Depression Flashcards
What is meant by depression
A reduction in serotonin, dopamine, norepinephrine at the synaptic cleft
What is the prescribing pathway for depression
Mild: cognitive behavioural therapy
Moderate-severe: antidepressants
Patients may fell worse in the first 1-2 weeks
Should be taken for 4 weeks (6 weeks in the elderly) before deemed ineffective
Take for 6 months after remission, 1 year in elderly, 2 years in recurrent
What is the first line of depression
Ssri
What do you do if the SSRI doesn’t work when treating depression
Increase the dose
Change SSRI
Mirtazapine
MAO-I (specialist)
TCA or venlafaxine if severe
If that doesn’t work add in another class, lithium or antipsychotic
How do you treat severe refractory depression
Use electroconvulsive therapy
What is meant by refractory depression
When 2 or more anti-depressants doesn’t work
What do you give to someone who id older than 5 but under 17 which Ssri can we use
Fluoxetine.
The only one licences for under 17
Why are SSRIs first line
Better tolerated and are safer in overdose
Considered first line for treating depression
Sertraline safest in patients with cardiac events
In children under 17 and under but above 5- use fluoxetine
What are the side effects of SSRIs
GI disturbances (diarrhoea and vomiting)
Appetite/ weight gain
Sexual dysfunction
Risk of bleed ( avoid nsaids and warfarin and usually need a PPI)
Insomnia (take medication in the morning)
QT prolongation (citalopram and escitalopram)
Name SSRIS
examples Citalopram/ Escitalopram/ Fluoxetine/ Fluvoxamine/ Paroxetine/ Sertraline
What are the interactions of SSRIs
CYP enzyme inhibitors (avoid grapefruit- increases plasma concentration)
CYP enzyme inducers (reduces effectiveness)
Drugs that causes QT prolongation ( Amiodarone, sotolol, quinolones)
Drugs that cause an increase risk of bleed
Hyponatraemia (carbamazepine and diuretics)
Serotonin syndrome
What are the effects of serotonin syndrome
Cognitive effects: headaches, agitation, hypomania, coma, confusion
Autonomic effects: sweating, hyperthermia, nausea, diarrhoea
Neuromuscular excitation: myoclonus, tremor, teeth grinding
What is serotonin syndrome caused by
SSRI, TCAs, MAO-Is
Triptans
Tramadol
Lithium
Which Tricyclic antidepressants are sedating
TCAs which are sedating and are better for agitated and anxious patients:
Amitriptyline
Clomipramine
Dosulepin
Trazadone
Which tricyclic antidepressants are less sedating
TCAs which are less sedating and are better for withdrawn and apathetic patients :
Imipramine
Lofepramine
Nortriptyline
