Problem 11: Management of Depression, inappropriate increasing doses of SSRI Flashcards
What are your thoughts on the signs and symptoms that Peter is showing?
Common signs and symptoms of depression include: trouble concentrating, fatigue, feelings of guilt, worthlessness, and helplessness, pessimism and hopelessness. Insomnia, early-morning wakefulness, or sleeping too much, irritability, restlessness.
Loss of interest in things once pleasurable, including sex
Overeating, or appetite loss
Aches, pains, headaches, or cramps that won’t go away
Digestive problems that don’t get better, even with treatment
Persistent sad, anxious, or “empty” feelings
Suicidal thoughts or attempts
Peter has s&s including little interest in his surrounds, diminished appetite, poor sleeping situation.
Explain the rationale for the use of citalopram?
Citalopram is an SSRI, the first line class of drugs for depression. CBT has been offered and tried in the past without success but should be re-initiated alongside SSRI use.
Other drugs:
SSRIs (Selective Serotonin Reuptake Inhibitors)
SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants)
Tricyclics
MAOIs (Monoamine oxidase inhibitors)
Describe the mechanism of action of SSRIs and apply this to how they are dosed. Comment on the appropriateness of the need to increase citalopram therapy
SSRIs inhibit the SERT (reuptake protein) of serotonin meaning that the concentration increases in the synaptic cleft of serotonin.
Initially the autonomic receptors are not downregulated and so a negative feedback system means that serotonin release is reduced. Eventually they are downregulated.
What are the steps of care for depression
- All known and suspected presentations of depression
- Mild to moderate depression
- Inadequate response to current interventions but persistent mild to moderate depression
- Severe and complex depression; risk to life, severe self neglect
