Depression

Question 1

True or false: Antidepressants should be used for mild depression

Answer 1

FALSE - Psychological therapies are first line

Question 2

How long does it usually take before the effects of an SSRI are noticed ?

Answer 2

3 - 4 weeks

Question 3

How long should antidepressants be continued after remission to prevent relapse?

Answer 3

6 months

2 years if they are at high risk of relapse or history of recurrent depression

Question 4

Increased risk of suicide when treatment with an antidepressant is started, particularly in patients aged _______

Answer 4

Under 30 years old

Question 5

Which SSRI is known to have a long half life

Answer 5

Fluoxetine

Question 6

How long of a wash out period is needed when switching from a MAOI to another antidepressant?

Answer 6

2 weeks

Question 7

What are the 3 categories of symptoms associated with serotonin syndrome?

Answer 7

1. Neuromuscular hyperactivity e.g. tremor or rigidity
2. Autonomic dysfunction e.g. tachycardia and hyperthermia
3. Altered mental state e.g. confusion, mania and agitation

Question 8

Which SSRI is associated with QT prolongation

Answer 8

Citalopram

also Escitalopram - an isomer of citalopram

Question 9

The only antidepressant licensed for use in children

Answer 9

Fluoxetine

Question 10

Antidepressant of choice for patient with history of MI/unstable angina

Answer 10

Sertraline

Question 11

______ is a less sedating TCA

3 options

Answer 11

Lofepramine

Notriptyline

Imipramine

Question 12

Phenalzine is an example of which class of antidepressant?

Answer 12

MAOI

Question 13

True or false: MAOI interact with mature cheeses and marmite

Answer 13

TRUE - cheese contains Tyramine. The interaction can lead to a hypertensive crisis

Question 14

Which antidepressant can (rarely) cause blood disorders?

Answer 14

Mirtazapine (counsel patients on signs of blood disorders)

Question 15

What is the interaction between fluoxetine and phenelzine?

Answer 15

Increased risk of serotonin syndrome (phenelzine is a MOAI)

Question 16

Continue antidepressant treatment for at least ______ before switching to a different drug due to lack of efficacy

Answer 16

4 weeks

Continue for 6 weeks in the elderly

Question 17

How long should antidepressants be continued after remission ?

Answer 17

At least 6 months (at the same dose)

NB: May be ~12 months in the elderly

Question 18

How long should antidepressants be continued as maintenance in those with a history or recurrent depression?

Answer 18

At least 2 years

Question 19

Which class of antidepressants are known to cause hyponatraemia

Answer 19

SSRIs

Usually in the elderly. Possible due to inappropriate ADH secretion.

Question 20

Most sedating TCA

Answer 20

Dosulepin

Question 21

Wash out period when switching from TCA to MAOI

Answer 21

1-2 weeks

Question 22

True or false:

Amitriptylline is known to have antimuscarinic effects. This includes dry eyes

Answer 22

FALSE

While it does have antimuscarinic properties, dry eyes is not listed as a side effect (BNF)

It DOES cause constipation, drowsiness and dry mouth

Question 23

The maximum dose of citalopram is ______ in patients aged _____ and over.
This is because higher doses increase the risk of ________

Answer 23

1) 20mg
2) 65 and over
3) QT prolongation