Depression QA

Question 1

Three treatment options in depression

Answer 1

• SSR1s (safe
• TCA (problems with sedation and addiction)
• MOAIs (interact with a lot of drugs)

Question 2

Why are SSRis first line + length of treatment

Answer 2

• They are better tolerated in overdose and have less side effects
• TCA’s have more side effects such as sedation
• MOAis interact with a lot of food
• Length of treatment = 2wks

Question 3

When do you review pt on SSRis

Answer 3

1) 1-2 start of treatment

2) After 4 wks in (6wks in elderly)

Question 4

If SSR1s don’t work there are second line options which include

Answer 4

• Increase SSRI dose
• Choose another SSR1
• Mirtazapine
• Other TCA (consider venlafaxine in more serious depression)
• Irreversible MOAis = only under specialist supervision

Question 5

Third line treatment options if SSR1s don’t work

Answer 5

1) Add another antidepressant class
2) Add am augmenting agent e.g lithium / antipsychotics
3) Electroconvulsive therapy In server refractory depression

Question 6

Side effect of antidepressant medication (4)

Answer 6

• Hyponatremia (in SSR1s are most common)
• Suicidal ideation (monitor)
• Serotonin syndrome
• Drowsiness (driving)

Question 7

What are the three effect of Serotonin syndrome

Answer 7

o	Neuromuscular (drowsiness , confusion , convulsion
o	Altered mental state (confusion, agitation, mania) 
o	Autonomic dysfunction (liable BP, Urination , Diarrhoea , Hyperthermia

Question 8

When switching between antidepressants how long is the waiting time + exception
MOAIs :
SSR1s:
TCAs:

Answer 8

• MOAIs : 2 weeks before switching
• SSR1s: One week before switching
  o 2 wks If sertraline
  o 5 wks if fluoxetine
• TCAs: Wait 1-2 weeks before switching

Question 9

How long should depression medication be withdrawn over

Answer 9

Reduced over 4 wks

6 months if long term use

Question 10

Risk of withdraw increased with medication treatment over how long?

Answer 10

8 weeks

Question 11

When do withdrawal symptoms of antidepressant occur

Answer 11

After 5 days

Question 12

Which antidepressants have the highest risk of withdrawal

Answer 12

• Paroxetine

- Venlafaxine

Question 13

SSRIs MOA

Answer 13

Inhibit the reuptake of 5-HT from synaptic cleft

Question 14

Examples of SSR1s

Answer 14

Citalopram
Esocitalopram (QT prolongation)
Fluoxetine (only one licensed in children)
Paroxetine (high risk of withdrawal)
Sertraline (safest and can be used in MI)

Question 15

Side effects of SSRIs GASH

Answer 15

G = GI 
A = Appetite or weight disturbances 
S = Serotonin syndrome 
H = Hypersensitivity reaction 
-	Bleeding risk 
-	QT prolongation 
-	Seizure
-	Movement disorder (dyskinesia)

Question 16

Overdose symptoms of SSRIs

Answer 16

Nausea + Vomiting , Agitation , tremor, Nystagmas , Drowsiness , Sinus tachycardia, Convulsions

Question 17

Interaction of SSRIs

Answer 17

• Grapefruit juice
• Increase risk of bleeding (NSAIDs/Anticoagulants/ Antiplatelet)
• Increase risk of QT prolongation
• Hyponatermia (Loop / thiazide diuretics / Desmopressin )
• Serotonin syndrome (st johns wart / Sumatriptan / Tramadol / TCA / MOAis)

Question 18

Tricyclic antidepressants

- Which one is sedating

Answer 18

Amitriptyline

Question 19

Tricyclic antidepressants

- Which one is NOT sedating

Answer 19

Nortriptyline

Question 20

Side effects (TCAs)

Answer 20

T= Toxic in overdose
C= Cardiac side effects (QT prolongation / Arrhythmias / Heart Block / Hypertension) 
A = Antimuscarinic side effects 
S = Seizures 

• Can cause hallucinations and mania

Question 21

Interaction which with drug classes of TCA

Answer 21

Increase plasma concentration 
Decrease plasma concentration 
Antimuscarinic
Serotonin syndrome 
Hyponatremia 
QT prolongation 
Hypotension

Question 22

MOAIs MOA

Answer 22

Block monoamine oxidase enzyme which leads to accumulation of monoamines.

Question 23

Examples of MOA’s

Answer 23

Irreversible MOAs

• Phenelazine
• Isocarboxazid
• Tranycypromine

Reversible MOAIs
- Moclobemide (short acting / no washout period)

Question 24

Side effects of MOA’s

Answer 24

Hepatotoxic
Hypertensive crisis
Postural hypertension

Question 25

Interaction of MOA’s

Answer 25

Hypertensive crisis

Question 26

Patient counselling of MOA’s

Answer 26

Avoid tyramine rich food
Eat only fresh food
Avoid alcohol