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depression Flashcards

1
Q

when should antidepressants be used

A
  • for moderate-severe depression psychomotor and physiological changes such as loss of appetite and sleep disturbance
  • should not be routinely used in mild depression, psychological therapy first line
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2
Q

when would electroconvulsive treatment be suitable to treat depression

A

antidepressants can take 2 weeks before they start to have an effect, can use electroconvulsive treatment in patients with severe depression where this delay (2 weeks) may be hazardous or intolerable

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3
Q

what side effects may occur during the first few weeks of starting antidepressants

A

there is an increased risk of agitation, anxiety, and suicidal ideation.

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4
Q

which class of antidepressants is first-line for treating depression and why

A

SSRIs because they are:

  • better tolerated and are safer in overdose than other classes of antidepressants
  • less sedating (than Tricyclic antidepressants)
  • have fewer cardiotoxic effects (than Tricyclic antidepressants)
  • can be used in unstable angina or who have had a recent myocardial infarction
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5
Q

which class of antidepressants has dangerous interactions with food

A

monoamine oxidase inhibitors (MAOI)

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6
Q

why should st johns wort not be prescribed or recommended to treat mild depression

A
  • St John’s wort can induce drug metabolising enzymes which causes interactions with conventional drugs including antidepressants.
  • The amount of active ingredient varies between different preparations of St John’s wort and switching from one to another can change the degree of enzyme induction
  • if a patient stops taking St John’s wort, the concentration of interacting drugs may increase, leading to toxicity
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7
Q

once a person is in remission due to taking antidepressants, do they stop taking the antidepressants

A

no, should be continued at the same dose for at least 6 months (about 12 months in the elderly, those with anxiety or 2 years if they have recurrent depression)

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8
Q

what symptoms may indicate a person has hyponatraemia from taking antidepressants

A

hyponatraemia can be caused by all antidepressants but more often SSRIs

symptoms of hyponatremia:
drowsiness, confusion, or convulsions while taking an antidepressants

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9
Q

which patients have a higher risk of suicidal thoughts and behaviour linked to taking antidepressants

A
  • children
  • young adults
  • patients with a history of suicidal behaviour
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10
Q

when is it most important to monitor patients for suicidal thoughts and behaviours when they are taking antidepressants

A
  • at the start of treatment

- if dose is changed

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11
Q

what may cause Serotonin syndrome (or serotonin toxicity) in a patient taking antidepressants

A
  • the initiation of antidepressants
  • dose escalation
  • overdose of a serotonergic drug
  • adding a new serotonergic drug to treatment
  • replacement of one serotonergic drug by another without allowing a long enough washout period in-between, particularly when the first drug is an irreversible MAOI or a drug with a long half-life
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12
Q

what are the symptoms of Serotonin syndrome (or serotonin toxicity) in a patient taking antidepressants

A

3 categories of symptoms:

  • neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity)
  • autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea)
  • altered mental state (agitation, confusion, mania).
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13
Q

how do you treat Serotonin syndrome (or serotonin toxicity)

A

stop the serotonergic medication and supportive care; specialist advice should be sought.

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14
Q

name some examples of SSRIs

A
  • sertraline
  • citalopram
  • escitalopram
  • fluoxetine
  • paroxetine
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15
Q

what is the next step in treatment if a patient doesn’t respond to initial treatment with an SSRI

A

may require an increase in the dose, or switching to a different SSRI or Mirtazapine (a tetracyclic antidepressant)

  • Other second-line choices include lofepramine, moclobemide, and reboxetine.
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16
Q

which antidepressants are used for severe forms of depression

A

tricyclic antidepressants and venlafaxine (serotonin and noradrenaline re-uptake inhibitors SNRI)

17
Q

when would you treat generalised anxiety disorder with antidepressants

A
  • if the patient has chronic anxiety (of longer than 4 weeks’ duration) and has been offered psychological treatment before starting antidepressant
  • note acute anxiety generally involves the use of a benzodiazepine or buspirone hydrochloride. a patient may also be taking a antidepressant + benzodiazepine whilst waiting for antidepressant to take effect*
18
Q

which antidepressants can be used to treat generalised anxiety disorder

A
  • an SSRI such as escitalopram, paroxetine, or sertraline [unlicensed]
  • Duloxetine and venlafaxine (serotonin and noradrenaline reuptake inhibitors (SNRIs)) are also recommended
  • note if a patient can’t tolerate both SSRI and SNRI, pregabalin can be used*
19
Q

which class of drugs are used to treat panic disorders, Obsessive-compulsive disorder, post-traumatic stress disorder, and phobic states such as social anxiety disorder

A

SSRIs e.g sertraline, citalopram, escitalopram, fluoxetine, paroxetine

20
Q

name some examples of Tricyclic antidepressants which have sedative properties

A
  • amitriptyline ,
  • clomipramine
  • dosulepin
  • trazodone
  • trimipramine

note agitated and anxious patients tend to respond best to the sedative compounds

21
Q

give some examples of Tricyclic antidepressants that are less sedating

A

imipramine hydrochloride, lofepramine, and nortriptyline

note withdrawn and apathetic patients will often obtain most benefit from the less sedating ones

22
Q

which class of antidepressants causes antimuscarinic side-effects and cardiotoxicity in overdose

A

Tricyclic antidepressants

  • examples of antimuscarinic side effect include: dry mouth, blurred vision, hot + flushed skin, urinary retention*
23
Q

which 2 antidepressants Tricyclic antidepressants are NOT recommended for treatment in depression and why

A

Amitriptyline hydrochloride and dosulepin hydrochloride

They are not recommended in depression because they are particularly dangerous in overdose. if they are given, it is by a specialist

24
Q

why can most tricyclic antidepressant drugs be given once daily

A

because they have a long half life

note this is why the use of modified-release preparations is unnecessary

25
Q

which class of antidepressants is not effective at treating depression in children + adolescents

A

tricyclic antidepressants

26
Q

name some examples of Monoamine-oxidase inhibitors (MAOI)

A

Tranylcypromine, phenelzine, isocarboxazid, Moclobemide

27
Q

which foods interact with Monoamine-oxidase inhibitors (MAOI)

A
  • tyramine-rich food (such as mature cheese, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract
  • some beers, lagers or wines)
  • foods containing dopa (such as broad bean pods).
28
Q

how long should patients taking Monoamine-oxidase inhibitors (MAOI) avoid tyramine-rich or dopa-rich food/drinks 

A

avoid during treatment with MAOI and for 2-3 weeks after stopping treatment

29
Q

how long should you wait to start a Monoamine-oxidase inhibitor (MAOI) if the patient has previously been taking other antidepressants

A
  • at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose)
  • at least 7–14 days after a tricyclic antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped
  • at least a week after an SSRI or related antidepressant (at least 5 weeks in the case of fluoxetine) has been stopped
30
Q

if a patient has previously been taking a Monoamine-oxidase inhibitor (MAOI), how long should you wait before starting a different antidepressant

A

2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine)

31
Q

which class of antidepressants cause an increased risk of bleeding

A

SSRIs

central nervous system (12 decks)

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