Antidepressants Flashcards
treatment for mild depression
watchful waiting
problem solving exercises
treatment for moderate depression
1st line - SSRI
2nd line - try different SSRI/SNRI
3rd line- try adding mitazapine to the SSRI/SNRI
other - try antipsychotic for treatment resistant depression
examples of SSRIs
Citalopram Sertraline Escitalopram Fluoxetine Fluvoxamine Paroxetine
how to SSRIs work
block the re-uptake of serotonin by the pre-synaptic neuron so it stays in the synapse longer and has a greater effect
SSRI side effects
GI symptoms -nausea -vomiting -diarrhoea agitation/restlessness insomnia dizziness headaches sexual dysfunction hyponatraemia bleeding worsened thought of hurting self or others (more in <30s)
which SSRI is most likely to cause sexual dysfunction
paroxetine
examples of SNRIs
venlafaxine
des-venlafaxien
duloxetine
How do SNRIs work
block serotonin and nor-adrenalin re-uptake
nor-adrenaline re-uptake inhibition only occurs at doses above 150 mg
side effects of SNRIs
similar to SSRIs +
- seizure in overdose
- hypertension
- discontinuation syndrome
has a higher rate of adverse effects than SSRIs
with which SNRI should you avoid alcohol consumption
Duloxetine
-causes liver disease
what is mirtazapine and how does it work
alpha 2 adrenoreceptor antagonist
increases nor-adrenaline concentration by blocking negative feedback on alpha 2 receptors
also block receptors which can cause SSRI side effects eg. sexual dysfunction, insomnia and nausea
mirtazapine side effects
increased appetite
weight gain
sedation
when is mirtazapine best used
in addition to SSRI/SNRI in treatment resistant depression
examples of tricyclic antidepressants
Amitriptyline Clomipramine Dosulepin Imipramine Lifepramine Nortriptyline
side effects of tricyclics
anti-muscarinic effects
- dry mouth
- constipation
- urinary retention
- blurred vision
anti-histamine effects
- sedation
- weight gain
alpha-1-adrenergic action
- dizziness
- orthostatic hypotension
blockage of sodium channels
- seizure
- comma
- cardiac arrest
- death
mania in bipolar
discontinuation syndrome
neurotoxicity
cardio toxicity
when are tricyclics contraindicated
arrhythmia previous MI heart block mania hypomania acute porphyria
what do mono-amine oxidase inhibitors do
instead of working on the pre-synaptic neurone to increase re-uptake, they block mono-amine oxidase which would usually work in the synapse to break down the neurotransmitter
examples of reversible MAOIs
phenelzine
isocarboxazid
example of non-reversible MAOIs
Moclobemide
-better tolerated
side effects of MAOIs
Hypertensive crisis caused by tyramine containing foods
- cheese
- yeast extracts
postural hypotension
What causes hypertensive crisis in MAOIs
Monoamine oxidase is present in the CNS but also in the periphery
It is used in the GI tract to break down tyramine
MAOIs inhibit CNS and GI monamine oxidase so the tyramine is not broken down and causes the hypertensive crisis
what is serotonin syndrome
an acute neuropsych presentation caused by raised CNS serotonin activity
caused by simulataneous prescription of more than one antidepressant, or agents that increase serotonin function
how does serotonin syndrome present
Agitation Sweating Confusion Myoclonus Nystagmus Headache Pyrexia Mood changes Fits
treatment of serotonin syndrome
stop anti-depressants
supportive
