Depression Management

Question 1

What are the common SSRIs

Answer 1

First line Fluoxetine

Sertraline (Post MI)

Citalapram (Can prolong QT)

Question 2

What are the SSRI side effects?

Answer 2

Gi

Hyponaetremia

Insomnia

Sex life, serotonin syndrom Qt prolongation

Take two weeks to work, are not addictive but not to <18

Question 3

Summarise TCA

Answer 3

Inhibit serotonin and noradrenaline uptake

Amytryptiline is first line.

Dosulpine has a narrow therapeutic window so should be stopped

Question 4

What are the side effects of TCA?

Answer 4

They have anti muscarinic affects so: Dry mouth, blurred vision, urinary retention, tachycardia Sedation and confusion A1 adrenergic antagonists so postural hypotension

Question 5

Summarise MAOI

Answer 5

Inhibit MAO so increased serotonin, dopamine and noradrenaline eg phenelzine

Question 6

What are the side effects of MAOI

Answer 6

CNS stimulation so insomnia and restlessness. Cheese like reaction causing hypertension when eating tyrosine in cheese

Question 7

Which TCA should be stopped?

Answer 7

Dosulpine

Question 8

Which ones can not be given to under 18s?

Answer 8

SSRI

Question 9

What is an example of an SSRI, TCA and MAOI

Answer 9

Sertraline, citalopram Amitryptiline Phenelzine

Question 10

What is a last resort anti depressant?

Answer 10

Mirtezapine