Antidepressants Flashcards
Drug class: dosulepin
TCA
Drug class: tranylcypromine
irreversible MAOI
Drug class: Dapoxetine
SSRI
Drug class: imipramine
TCA
Drug class: bupropion
SNRI
Drug class: moclobemide
reversible MAOI
Drug class: phenelzine
Irreversible MAOI
Drug class: trazadone
TCA
Drug class: fluvoxamine
SSRI
Drug class: Isocarboxazid
Irreversible MAOI
antidepressant of choice for patients with angina/MI
sertraline
Issue with TCAs
cardiotoxic
toxic in overdose
How often should patients be reviewed after starting antidepressant therapy?
1-2 weeks
How long should therapy be continued before switching
4 weeks
elderly = 6 weeks
Following remission, how long should antidepressant therapy be continued?
6 months at the same dose
Following remission, how long should antidepressant therapy be continued in the elderly?
12 months in the elderly
Following remission, how long should antidepressant therapy be continued in patients with GAD?
12 months- high risk of relapse
Symptoms of serotonin syndrome
- Neuromuscular- tremor, hyperreflexia, clonus/ myoclonus (spasms), rigidity
- Autonomic- tachycardia, BP changes, Hyperthermia, diaphoresis (cold sweats), shivering, diarrhoea
Treatment of anxiety disorders and OCD
Benzodiazepines or buspirone
Treatment of chronic anxiety
antidepressants
in combo with benzo’s until antidepressant takes effect
Treatment of GAD
psychological treatment prior to initiation of antidepressant
Treatment pathway GAD
- SSRI
Licensed- escitalopram, paroxetine Unlicensed- sertraline
- SNRI
Duloxetine Venlafaxine - Pregabalin
Treatment pathway panic disorders
SSRIs
Clomipramine HCL (unlicensed) or imipramine HCL (unlicensed)
Venlafaxine
Treatment pathway OCD/PTSD/Social anxiety disorder
SSRIs
Clomipramine – OCD
Moclobemide- SAD
sedating TCAs
Amitriptyline
Clomipramine
Dosulepin
Doxepin
Mianserin
Trazadone
Trimipramine
less sedating TCAs
Imipramine
Lofepramine
Nortriptyline
Which TCA has a lower incidence of S/Es and less dangerous in overdose
Lofepramine
Which TCA has more antimuscarinic S/Es than other TCAs
Imipramine
Which TCAs are particularly dangerous in overdose
Amitriptyline
Dosulepin
Which SSRI is given for children and what is the licensing?
Fluoxetine
8+
When should TCAs be stopped in the elderly?
Dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism, history of urinary retention
when given as first line treatment- switch to SSRI or SNRI
Which MAOI is most likely to cause hypertensive crisis?
Tranylcypromine
which MAOI should be reserved for 2nd line treatment
moclobemide
When should you see an effect when taking MAOIs
3 weeks or more
MAOI –> other antidepressants
- how long should you wait before starting
2 weeks
3 weeks for clomipramine or imipramine
MAOI –> MAOI
- how long should you wait before starting
2 weeks
MAOI –> TCA
- how long should you wait before starting
7-14 days
3 weeks for clomipramine or imipramine
MAOI –> SSRI
- how long should you wait before starting
1 week
5 for fluoxetine
