Central Nerous System - Depression Flashcards
What is depression?
less serotonin, dopamine, norephedrine, atosynaptic cleft
mild depression tx
CBT
moderate to severe depression tx
antidepressants
how long should antidepressants be used to be seen as ineffective?
elderly
4WK and 6WK for elderly
-pt may feel worse in 1st 1-2WKs
How long should antidepressants be taken after remission
-normal, elderly, recurrent
-normal = 6MT
-elderly = 1YR
-recurrent = 2YR
What is 1st line tx of depression
SSRI
What is done if SSRI does not work as a first line tx?
-increase dose
-change SSRI
-change to mitazepine
-change to MAO-I (specialist)
-if severe TCA or venlafaxine
If changes to SSRI doesn’t work what do you add?
Add another class - lithium or antipyschotics
tx of severe refractory depression?
electroconvulsive therapy
What are the s/e of SSRIs?
-GI disturbances (D+V)
-appetite/weight gain
-sexual dysfunction
-risk of bleeding
-insomnia (morning dose)
-QT prolongation (escitalopram + citalopram)
What are SSRI interactions?
-CYP inhibitors -> avoid grapefruit inc plasma conc
-CYP inducers -> lower effectivness
-drugs that cause QT prolongation (amiodarone, sotalol, quinolones)
-drugs inc risk of bleed
-hyponatraemia (carbamazepine + diuretics)
-serotonin syndrome
what is serotonin syndrome?
life-threatening drug-induced condition caused by too much serotonin in synapses of the brain
what are the three main symptoms of serotonin sydrome?
-cognitive effects
-autonomic effects
-neuromuscular excitation
serotonin sydrome
What are the signs of cognitive effects?
headahces
agitation
hypomania
coma
confusion
serotonin sydrome
What are the signs of autonomic effects?
sweating
hyperthermia
nausea
diarrhoea
serotonin sydrome
what are the signs of neuromuscular excitation
myclonus
tremor
teeth grinding
which drugs cause serotonin sydrome?
SSRI
TCA
MAO-I
triptans
tramadol
lithium
sedating better for agitated + anxious pt
Which tricyclic antidepressants are sedating?
CADT
-amitriptyline, clomipramine, dosulepim, trazadone
less sedating = better for withdrawn / apathetic pt
Which tricyclic antidepressants are less sedating?
NIL
nortriptyline
imipramine lofepramine
which two TCA are dangerous and can cause overdose
amitriptylline + dosulepin
what are the s/e of TCA?
-cardiac events
-anti-muscarnic
-seizures
-hypotension
-hallucinations
what are the interactions of TCA?
-cyp inhibitors (avoid grapefruit)
-cyp inducers ( reduce effectiveness)
-drugs that cause QT prolongation
-anti-muscarinic drugs
-anti-hypertensive drugs
-serotonin syndrome
when is MAO-I used?
only when specialist initated
what are the interactions of MAO-I
OTC, food, drugs
-phenazine + isocarboxazid
-OTC pseudoephedrine
-tyramine rich foods
-tranylcypromine + clomipramine = fatal
what is caused if MAO-I and phenazine + isocarboxazid is given together?
hepatotoxicity
what is caused if MAO-I + pseudoephedrine is given together
hypertensive crisis
how long should you wait before giving antidepressant after tx with MAO-I
-2 weeks
-3weeks if clomipramine or imipramine
how long should you wait before giving MAO-I after previous tx with MAO-I
-2 weeks after previous MAO-I has been stopped
-0 weeks with meclobemide
how long should you wait before giving MAO-I after previous tx with TCA or related antidepressant?
1-2 weeks after it has been stopped
how long should you wait before giving MAO-I after previous tx with SSRIs or related antidepressants?
-1 week after
-5 weeks for fluoxetine
