Antidepressants

Question 1

What are common Side Effects of SSRi?

Answer 1

Common side effects:
* headache
* Anxiety/ Agitation
* GI (nausea, diarrhoea/constipation, dyspepsia)
* sleep disturbance/vivid dreams
* sexual dysfunction
* Hyponatraemia
* Mania (if undiagnosed BPAD)

Question 2

What are common drug-interactions in SSRIs? *

Answer 2

GI bleeding (interference with platelet aggregation e.g. NSAIDs)

Question 3

How long should SSRIs for depression be continued?

Answer 3

Once well continue for
1. 6-12 months
2. 2 years if high risk of relapse / consider life long if very high risk

Question 4

When should patients started on SSRIs be followed up?

Answer 4

1. initlaly 2 weeks
   Then regularly

Question 5

What are side-effects of TCAs?

Answer 5

Anti-cholinergic/muscarinic effects
* dry mouth, blurred vision, constipation, urinary retention
* Cardiotoxic - have ECG

Question 6

What are side effects of MAOIs?

Answer 6

• Tyramine interactions: patients need a special low tyramine diet (cheese reaction)

Question 7

What is the MOA of Mertazapine

Answer 7

NaSSa
+ blocks presynaptic alpha-2 adrenergic receptors –> less feedback and more NA release

Question 8

What are side effects of NaSSa?

Answer 8

Mertazapine
* Dowsiness
* increased appetite
* Weight gain

Question 9

What is the MOA of SNRIs?

Question 10

What are the side-effects of SNRIs?

Answer 10

Require regular BP monitoring

Question 11

What are symptoms of discuntinuation syndrome?

Answer 11

Due to seratinergic discontinuation
* flu-like symptoms
* headaches
* GI side effects
* Trouble sleeping
* anxiety
* dizziness
* Electric shocks

Question 12

What is the association between drug half life and discontinuation syndrome?

Answer 12

Generally, the shorter the half life, the more necessary it is to discontinue dose with tapering it down (rather than stop)

Question 13

What is the treatment algorythms for refractory Depression

Answer 13

1. Check adherence, side effects, optimize dose
2. Switch antidepressant to another 2nd SSRI
3. Alternative antidepressant class: e.g.
   Mirtazapine, venlafaxine, TCAs, MAOIs etc
4. 4. Refractory depression
      ➢ Combinations: such as adding Mirtazapine to an SSRI
      ➢ Augmentation with Lithium/antipsychotic
      ➢ ECT

Question 14

What is Serotonin syndrome? What are the risk factors?

Answer 14

Excessive serotonin in the synapse of the brain

Can occur in <1% of patients, soon after antidepressant therapy started

Risk factors
1. higher dose Antidepressant
2. Combination of different Antidepressants
3. Overdose
4. Lithium
5. ECt
6. opiated, antiemenetics, recreational drugs

Question 15

What is the presentation of Serotonin syndrome?

Answer 15

1. Altered mental state

Question 16

What are the complications of Serotonin syndrome?

Answer 16

Complications:
o DIC,
o Rhabdomyolysis,
o renal failure/Metabolic
acidosis,
o seizures

Question 17

What classes of Drugs can be used as mood stabelisers?

Answer 17

1. Lithium
2. Anti-epileptics
3. Atypical antipsychotics

Question 18

What are the indication for use of Mood stabelisers?

Question 19

What are the indications of use for Lithium?

Answer 19

1. Gold standard for
   * BPAD
   * Schizoaffective disorder
   * Depression (recurrent or treatment resistance)

Question 20

What are side effects of lithium?

Answer 20

Generally Many
*

Question 21

What are signs of Lithium Toxicity?

Answer 21

> 1.5 mmol/L
* Coarse tremor
Marked GI upset

Question 22

What needs to be done prior to starting Lithium Therapy?

Answer 22

1. FBC, U&E, Calcium, TFT, ECG
   * initially weekly monitoring of lithium levels

Question 23

How is lithium monitored?

Question 24

What antipsychotic is use din d

Answer 24

1. Olanzipine

Question 25

What are the indication of use of Olanzapine

Answer 25

anti-psychotic medications
*

Question 26

WHat are the indications for anticonvulsant medication (in psychiatry)?

Answer 26

For Mania and prophylaxis

Question 27

What are sideeffects of anticonvulsant ageents in use of

Question 28

What would be the firs-line medication in CAMHs
for
1. Purely mood/ depression
2.Depression + Strong anxiety

Answer 28

1. Fluroxetine (depression)
2. Sertraline (if strong element of anxiety )