Antidepressants - SSRIs Flashcards
What are common indications for the use of SSRI’s?
- Moderate to-severe depression
- Mild depression - if psych treatment fails
- Panic disorder
- OCD
What is the mechanism of action of SSRI’s?
Inhibit neuronal reuptake of serotonin (5-HT) from the synaptic cleft, thereby increasing its availibility for neurotransmission. They do not inhibit norad uptake, unlike TCAs
What are common adverse effects of SSRI’s?
- GI upset
- Appetite and weight disturbance
- Hypersensitivity
- Suicidal thoughts/behaviour
- Hyponatraemia
- Lower seizure threshold
- Prolong QT
- Bleeding
- Serotonin syndrome
- Withdrawal syndrome
What is serotonin syndrome?
Triad of autonomic hyperactivity, altered mental state and neuromuscular excitation
What are cognitive symptoms of serotonin syndrome?
- Headache
- Agitation
- Hypomania
- Mental confusion
- Hallucinations
- Coma
What are autonomic sympotms of serotonin syndrome?
- Shivering
- Sweating
- Hyperthermia
- Vasoconstriction
- Tachycardia
- Nausea
- Diarrhoea
What are somatic features of serotonin syndrome?
- Myoclonus (muscle twitching)
- Hyperreflexia (manifested by clonus)
- Tremor.
What group of patients are particularly suceptible to developing hypnatraemia when on SSRI’s?
Elderly
What can sudden withdrawal of SSRIs cause?
- GI uupset
- Neurological disturbance
- Influenza like symtpoms
- Sleep disturbance
What are young people at increased risk of when using SSRIs?
Increased risk of self-harm and suicidal thoughts
What conditions should you be careful prescribing SSRI’s in?
- Epilepsy
- Peptic ulcer disese
- Hepatic impairment
What drugs should SSRI’s not be given with?
- MAOIs - may precipitate serotonin syndrome
- Drugs which prolong QT - antipsychotics
What else should be prescribed if giving someone SSRI’s with NSAIDs or aspirin?
Gastroprotection
