Depression

Question 1

When should you review a patient with depression?

Answer 1

Increased Rx suicide
o Review within 1 week
o Review frequently after

Not at increased Rx suicide
o Review in 2 weeks
o Review every 2-4 weeks for the first 3 months and if response to treatment is good, longer intervals can be considered

Question 2

How long does it take before an improvement in mood is seen with ADs?

Answer 2

3-6 weeks

Question 3

How do you change between SSRIs?

Answer 3

The first SSRI should be withdrawn before the alternative SSRI is started

Question 4

How do you change from fluoxetine to SSRIs?

Answer 4

o Withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI
o Interactions with fluoxetine may still occur for 5 weeks after stopping it due to its long half-life

Question 5

How do you change from SSRIs to TCA?

Answer 5

cross-tapering

Question 6

How do you change from SSRIs to venlafaxine?

Answer 6

cross-tapering

Question 7

What are SSRIs:

• Function
• Examples
• Side effects

Answer 7

Block presynaptic serotonin uptake

Fluoxetine
- P450 inhibitor, Insomnia

Sertraline
- GI SE

Citalopram
- QTc prolongation, sedation, GI SE

Escitalopram
- QTc prolongation, sedation, GI SE

Paroxetine

Question 8

What are SNRIs:

• Function
• Examples
• Side effects

Answer 8

Blocks serotonin and norepinephrine reuptake

Venlafaxine
- Increase in BP, Nausea, QTc prolongation

Duloxetine

Question 9

What is mirtazepine:

• Function
• Side effects

Answer 9

5HT2 and 5HT3 receptor antagonist

SE: sedation, weight gain, agranulocytosis, increases serum cholesterol and triglycerides

Question 10

What are tertiary TCAs:

• Function
• Examples
• Side effects

Answer 10

Act on serotonin receptors

Amitriptyline

SE: antihistaminic (sedation, weight gain), anticholinergic (dry mouth, dry eyes, constipation, memory deficits) and anti-adrenergic (OH, sedation)

Question 11

What is serotonin syndrome?

Answer 11

• Neuromuscular hyperactivity
• Autonomic dysfunction
• Altered mental state

Question 12

What are discontinuation symptoms?

Answer 12

Those who stop taking Antidepressants abruptly, miss doses or do not take the full dose may experience discontinuation symptoms

Restlessness, problems sleeping, unsteadiness, sweating, abdominal symptoms, altered sensations or altered feelings