Antidepressants

Question 1

Examples of SSRI’s

Answer 1

Fluoxetine
Paroxetine
Citalopram
Sertraline
Fluvoxamine
Escitalopram

Question 2

Side effects and contraindications of SSRI’s

Answer 2

GI disturbance
Appetite and wt loss
Insomnia
Sweating
Sexual dysfunction
Apathy and fatigue
Restlessness
Cardiac defects in first trimester 
-

Question 3

SNRI’s mechanism of action, examples and side effects

Answer 3

Presynaptic blockade of both noradrenaline and serotonin re uptake pumps
2nd most commonly used
Venlafaxine, duloxetine
-comparable to SSRI's
-sedation
-greater withdrawal symptoms
-less sexual side effects

Question 4

Tricyclics antidepressants, mechanism of action and indications

Answer 4

Presynaptic blockade of both noradrenaline and serotonin reuptake pumps (+dopamine, muscarinic, histaminergic, and a adrenergic)

• depression 2nd line
• anxiety
• OCD
• chronic pain
• nocturnal enuresis
• narcolepsy
• 1st line in pregnancy

Question 5

Examples of tricyclic antidepressants

Answer 5

Amitriptyline
Imipramine
Clomipramine
Dosulepin
Lofepramine

Question 6

Tricyclic antidepressants side effects and contraindications

Answer 6

Anticholinergic-> dry mouth, constipation, retention, blurred vision 
A adrenergic-> postural hypotension
Histaminergic-> weight gain, sedation
Cardio toxic-> long QT, ST elevation, heart block, arrhythmias
Delirium
-recent MI/arrhythmia
-liver disease
-mania
-high suicide risk

Question 7

Monoamine oxidase inhibitors mechanisms of action and indications

Answer 7

Non selective, irreversible inhibition of monos mine oxidase A and B

• resistant depression
• atypical depression

Question 8

Monoamine oxidase inhibitors examples

Answer 8

Phenelzine
Tranylcypromine
Isocarboxide
Moclobemide

Question 9

Monoamine oxidase inhibitors side effects

Answer 9

Amines may accumulate-> hypertensive crisis
-> cheese reaction
High risk of serotonin syndrome if co prescribed with another antidepressant

Question 10

NaSSA mechanism of action and indications

Answer 10

Presynaptic blockade a2 receptor -> increases NA and 5HT3
Depression when sedation is desirable
Anxiety
Mirtazipine

Question 11

NaSSA side effects

Answer 11

Increased appetite and wt gain
Sedation 
Headache
Dry mouth
Dizziness and postural hypertension
Tremor 
Peripheral oedema 
-mania

Question 12

General points about treatment

Answer 12

Select a medication the patient is likely to tolerate
Try for at least 3-4 weeks (12 elderly) at an effective dose before deciding if treatment has worked
Partial improvement in 4 w continue for 2-4 w
Continue at least 6 months following resolution of treatment
Taper down over at least 4 weeks

Question 13

Withdrawal symptoms

Answer 13

*paroxetine, venalfaxine
GI disturbance
Agitation
Dizziness and numbness
Headaches
Tremor
Insomnia and strange dreams
Anxiety and sweating

Question 14

SSRI’s mechanism and indications

Answer 14

Selective presynaptic blockade of serotonin re uptake pumps

• cardiac disease
• suicide risk
• depression
• anxiety
• OCD
• bulimia nervosa