Antidepressants

Question 1

What are the different classes of antidepressants and what are some examples?

Answer 1

1. Selective serotonin reuptake inhibitors (SSRIs) - citalopram, sertraline, fluoxetine
2. Noradrenergic and specific serotonergic antidepressant (NaSSA) - mirtazapine
3. Serotonin and noradrenaline reuptake inhibitors (SNRIs) - venlafaxine
4. Tricyclics - amitriptyline, lofepramine, clomipramine
5. Monoamine oxidase inhibitors (MAOI) - phenelzine

Question 2

What is the therapeutic time frame and side effects of SSRIs and NaSSA?

Answer 2

1. 4-6 weeks for full therapeutic effect
2. SE - GI upset/bleeding, sexual dysfunction, suicidality
3. Worsening symptoms in first 2-3 weeks

Question 3

How can mirtazapine be taken?

Answer 3

Alone or in conjunction with an SSRI

Question 4

What are the side effects of SNRIs?

Answer 4

Nausea, GI upset, weight gain, sexual dysfunction, hypertension (require regular BP measurement at higher doses)

Question 5

What is the mechanism of action of Tricyclics?

Answer 5

Serotonin, noradrenaline and some dopamine reuptake inhibition

Question 6

What are the side effects of Tricyclics?

Answer 6

Antimuscarinic (dry mouth, blurred vision, constipation, urinary retention, weight gain, sexual dysfunction, postural hypotension, drowsiness)

Question 7

What do Tricyclics cause in overdose?

Answer 7

Cardiac QTc on ECG

Question 8

What are the side effects of MAOIs?

Answer 8

Insomnia, hepatotoxicity, weight gain, postural hypotension, hypertensive crisis risk (cheese reaction)

Question 9

What is the cause of a hypertensive crisis in the use of MOAIs?

Answer 9

Foods/medications high in Tyramine (cheese reaction)