Antidepressants Flashcards
How long do they take to start working?
4-6 weeks to start working
how do we monitor them?
how often?
baseline monitor weekly for 4 weeks, then after, 2 weekly
what is a common side effect of starting antidepressants and in which age group?
30 and under
high suicidality risk when first starting
How long do they need to be taken for and when can they be stopped and how?
need to take for 6 months after Sx improve and wean over 4 weeks
why do we wean Px off antidepressants?
To prevent SSRI/Serotonin discontinuation syndrome
Sx = Flu Sx, N+V, Agitation, insomnia, parasthesia
name some antidepressant classes?
SSRI
SNRI
MAOI
TCA
MIRTAZIPINE
What does SSRI stand for?
what is it?
selective serotonin reuptake inhibitor
5HT (Serotonin) presynaptic reuptake inhibitor
what are 4 examples of SSRIs?
sertraline
fluoxetine
paroxetine
citalopram
Sertraline
good in which conditions?
Fluoxetine
used in which age group and good in what group?
good for generalised anxiety disorder and depression
CAMHS + breast feeding
paroxetine
good in what group? high risk of what?
Citalopram
can cause?
good for breastfeeding
high discontinuation Sx
QTc prolongation
Side effects for SSRIs?
GI (enteric NS) - N+V, pain, High GI bleed risk, if lots of NSAID use
Impotence + low libido
Serotonin syndrome
QTc prolongation (>450 ms)
HyPO natremia (low Na)
what interactions can SSRIs have with which 2 meds?
triptans
reduces efficacy of triptans and low seizure threshold
NSAIDS
co prescribe PPI
What is paroxetine associated with?
high associated congenital defects
what cong defects in 1/3 and 3/3?
1/3 = CHD + Cleft palate
3/3 = persistent pul htn of newborn (PPHN)
which 2 SSRIs are good for breast feeding?
sertraline and paroxetine
What are SNRI’s?
what are they also used in?
Serotonin + norepinephrine reuptake inhibitor
NA reuptake-i presynaptically (+ 5HT Reuptake inhibitor)
used in stress incontinence
what are 2 examples of SNRI’s?
venlafaxine
Duloxetine
SE of SNRI’s?
N+V
Dry mouth
Rhabdomyolysis
SIADH
What is MAOI?
how do they work?
Monoamine oxidase inhibitor
Prevent NAd, Adr, serotonin breakdown in CNS
examples of MAOI?
Isocaboxaid
phenoxybenzamine
sellegilline
What are TCA?
how do they word?
what is it also used for?
tricyclic antidepressants
serotonin + NAd reuptake inhibitor
+ Antagonises Ach + alpha 1+2 + histamine
neuropathic pain
what are 2 examples of TCAs and types?
amitryptiline (sedative)
Imipramine (non sedative)
SE of TCAs?
Ach (can’t see, pee, spit and shit), impotence, sedation
what symptoms do you get in a TCA overdose?
confused, dry hot skin, high Ach Sx
Dx and Tx of TCA overdose?
Wide QRS >100ms
QTx prolongation >480ms
IV Bicarb
what is mirtazipine?
NaSSA
Noradrenergic + specific serotonin antidepressant
SE of mirtazipine?
Weight gain and sedation
what does NICE recommend mirtazipine for?
a Px on warfarin or lmwh
what is a major SE of antidepressants?
Serotonin syndrome
what is serotonin syndrome?
what drugs cause it?
high serotonin
SSRI, MAOI, Tramadol, metoclopramide, ondansetron, MDMA, amphetamines, LSD, Cocaine, st Jons wort
Sx of serotonin syndrome?
How long it occurs for?
Over hours
hypER reflexia, clonus, DILATED pupils, autonomic Sx (htn, tachy, flushing eg) + AMS
May have high CK (Do u+e, toxicology)
Tx for serotonin syndrome?
ABCDE
Supportive
stop SSRI + Give chlorpromazine
(typical antipsychotic which reduces serotonin)
what toxicity criteria is used for serotonin syndrome?
Hunter serotonin toxicity criteria
used in serotonin syndrome diagnosis (severity)
