Antidepressants Flashcards
Antidepressant associated with higher risk of withdrawal symptoms
Venlafaxine
First line antidepressant class
SSRIs
Only licensed reversible MAOI
Meclobemide
Interactions of MAOIs
- tyramine (cheese, pickled herring, broad bean pods, marmite, yeast)
- indirect acting sympathomimetics (in some cough/decongestants)
How long after MAOI can cheese reaction occur?
2 weeks
What are the symptoms of the MAOI interaction
throbbing headache due to dangerously high rise in BP
Can you give MAOIs with other antidepressants
this is considered very dangerous except in experienced hands
2 weeks between SSRI and starting MAOI (5 weeks for fluoxetine)
Can you drink with MAOIs
pt should be advised not to drink or to drink de-alcoholised drinks
Can the cheese reaction still occur if the MAOI is reversible
Yes - avoid large amounts. Risk is less than traditional.
Antidepressant action can begin …. weeks after begining
2 weeks
Before symptoms of depression improve what symptoms might be experienced
aggitation
anxiety
suicide risk
Why is the first line class for depression first line?
less dangerous in overdose and better tolerated
TCAs have what side effect profile compared to SSRIs?
more antimuscurinic, more sedating and less cardiotoxic
following remission how long should antidepressant treatment be continued for?
6 months
12 months in the elderly
12 months with anxiety disorder as relapse risk is higher
All types of antidepressant are associated with what electrolyte change?
Hypernatraemia (most common with SSRIs)
Symptoms of hyponatramia
drowsiness, confusion, convulsions
Symptoms of serotonin syndrome (3 main areas)
neuromuscular hyperactivity - tremour, rigidity
autonomic dysfunction - diarrhoea, hyperthermia, BP change
altered mental state - agitation, confusion, mania
What is the cause of serotonin syndrome?
excessive central and peripheral serotonergic activity
Second line options and
…….. is reserved for more severe depression
Other SSRI or dose increase or mirtazepine
Venlafaxine
What class is reboxetine and what line is it?
NRI
2nd/3rd line
- Class of drug for treatment of anxiety with EMA warning that side-effect risks outweigh potential benefit….
- example of this ….
- e.g. of sideffects
Carbamates
e.g. meprobamate (the only licensed med)
convulsions on abrupt withdrawl amnesia ataxia confusion paradoxical excitment
All TCAs are considered sedating appart from (3)
imipramine - more antimuscurinic s/e
lofepramine - fewer s/e, less dangerous in OD, potential hepatic s/e
nortriptyline
2 main s/e of the TCA class
cardiotoxicity in overdose and antimuscurinic effects
which two TCAs are particularly dangerous in overdosage
amitryptiline
dolsupin
Why is there no point in MR preps of TCAs
they have long half lives allowing once daily (at night) admin
Can you treat children with TCAs?
no - not efficatious
what patients are said to respond best to MAOIs?
phobic and depressed pt with atypical hypocondriachal or hysterical features
what antipsychotic has antidepressant properties at low doses
fluclupenthixol
Name the three irriverible MAOIs
Which is most stimulating
which is mot likely to cause hepatotox
tranycypromine - stimulating & hepatotox, more likely to cause hypertensive crisis
isocarboxid
phenelzine
is reversible or irriversible MAOI second line
weirdly - reversible MAOI meclobide is second line
only SSRI proven to work in adolescents
fluoxetine
Symptoms of
- SSRI overdose
- Serotinin syndrome:
Nausea, vomiting, agitation, drowsiness, tremour, nystagmus, sinus tachycardia, convulsions
Serotonin syndrom: neuropsychiatric effects, neurmuscular hyperactivity, autonomic instability, hyperthermia, rahbdomyolysis, renal failure, coagulopathies
citalopram and ecitalopram are contraindicated in what caridac condition
QT prolongation
Duloxtetine is what drug class
SNRI
What class of drug is mirtazepine and mianserin? What are the monitoring requirements of mianserin?
Tertracyclic
FBC - report signs of sore throat, stomatitis or other signs of infection
Trazadone is what class and is used to treat what
triazolopyridine antidepressant
used to treat depression where sedation is required
