Antidepressants

Question 1

Name SSRIs and disorders they are used in

Answer 1

Effective For Sadness, Panics, & Compulsions.

Effective – Escitalopram
For – Fluoxetine, Fluvoxamine
Sadness – Sertraline
Panic – Paroxetine
Compulsions – Citalopram

Used in
1. Depression (sadness)
2. PTSD, Anxiety disorders (panic)
3. OCD (compulsions)

Question 2

Name SNRIs and disorders they are used in

Answer 2

Vexed & Depressed

Vexed – Venlafaxine
Depressed – Duloxetine & Desvenlafaxine

Used in
1. Generalised anxiety disorder (vexed)
2. Major depressive disorder (depressed)

Question 3

S/E of SSRI and SNRI

Answer 3

7 S’s: SSRI
Stomach upset (GI upset)
Sexual dysfunction
Serotonin syndrome – with other serotonergic agents (i.e. MAOs) – hyperthermia, muscle rigidity, flushing, diarrhea
Sleep difficulties (insomnia)
Suicidal thoughts ( esp. in patients age 24 and under)
Stress (agitation, anxiety)
Size increase / Weight gain

SHAT: SNRI
Same adverse effects as SSRI’s, plus
Suicidality**
Hypertension**
Adrenergic effects (awake [insomnia], anxious, agitated)
Tachycardia

Question 4

S

Question 5

If a pt is taking 100mg Sertraline is having GIT problems, next step of MX

Answer 5

1. ↓Dose if symptoms well managed
2. Give another SSRI
   Follow washout period ie., dec dose …
   wait for 3 days for sertraline (washout period) …
   Start newer Antidepressant

Question 6

Sexual dysfunction S/E due to antidepressants. Next Mx?

Answer 6

1. ↓Dose
2. Switch to other CLASS (all SSRIs cause sexual dysfunction)
3. Add Sildenafil (Viagra)

Question 7

Mirtazapine S/E

Answer 7

Atypical TeCA (tetracyclic)
1. Severe sedation
2. Drowsiness, insomnia
3. Constipation
4. Weight gain
5. ↑Sr cholesterol
6. ↓Appetite

Question 8

Which antidepressant causes weight loss. S/E?

Answer 8

Venlafaxine/Effexor (SNRI)
Serious:
1. HTN
2. Seizures
3. Suicidality

*Venlafaxine induced hyponatraemia

Others: (7 S’s)
1. Anxiety, sweating
2. Nausea, loss of appetite
3. Drowsiness, insomnia
4. Ejaculation disorder

Question 9

Which antidepressants can be used in pregnancy

Answer 9

1. SSRI, SNRI, mirtazepine - 1st line
   EXCEPT PAROXETINE - fetal malformations
2. TCA - 2nd line

SSRI/SNRI/mirtazepine -
●Given antenatally:
Preterm delivery Spontaneous abortion

●Given in late preg:
`Neonatal discontinuation syndrome
=CNS, respiratory effects,
low Apgar score, myoclonic jerks, jitteriness, and restlessness and
irritability (self limiting)
=Try to dec dose/stop in late preg

●Compatible with breastfeeding

Question 10

Which antidepressants are most compatible with breast feeding

Answer 10

TCA
EXCEPT DOXEPIN

Question 11

Which drug to avoid during breast feed

Answer 11

Lithium (mood stabiliser)