Depression and Anxiety Flashcards
1st line for less severe depression?
psychological or psychosocial therapy
Antidepressant choice in less severe depression?
SSRI
Why is St John’s Wort not recommended in depression?
Variability between preparations, drug interactions, and uncertainty about appropriate dose.
1st line for more severe depression?
Antidepressant + individual CBT OR monotherapy with antidepressant or psychological treatment
What should not routinely be used in less severe depression?
Antidepressants
How often should treatment be reviewed after initiation/dose change?
2-4 weeks
Preferably 2 weeks if antidepressants initiated
1 week if aged 18-25
Recommended length of treatment for depressive episode?
6 months
How long do antidepressants take to work?
4 weeks
List potential withdrawal symptoms
vertigo/dizziness, abdo pain, sweating, sleep disturbances, mood alterations, palpitations, headaches, tiredness
How should antidepressants be withdrawn?
Over weeks to months, with smaller dose reductions occuring the lower the dose becomes
Which tricyclic antidepressants are better used in anxious/agitated patients?
Amitrityline, clomipramine, dosulepin, trimipramine, doxepin, mianserin
Which tricyclic antidepressants are better used in apathetic patients or withdrawal?
Lofepramine, Imipramine, Norptriptyline (less sedating)
Tricyclic antidepressant side effects
Sedation, postural hypotension, hyponatreamia, weight gain, antimuscarinic effects.
Why are Tricyclic antidepressants so dangerous in overdose?
Cause AV block and arrythmias
Which class of antidepressants would be avoided in suicidal patients?
Tricyclic antidepressants
antidepressants associated with an increased risk of suicide <18s
SSRIs
antidepressants associated with sexual dysfunction
SSRIs
antidepressants better SE profile in terms of GI and sexual dysfunction?
NASSAs e.g., Mirtazapine
antidepressant associated with priapism?
Trazadone (mixed serotonin agonist/antagonist)
antidepressants associated with cardiotoxicity other than TCAs?
SNRIs e.g., venlafaxine
Side effects of trazadone?
pronounced hypotension and sedative effects
antidepressants associated with an increased apetite?
Mirtazapine
Signs of serotonin syndrome
sweating, shivering, tachycardia, hypertension, muscle twitching, confusion/agitation, diarrhoea, vomiting
Licensing of vortioxetine
No response to a minimum of 2 antidepressants
