Antidepressants Flashcards
What drugs are first line for depression?
SSRIs
What is the mechanism of action of SSRIs?
selectively inhibits reuptake of 5HT from postsynaptic cleft
What does SSRI stand for?
selective serotonin reuptake inhibitors
What are some examples of SSRIs?
sertraline
citalopram
fluoxetine
What SSRI is licensed in children?
fluoxetine
What SSRIs are safe in pregnancy?
sertraline and fluoxetine
What SSRI is good for use in patients with epilepsy?
citalopram
What SSRI can prolong the QTc interval?
citalopram
What SSRI is good for use in patients with cardiac problems?
sertraline
What are some discontinuation side effects of SSRIs? How can these be avoided?
diarrhoea
sweating
postural hypotension
gradually decrease dose over 4 weeks instead of coming off all at once
What are the side effects of SSRIs?
sexual dysfunction vivid dreams headache nausea sweating
SSRIs are safe in overdose - true or false.
True
When should you take SSRIs?
in the morning
How long should an antidepressant be trialled before trying something else?
4-6 weeks
Which antidepressant can cause an increase in suicidal idealisation in under 25s?
SSRIs
What antidepressant class should you try if SSRIs aren’t working?
SNRIs
What does SNRI stand for?
serotonin and noradrenaline reuptake inhibitors
What is the mechanism of action of SNRIs?
block reuptake of NA and 5HT into presynaptic cleft
What are some examples of SNRIs?
duloxetine
venlafloxine
When should you take SNRIs?
IN the morning
What are some examples of tricyclic antidepressants?
amitryptilline
lifepramine
imipramine
Are tricyclics toxic in overdose?
Yes - cardiotoxic
don’t give to people with a history of suicide attempt by overdose
What is the mechanism of action of tricyclic antidepressants?
block reuptake of NA and 5HT
When do you take tricyclic antidepressants? Why?
At night - sedation
What are the side effects of tricyclic antidepressants?
weight gain
anticholinergic effects - dry mouth, constipation, urinary retention
arrhythmias
postural hypotension
What is the mechanism of action of monoamine oxidase inhibitors?
inhibit MAO A and B enzymes
What are some examples of MAO inhibitors?
phenylzine
mobeclomide
When are MAO inhibitors used? Why?
IN resistant depression - due to side effects and diet restriction
Why is diet restricted with MAO inhibitors?
Can cause hypertensive crisis
Build up of tyramine (usually broken down by MAO enzymes) - in certain foods e.g. cheese, chocolate
Potent releasor of NA –> hypertension
What are some symptoms of hypertensive crisis?
nose bleeds
anxiety
SOB
headache
How is a hypertensive crisis treated?
phentolamine infusion
What are some side effects of MAO inhibitors?
insomnia postural hypotension jaundice oedema rare - liver damage
What does NaSSA stand for?
noradrenergic and specific serotonergic antidepressant
What is an example of NaSSA?
mirtazapine
When is mirtazapine used?
If SSRI/SNRIs haven’t worked
What is the mechanism of action of mirtazapine?
blocks alpha 2 and 5-HT 2 and 3
What can you give with mirtazapine to stop the seratonergic side effects?
SSRI
What are side effects of mirtazapine?
weight gain
sedation - good in insomnia
What happens if you take mirtazapine with alcohol?
GI upset
