general info 3

Question 1

Do not stop AD unless

Answer 1

exceptional medical circumstances e.g. occurrence of serious SE such as upper GI b need

Question 2

Which AD have high risk of withdrawal (3)

Answer 2

paroxetine
SNRIs (dulox, venlafaxine)

Question 3

1st line for subtheshold or mild depression, new episode

Answer 3

1st line: psychological or psychosocial therapy e.g. guided self help, CBT, BA
do not routinely offer AD unless pt preference, if so give SSRI
For pt who decide against treatment, offer active monitoring with the option to reconsider treatment at any time, and arrange further assessment (usually within 2-4 weeks)

Question 4

1st line for new episode of moderate or severe depression

Answer 4

combination - AD + individual CBT
monotherapy of either of the above may also be offered as 1st line

Question 5

chronic depressive symptoms that significantly impair functioning - treatment options

Answer 5

monotherpay with either CBT or drug treatment (SSRI, SNRI, TCA)
or combination

if no response to SSRI or SNRI, consider alt drugs and specialist settings or on specialist advice e.g. TCAs, moclobemide, irreversible MAOIs, amisulrpide (unlicensed)

Question 6

Name a reversible and name 3 irreversible MAOIs

Answer 6

reversible: moclobemide
irreversible: phenelzine, isocarboxazid, tranylcypromine