Mental Health

Question 1

How can side effects of SSRIs be managed

Answer 1

Sexual -> trial reducing dose or switch, or to Bupropion (unapproved)

Nausea -> take with food
Dyspepsia -> with PPI if NSAID and older, Hx bleeds

QTc: x escit/citalopram if >450m, >470f. Do ECG prior/at change dose if risks OR symptoms.
- Female, older, structural cardiac, <K, <Mg, >QT meds e.g. PPI

Question 1

What are the advantages / disadvantages of SSRIs?

Answer 1

Citalopram
+ lowest interactions
- x QTc, mod discont Sx

Escitalopram
+ low interactions
- x QTc, <Na

Sertraline
+ low interaction, breastfeed
- GI, needs titration, <Na

Fluoxetine
+ < discont Sx, best in <18
- interactions, hard to switch, less good for breast

Paroxetine
+ Best for QTc
- Sexual, discont Sx, interactions, anti-chol SEs

Question 2

What are the alternatives to SSRIs?

Answer 2

Mirtazepine:
- faster onset in 2-4w
- good for sleep, can gain weight + > appetite
- Anti-chol SEs

Bupropion (NDRI)
- unapproved, so after above
- best for sexual dysfunction
- weight LOSS
- stimulant so <sleep

Venlafaxine
- SNRI: better for severe
- Same SSRI SE + cardiac, seizures in OD, discont SE
- HTN so CI if not controlled

TCAs
- Amitriptyline is > effective
- Notrip least toxic, for pain

Question 3

Somatisation etc

Answer 3

Somatisation
- Multiple symptoms >2yr
- Not accepting neg results

Illness anxiety; hypochond
- belief in DISEASE
- Not accepting neg results

Functional / conversion
- loss of motor/sensory
- not concious or for gain

Dissociative
- psychiatric symptoms. May be identify disorder i.e. multiple personality

Factitious (Munchausen)
- Intentional to be ‘sick’

Malingering
- Intentional for GAIN