Antidepressant drugs Flashcards
Antidepressants
1st line - SSRI
2nd line- another SSRI
3rd line- mirtazipine, SNRI
4th- consider tricyclics, monoamine oxidase inhibitors
Egs of SSRIs
Fluoxetine, sertraline, citalopram/escitalopram, paroxetine
Antidepressant of choice for children/ adolescents
Fluoxetine- only one licensed
which antidepressant drug increases risk of congenital malformations, particularly in 1st trimester
paroxetine
SSRIs and pregnancy- safe?
weigh up risks and benefit
1st trimester- small increased risk of congenital heart defects
3rd- persistent pulmonary hypertension of newborn
which antidepressant is favoured post MI
sertraline
Interations of SSRI
NSAIDs- PPI should be given if patients taking both
warfarin/heparin- avoid SSRI
Triptans- avoid SSRI
How long should you continue SSRIs for after remission
6 weeks
how to stop SSRIs
gradually over 4wks (except fluoxetine)
Common side effects of SSRIs
nausea, headache, sweating/vivid dreams, worsened anxiety, sexual dysfunction, hyponatraemia (in elderly). transient increase in self harm and suicidal ideation in <25yrs
What is citalopram/escitalopram associated with
dose dependent QT prolongation
eggs of tricyclics
imipramine, dosulepin, amitriptyline, lofepramine, clomipramine
how do tricyclics work
block reuptake of monoamines into presynaptic terminals- mainly noradrenaline and 5HT
Common side effects of TCAs
anticholinergic- blurred vision, dry mouth, sedation, weight gain, constipation, urinary retention, postural hypotension, tachycardia, arrhythmia, cardiotoxic in overdose
Why are TCAs used less often now
dangerous in overdose
Monoamine oxidase inhibitors eg
irreversible- phenelzine
reversible- moclobemide
side effects of monoamine oxidase inhibitors
cheese reaction/hypertensive crisis, increase metabolism of other drugs, postural hypotension, peripheral oedema
SNRIs eg
venlafaxine, duloxetine
block reuptake of monoamines into presynaptic terminals
Mirtazipine
blocks alpha 2- increases release of neurotransmitters
mirtazipine side effects
fewer side effects than other ADs, main ones are weight gain and sedation- useful for people that are suffering from insomnia and poor appetite
