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 when first starting
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
How are SSRIs taken?
Once daily tablet
How long does it take for SSRIs to take effect?
4-8 weeks
