Antidepressants

Question 1

Risks of antidepressants

Answer 1

Serotonin syndrome.
Hyponatraemia.
Withdrawal syndrome.
Switching or swapping medications.
Interactions.

Question 2

Risk factors for adverse effects

Answer 2

Old age, female, low body weight, reduced renal function

Question 3

Symptoms of serotonin syndrome

Answer 3

Restlessness, sweating, tremor, shivering, fits

Question 4

Examples of SSRIs

Answer 4

Citalopram, escitalopram, Flavoxamine, fluoxetine, paroxetine, sertraline

Question 5

Examples of TCAs

Answer 5

Amitriptylline, clomipramine, dosulepin, imipramine, lofepramine

Question 6

Examples of SNRIs

Answer 6

Venlafaxine and Duloxetine

Question 7

Examples of MAOIs

Answer 7

Tranylcypromine, phenelzine and isocarboxazid

Question 8

Side effects of SSRIs

Answer 8

Nausea, sexual dysfunction, insomnia

Question 9

What medication is first line

Answer 9

Sertraline for anxiety and depression

Question 10

Side effects of TCAs

Answer 10

Drowsiness, weight gain, dry mouth, constipation

Question 11

Side effects of SNRIs

Answer 11

Nausea, insomnia, sexual dysfunction

Question 12

Side effects of MAOIs

Answer 12

Weight gain, sleep problems

Question 13

Side effetcs of Mirtazapine

Answer 13

Weight gain, sedation

Question 14

Side effects of Vortioxetine

Answer 14

Abnormal dreams, dizziness, nausea, diarrhoea, constipation, vomiting, pruritis

Question 15

What are the actions of Agomelatine

Answer 15

3rd line option only initiated in secondary care. Sedative. USed where patient is intolerant to 5HT

Question 16

How long is withdrawal of antidepressants

Answer 16

At least over 4 weeks ro reduce risk of discontinuation symptoms

Question 17

Discontinuation symptoms of SSRIs

Answer 17

Coryzal, shock like sensations, dizziness, insomnia, vivid dreams, irritability

Question 18

Discontinuation symptoms with TCAs

Answer 18

Coryzal symptoms, insomnia, excessive dreaming

Question 19

Discontinuation symptoms of MAOIs

Answer 19

Agitation, irritability, ataxia, movement disorders, insomnia, somnolence, vivid dreams, cognitive impairment, slowed or pressured speech

Question 20

Strategies in treatment resistant depression

Answer 20

Lithium augmentation.
Venlafaxine high dose.
Quetiapine or aripiprazole augmentation.
Mirtazapine with either vanlafaxine or SSRI.
Lamotrigine augmentation.
ECT

Question 21

How often are lithium levels monitored

Answer 21

3-4 months

Question 22

Side effects of lithium

Answer 22

Dry mouth, metallic taste, thirst, increased urine, dizziness, mild diarrhoea, mild tremor, nausea