depression Flashcards
what are the 4 major classes of antidepressants?
what do they each increase the levels of?
- SSRI : increase levels of 5HT
- tricyclic antidepressants: increase levels of 5HT, NA
- monoamine oxidase inhibitors MAOIs: increase levels of 5HT, NA, Dopamine
- SNRI
give examples of some drugs in the 4 drug classes of antidepressants: SSRI, SNRI, tricyclic antidepressant, MAOI
SSRI: fluoxetine, citalopram, escitalopram, paroxetine
SNRI: venlafaxine, duloxetine
MAOI: phenelzine, isocarboxazid, tranylcypromine, moclobemide
Tricyclic antidepressants: amitriptyline, nortriptyline, clomipramine, dosulepin.
which SSRI licensed in children?
fluoxetine
which tricyclic antidepressant out of these causes liver toxicity: amitriptyline lofepramine nortriptyline dosulepin imipramine
L = liver
lofepramine
how long does it work for anti-depressants to work?
what symptoms might be increased in the first few weeks of taking anti-depressants?
- 2 weeks
- agitation, anxiety, suicidal behaviour
which antidepressant drug class is 1st line for treating depression? and why?
SSRI
- less anti-muscarinic effects, more safe in overdose and better tolerated
which SSRI is safe in pt with depression who also have unstable angina, recently had an MI?
citalopram
escitalopram
fluoextine
sertraline
sertraline
which antidepressants are the most dangerous and has the most side effects so should be reversed for use by specialists?
SSRI
SNRI
MAOI
maoi
what can st johns wort [hypericum perforatum] be used to treat OTC?
what is the risk of a pt stopping st johns wort?
mild depression
its an enzyme inducer so the concentration of the interacting drug may suddenly increase causing toxicity
how often must you review a patient when they are on antidepressants to make sure drug is working?
1-2 weeks at start
then continue treatment for 4 weeks [6 weeks in elderly] before considering to switch
how long should a pt with RECURRENT depression, receive maintenance treatment [with antidepressants] for?
- 5 years
- 3 years
- 2 months
- 2 years
2 years
which electrolyte imbalance occurs with ALL times of antidepressants esp SSRI? hyperkalaemia hypokalaemia hyponatraemia hyperglycaemia
hyponatraemia
what are the signs and symptoms of HYPONATRAEMIA?
*salt loss* Stupor/coma Anorexia Lethargy Tendon reflexes decreased Limp muscles [weakness] orthostatic hypotension seizures/headaches stomach cramps
what behavioural patterns should ALL pt be monitored for at start of antidepressant therapy?
risk of suicidal thoughts/behaviours , self harm etc
when can serotonin syndrome occur? with which antidepressants is it most common in?
when there is too much serotonin in body
SSRI, SNRI [drugs that increase serotonin]
which antidepressant may cause severe toxicity of serotonin syndrome when you combine it with other serotogenic drugs? SSRI SNRI MAOI tricylic antidepressants
MAOI - MAOI DO NOT MIX
what are the signs and symptoms of serotonin syndrome?
- muscular hyperactivity: tremor, muscle spasm, rigid, hyperflexia
- autonomic dysfunction: tachycardia, changes in BP, diaphoresis [sweating], shivering
- altered mental state: agitation, confusion, mania
if a pt is on antidepressants and develops serotonin syndrome what must be done?
withdraw medication
a pt on initial treatment for depression with SSRI. you notice it is not working, what is the next step?
either increase dose or switch to a different SSRI or give mirtazpine
what are the 2nd line options of depression if SSRIs and mirtazapine fail?
when would you give venlafaxine or MAOI?
give lofepramine, moclobemide, reboxetine
venlafaxine for severe cases and MAOI needs specialist supervision
what is the 3rd line treatment of depression if lopeframine, meclobemide or reboxetine fail?
ADD another antidepressant class OR lithium/antipsychotic
