy continue to avoid rebound symptoms?

Answer 21

6 months general (12 months in elderly)
12 months for anxiety disorders
2 years for those with a history of recurrent depression

Question 22

What are the two main modes of action of antidepressant drugs?

Answer 22

Blocking the enzymatic breakdown of noradrenalin

Slowing re-uptake of serotonin and/or noradrenalin