antidepressants Flashcards
What are the different classes of antidepressants
SSRI
SNRI
TCA
NaSSA
MAOI
name 5 SSRIs
Sertraline
Citalopram
Escitalopram
Fluoxetine
Paroxetine
most common side effect ssris
GI disturbance
Complications of SSRIs
- QT prolongation / ventricular arrhythmias including torsade de pointes in citalopram
- Hyponatremia
- SSRI discontinuation syndrome
Interactions SSRIs
NSAIDs/aspirin: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
SSRI in first trimester can cause?
congenital heart defects
SSRI in third trimester can cause?
persistent pulmonary hypertension of the newborn
worst SSRI pregnancy
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
SSRIs of choice in breastfeeding women
Sertraline or paroxetine
SSRI of choice post MI
Sertraline
SSRI of choice children
fluoxetine
Name 2 SNRIs
Venlafaxine
Duloxetine
Side effects SNRIs
include nausea/vomiting, sweating, loss of appetite, dizziness, headache, increase in suicidal thoughts, and sexual dysfunction.
Complication SNRI
HTN
(Elevation of norepinephrine levels can sometimes cause anxiety, mildly elevated pulse, and elevated blood pressure. )(monitor before initiation and after titration)
Name 3 TCAs
Imipramine
Clomipramine
Amitriptyline
Mechanism TCAs
inhibit the reuptake of serotonin and noradrenaline.
Side effects TCAs?
anticholinergic effects:
Can’t see (blurred vision)
Can’t pee (urinary retention)
Can’t spit (dry mouth)
Can’t shit (constipation)
Can’t sit for too long - postural hypotension
TCAs can cause overflow incontinence due to chronic urinary retention
Drowsiness
Postural hypotension
lengthening of QT interval
Name 1 NaSSA
Mirtazapine
Mechanism NaSSA
Blocking alpha2-adrenergic receptors, which increases the release of neurotransmitters. Blocking α2-adrenergic autoreceptors and heteroreceptors, NaSSAs enhance adrenergic and serotonergic neurotransmission in the brain involved in mood regulation,[1] notably 5-HT1A-mediated transmission.
Side effects mirtazapine?
Sedative
Increases appetite
risk of bone marrow suppression including agranulocytosis
Name 3 MAOIs
Isocarboxazid
Phenelzine
Tranylcypromine
Complication MAOI
The tyramine cheese reaction is a classic side effect of MAOI (monoamine oxidase inhibitor) antidepressants, such as phenelzine. Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis. Symptom: Throbbing headache at bottom of skull
Presentation SSRI discontinuation syndrome
Dizziness, electric shock sensations and anxiety
how to prevent SSRI discontinuation syndrome?
reduce gradually over 4 weeks
Presentation seretonin syndrome
Neuromuscular excitation
- hyperreflexia
- myoclonus
- rigidity
autonomic nervous system excitation
- hyperthermia
- sweating
altered mental state
- Confusion
management seretonin syndrome
supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
what should pts taking MAOIs be advised in regards to food and drink
diet low in tyramine-containing foods, alongside cheese, patients should avoid cured meats, fermented foods, and alcohol consumption - the BNF states that patients should ‘be advised to avoid alcoholic drinks’.
