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Systems: Psychiatry AB > Psycho-Pharmacology > Flashcards

Psycho-Pharmacology Flashcards

1
Q

What are the general pharmacology strategies?

A

Indication
-Establish a diagnosis and identify the target symptoms that will be used to monitor therapy response

Choice of agent and dosage
-Select an agent with an acceptable side effect profile and use the lowest effective dose. Remember the delayed response for many psych meds and drug-drug interactions.

Management
-Adjust dosage for optimum benefit, safety and compliance. Use adjunctive and combination therapies if needed however always strive for the simplest regime.

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2
Q

What are the indications for antidepressants?

A
  • Unipolar and bipolar depression
  • Organic mood disorders
  • Schizoaffective disorder
  • Anxiety disorders (OCD, panic, social phobia, PTSD)
  • Premenstrual dysphoric disorder
  • Impulsivity associated with personality disorders
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3
Q

What is selection of antidepressant based on?

A
  • Past history of response
  • Side effect profile
  • Coexisting medical conditions
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4
Q

How long before symptoms start to improve on antidepressants?

A

There is a delay typically of 2-4 weeks after a therapeutic dose is achieved before symptoms improve.

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5
Q

What should be done if no improvement is seen on antidepressants?

A

If no improvement is seen after a trial of adequate length (at least 2 months) and adequate dose, either switch to another antidepressant or augment with another agent.

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6
Q

How should antidepressants be used prophylactically?

A
  • First episode continue for 6mth to a year
  • Second episode continue for 2 years
  • Third episode discuss life long
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7
Q

What are the classifications of antidepressants?

A
  • Tricyclics (TCAs)
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
  • Novel antidepressants
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8
Q

What side effects can TCAs have?

A
  • Antihistaminic, anticholinergic, antiadrenergic
  • Lethal in overdose (even 1 week supply can be lethal)
  • Prolonged QT complex
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9
Q

Describe the components of tertiary TCAs

A
  • Have tertiary amine side chains

- Have active metabolite including despipramine and nortripytline

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10
Q

Why do tertiary TCAs have more side effects than others?

A

Side chains are prone to cross react with other types of receptors which leads to more side effects

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11
Q

Give examples of tertiary TCAs.

A
  • Imipramine,
  • Amitriptyline
  • Doxepin,
  • Clomipramine
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12
Q

What are secondary TCAs?

A

They are often metabolites of tertiary amines

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13
Q

Give examples of secondary TCAs

A
  • Desipramine

- Nortriptyline

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14
Q

What side effects do secondary TCAs have?

A

Same as tertiary TCAs but less severe

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15
Q

What is the mechanism of secondary TCAs?

A

Primarily block noradrenaline

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16
Q

What is the mechanism of monoamine oxidase inhibitors?

A

Bind irreversibly to monoamine oxidase thereby preventing inactivation of amines such as norepinephrine, dopamine and serotonin leading to increased synaptic levels

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17
Q

What are MAOIs particularly effective in?

A

Resistant depression

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18
Q

What side effects do MAOIs have?

A
  • Orthostatic hypotension
  • Weight gain
  • Dry mouth
  • Sedation
  • Sexual dysfunction
  • Sleep disturbance
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19
Q

What is the cheese reaction?

A

Hypertensive crisis can develop when MAOI’s are taken with tyramine-rich foods or sympathomimetics

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20
Q

When can serotonin syndrome develop?

A

Serotonin Syndrome can develop if take MAOI with meds that increase serotonin or have sympathomimetic actions

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21
Q

What are the symptoms of serotonin syndrome?

A
  • Abdominal pain
  • Diarrhoea
  • Sweats
  • Tachycardia
  • HTN
  • Myoclonus
  • Irritability
  • Delirium
  • Can lead to hyperpyrexia, cardiovascular shock and death
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22
Q

How is serotonin syndrome avoided?

A

To avoid need to wait 2 weeks before switching from an SSRI to an MAOI. The exception of fluoxetine where need to wait 5 weeks because of long half-life.

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23
Q

What is the mechanism of SSRIs?

A

They block presynaptic serotonin reuptake

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24
Q

What are SSRIs used for?

A

Anxiety and depression symptoms

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25
Q

What side effects do SSRIs have?

A
  • GI upset
  • Sexual dysfunction
  • Anxiety
  • Restlessness
  • Nervousness
  • Insomnia
  • Fatigue or sedation
  • Dizziness
  • Cardiotoxicity (very little risk in overdose)
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26
Q

What are the symptoms of SSRI associated activation syndrome?

A
  • Nausea
  • Increased anxiety
  • Panic
  • Agitation
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27
Q

Why does activation syndrome occur with SSRIs?

A

Increase in serotonin

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28
Q

What are the symptoms of SSRI associated discontinuation syndrome?

A
  • Agitation
  • Nausea
  • Disequilibrium
  • Dysphoria
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29
Q

How long can SSRI associated activation syndrome last?

A

2-10 days

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30
Q

When is SSRI discontinuation syndrome more likely to occur?

A

More common with shorter half life drugs so consider switching to fluoxetine

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31
Q

What are the advantages of paroxetine?

A
  • Short half life with no active metabolite means no build-up (which is good if hypomania develops)
  • Sedating properties (dose at night) offers good initial relief from anxiety and insomnia
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32
Q

What type of drug is paroxetine?

A

SSRI

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33
Q

What are the disadvantages of paroxetine?

A
  • Sedating, wt gain, more anticholinergic effects

- Likely to cause a discontinuation syndrome

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34
Q

What type of drug is sertraline?

A

SSRI

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35
Q

What are the advantages of sertraline?

A
  • Very weak P450 interactions (only slight CYP2D6)
  • Short half life with lower build-up of metabolites
  • Less sedating when compared to paroxetine
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36
Q

What are the disadvantages of sertraline?

A
  • Max absorption requires a full stomach

- Increased number of GI adverse drug reactions

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37
Q

What type of drug is fluoxetine?

A

SSRI

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38
Q

What are the advantages of fluoxetine?

A
  • Long half-life so decreased incidence of discontinuation syndromes. Good for pts with medication noncompliance issues
  • Initially activating so may provide increased energy
  • Secondary to long half life, can give one 20mg tab to taper someone off SSRI when trying to prevent SSRI Discontinuation Syndrome
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39
Q

What are the disadvantages of fluoxetine?

A
  • Long half life and active metabolite may build up (e.g. not a good choice in patients with hepatic illness)
  • Significant P450 interactions so this may not be a good choice in pts already on a number of meds
  • Initial activation may increase anxiety and insomnia
  • More likely to induce mania than some of the other SSRIs
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40
Q

What type of drug is citalopram?

A

SSRI

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41
Q

What are the advantages of citalopram?

A
  • Low inhibition of P450 enzymes so fewer drug-drug interactions
  • Intermediate ½ life
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42
Q

What are the disadvantages of citalopram?

A
  • Dose-dependent QT interval prolongation with doses of 10-30mg daily- due to this risk doses of >40mg/day not recommended!
  • Can be sedating (has mild antagonism at H1 histamine receptor)
  • GI side effects (less than sertraline)
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43
Q

What type of drug is escitalopram?

A

SSRI

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44
Q

What are the advantages of escitalopram?

A
  • Low overall inhibition of P450s enzymes so fewer drug-drug interactions
  • Intermediate 1/2 life
  • More effective than Citalopram in acute response and remission
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45
Q

What are the disadvantages of escitalopram?

A
  • Dose-dependent QT interval prolongation with doses of 10-30mg daily
  • Nausea, headache
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46
Q

What type of drug is fluvoxamine?

A

SSRI

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47
Q

What are the advantages of fluvoxamine?

A
  • Shortest ½ life

- Found to possess some analgesic properties

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48
Q

What are the disadvantages of fluvoxamine?

A
  • Shortest ½ life
  • GI distress, headaches, sedation, weakness
  • Strong inhibitor of CYP1A2 and CYP2C19
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49
Q

What is the mechanism of SNRIs?

A

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

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50
Q

What are SNRIs used for?

A
  • Depression
  • Anxiety
  • Neuropathic pain
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51
Q

What type of drug is venlafaxine?

A

SNRI

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52
Q

What are the advantages of venlafaxine?

A
  • Minimal drug interactions and almost no P450 activity

- Short half life and fast renal clearance avoids build-up (good for geriatric populations)

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53
Q

What are the disadvantages of venlafaxine?

A
  • Can cause a 10-15 mmHG dose dependent increase in diastolic BP.
  • May cause significant nausea, primarily with immediate-release (IR) tabs
  • Can cause a bad discontinuation syndrome, and taper recommended after 2 weeks of administration
  • Noted to cause QT prolongation
  • Sexual side effects in >30%
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54
Q

What type of drug is duloxetine?

A

SNRI

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55
Q

What are the advantages of duloxetine?

A
  • Some data to suggest efficacy for the physical symptoms of depression
  • Thus far less BP increase as compared to venlafaxine, however this may change in time
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56
Q

What are the disadvantages of duloxetine?

A
  • CYP2D6 and CYP1A2 inhibitor
  • Cannot break capsule, as active ingredient not stable within the stomach
  • In pooled analysis had higher drop out rate
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57
Q

What type of drug is mirtazapine?

A

Novel antidepressant

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58
Q

What are the advantages of mirtazapine?

A
  • Different mechanism of action may provide a good augmentation strategy to SSRIs. Is a 5HT2 and 5HT3 receptor antagonist
  • Can be utilized as a hypnotic at lower doses secondary to antihistaminic effects
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59
Q

What are the disadvantages of mirtazapine?

A
  • Increases serum cholesterol by 20% in 15% of patients and triglycerides in 6% of patients
  • Very sedating at lower doses. At doses 30mg and above it can become activating and require change of administration time to the morning.
  • Associated with weight gain (particularly at doses below 45mg
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60
Q

What type of drug is buproprion?

A

Novel antidepressant

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61
Q

What are the advantages of burproprion?

A
  • Good for use as an augmenting agent
  • Mechanism of action likely reuptake inhibition of dopamine and norepinephrine
  • No weight gain, sexual side effects, sedation or cardiac interactions
  • Low induction of mania
  • Is a second line ADHD agent so consider if patient has a co-occurring diagnosis
62
Q

What are the disadvantages of buproprion?

A
  • May increase seizure risk at high doses (450mg+) and should avoid in patients with Traumatic Brain Injury, bulimia and anorexia.
  • Does not treat anxiety unlike many other antidepressants and can actually cause anxiety, agitation and insomnia
  • Has abuse potential because can induce psychotic sx at high doses
63
Q

What are the indications for mood stabilisers?

A
  • Bipolar
  • Cyclothymia
  • Schizoaffective
64
Q

What is the only medication to reduce suicide rate?

A

Lithium

65
Q

What is lithium effective for?

A

Effective in long-term prophylaxis of both mania and depressive episodes in 70+% of BAD I pts

66
Q

What factors predict a positive response to lithium?

A
  • Prior long-term response or family member with good response
  • Classic pure mania
  • Mania is followed by depression
67
Q

What should be done before starting lithium?

A
  • Get baseline U&E and TSH.
  • In women check a pregnancy test- during the first trimester is associated with Ebstein’s anomaly 1/1000 (20X greater risk than the general population)
68
Q

How should lithium use be monitored?

A
  • Steady state achieved after 5 days- check 12 hours after last dose.
  • Once stable check level 3 months and TSH and creatinine 6 months.
69
Q

What is the goal with lithium use?

A

Blood level between 0.6-1.2

70
Q

What are the side effects of lithium?

A
  • Most common are GI distress including reduced appetite, nausea/vomiting, diarrhoea
  • Thyroid abnormalities
  • Nonsignificant leukocytosis
  • Polyuria/polydypsia secondary to ADH antagonism. In a small number of patients can cause interstitial renal fibrosis.
  • Hair loss, acne
  • Reduces seizure threshold, cognitive slowing, intention tremor
71
Q

How does mild lithium toxicity present?

A

Levels 1.5-2

  • Vomiting
  • Diarrhoea
  • Ataxia
  • Dizziness
  • Slurred speech
  • Nystagmus
72
Q

How does moderate lithium toxicity present?

A

Levels 2-2.5

  • Nausea
  • Vomiting
  • Anorexia
  • Blurred vision
  • Clonic limb movements
  • Convulsions
  • Delirium
  • Syncope
73
Q

How does severe lithium toxicity present?

A

Levels >2.5

  • Generalised convulsions
  • Oliguria
  • Renal failure
74
Q

What type of drug is valproic acid (Depakote)?

A

Anticonvulsant

75
Q

What factors predict a positive response to valproic acid?

A
  • Rapid cycling patients (females>males)
  • Comorbid substance issues
  • Mixed patients
  • Patients with comorbid anxiety disorders
76
Q

How does valproic acid compare to lithium?

A
  • Valproic acid is as effective as Lithium in mania prophylaxis but is not as effective in depression prophylaxis.
  • Better tolerated than lithium
77
Q

What should be done before starting valproic acid?

A
  • Baseline LFTs
  • Pregnancy test
  • FBC
78
Q

Why should valproic acid be avoided in women of child bearing age?

A

Can cause neural tube defects

79
Q

How should valproic acid use be monitored?

A
  • Steady state achieved after 4-5 days

- Check 12 hours after last dose and repeat CBC and LFTs

80
Q

What is the goal of valproic acid use?

A

Target blood level 50-125

81
Q

What are the side effects of valproic acid?

A
  • Thrombocytopenia and platelet dysfunction
  • Nausea, vomiting, weight gain
  • Sedation, tremor
  • Increased risk of neural tube defect 1-2% vs 0.14-0.2% in general population secondary to reduction in folic acid
  • Hair loss
82
Q

What is the first line agent for acute mania and mania prophylaxis?

A

Carbamazepine

83
Q

What type of drug is carbamazepine (tegretol)?

A

Anticonvulsant

84
Q

What is carbamazepine indicated for?

A

Rapid cyclers and mixed patients

85
Q

What should be done before carbamazepine is started?

A
  • Baseline LFTs
  • FBC
  • ECG
86
Q

How should carbamazepine be monitored?

A
  • Steady state achieved after 5 days

- Check 12 hours after last dose and repeat CBC and LFTs

87
Q

What is the goal of carbamazepine used?

A

Blood levels 4-12mcg/ml

88
Q

Why should carbamazepine levels be checked after 1 month?

A

Need to check level and adjust dosing after around a month because induces own metabolism.

89
Q

What are the side effects of carbamazepine?

A
  • Rash- most common SE seen
  • Nausea, vomiting, diarrhoea
  • Sedation, dizziness, ataxia, confusion
  • AV conduction delays
  • Aplastic anaemia and agranulocytosis (<0.002%)
  • Water retention due to vasopressin-like effect which can result in hyponatremia
  • Drug-drug interactions!
90
Q

What type of drug is lamotrigine (lamictal)??

A

Anticonvulsant

91
Q

What are the indications for lamotrigine?

A
  • Mania

- Neuropathic/chronic pain

92
Q

What should be done before starting lamotrigine?

A

Baseline LFTs

93
Q

How should lamotrigine be initiated and titrated?

A
  • Start with 25 mg daily X 2 weeks then increase to 50mg X 2 weeks then increase to 100mg
  • Faster titration has a higher incidence of serious rash
94
Q

What happens if a patient stops taking their lamotrigine?

A

If the patient stops the med for 5 days or more have to start at 25mg again!

95
Q

What are the side effects of lamotrigine?

A
  • Nausea/vomiting
  • Sedation, dizziness, ataxia and confusion
  • TEN and Stevens Johnson’s syndrome
  • Blood dyscrasias (rare)
96
Q

What drugs can increase lamotrigine levels?

A
  • VPA (doubles concentration, so use slower dose titration),
  • Sertaline
97
Q

Why should lamotrigine be discontinued if ANY rash develops?

A
  • The character/severity of the rash is not a good predictor of severity of reaction
  • Therefore, if ANY rash develops, discontinue use immediately.
98
Q

What antipsychotic drugs are approved for use in bipolar disorder for mania?

A
  • Aripiprazole
  • Risperdone
  • Quetiapine
  • Quetiapine XR
  • Olanzipine
99
Q

What antipsychotic drugs are approved for use in bipolar disorder for mixed symptoms?

A
  • Aripiprazole
  • Risperdone
  • Olanzipine
100
Q

What antipsychotic drugs are approved for use in bipolar disorder for maintenance?

A
  • Aripiprazole
  • Quetiapine
  • Quetiapine XR
  • Olanzipine
101
Q

What antipsychotic drugs are approved for use in bipolar disorder for depression?

A

Quetiapine XR

102
Q

What are the indications for antipsychotic drug use in mod stabilisation?

A
  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder- for mood stabilization and/or when psychotic features are present
  • Psychotic depression
  • Augmenting agent in treatment resistant anxiety disorders
103
Q

What are the key pathways affected by dopamine in the brain?

A
  • Mesocortical
  • Mesolimbic
  • Nigrostriatal
  • Tuberoinfundibular
104
Q

Describe the mesocortical pathway and its role in mood disorders.

A
  • Projects from the ventral tegmentum (brain stem) to the cerebral cortex.
  • This pathway is felt to be where the negative symptoms and cognitive disorders (lack of executive function) arise.
  • Problem here for a psychotic patient, is too little dopamine.
105
Q

Describe the mesolimbic pathway and its role in mood disorders.

A
  • Projects from the dopaminergic cell bodies in the ventral tegmentum to the limbic system.
  • This pathway is where the positive symptoms come from (hallucinations, delusions, and thought disorders).
  • Problem here in a psychotic patient is there is too much dopamine.
106
Q

Describe the nigrostriatal pathway and its role in mood disorders.

A
  • Projects from the dopaminergic cell bodies in the substantia nigra to the basal ganglia.
  • This pathway is involved in movement regulation.
  • Remember that dopamine suppresses acetylcholine activity. -Dopamine hypoactivity can cause Parkinsonian movements i.e. rigidity, bradykinesia, tremors), akathisia and dystonia.
107
Q

Describe the tuberoinfundibular pathway and its role in mood disorders.

A
  • Projects from the hypothalamus to the anterior pituitary.
  • Remember that dopamine release inhibits/regulates prolactin release.
  • Blocking dopamine in this pathway will predispose your patient to hyperprolactinemia (gynecomastia/ galactorrhea/ decreased libido/ menstrual dysfunction).
108
Q

What is the mechanism of typical antipsychotics?

A

D2 dopamine receptor antagnoists

109
Q

Give examples of high potency typical antipsychotics.

A
  • Fluphenazine
  • Haloperidol
  • Pimozide
110
Q

Explain the effects of high potency typical antipsychotics.

A
  • High potency typical antipsychotics bind to the D2 receptor with high affinity.
  • As a result they have higher risk of extrapyramidal side effects
111
Q

Explain the effects of low potency typical antipsychotics.

A
  • Low potency typical antipsychotics have less affinity for the D2 receptors
  • They tend to interact with nondopaminergic receptors resulting in more cardiotoxic and anticholinergic adverse effects including sedation, hypotension
112
Q

Give examples of low potency typical antipsychotics.

A
  • Chlorpromazine

- Thioridazine

113
Q

What is the mechanism of atypical antipsychotics?

A

Serotonin-dopamine 2 antagonists (SDAs)

114
Q

In what way are atypical antipsychotics considered atypical?

A

They are considered atypical in the way they affect dopamine and serotonin neurotransmission in the four key dopamine pathways in the brain.

115
Q

What type of drug is risperidone (Risperdal)?

A

Atypical antipsychotic

116
Q

In what forms is risperidone available?

A
  • Regular tablet
  • IM depot forms
  • Rapidly dissolving tablet
117
Q

What are the side effects of risperidone?

A
  • Increased extrapyramidal side effects (dose dependent)
  • Most likely atypical to induce hyperprolactinemia
  • Weight gain and sedation (dosage dependent)
118
Q

How does the function of risperidone change at doses greater than 6mg?

A

Functions more like a typical antipsychotic at doses greater than 6mg

119
Q

What type of drug is olanzapine (Zyprexa)?

A

Atypical antipsychotic

120
Q

In what forms is olanzapine available?

A
  • Regular tablet
  • Immediate release IM
  • Rapidly dissolbing tab
  • Depo form
121
Q

What are the side effects of olanzapine?

A
  • Weight gain (can be as much as 30-50lbs with even short term use)-Hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain)
  • Hyperprolactinemia (< risperidone)
  • Abnormal LFT’s (2% of all patients)
122
Q

What type of drug is quetiapine (Seroquel)?

A

Atypical antipsychotic

123
Q

In what form is quetiapine available?

A

Regular tablet only

124
Q

What are the side effects of quetiapine?

A
  • Abnormal LFTs

- Weight gain (

125
Q

What type of drug is aripiprazole (abilify)?

A

Atypical aripiprazole

126
Q

In what forms if aripiprazole available?

A
  • Regular tablets
  • Immediate release IM formulation
  • Depo form
127
Q

What is the mechanism of ariprprazole?

A

Unique mechanism of action as a D2 partial agonist

128
Q

What are the possible interactions of ariprprazole?

A
  • CYP2D6 (fluoxetine and paroxetine), 3A4 (carbamazepine and ketoconazole) interactions that the manufacturer recommends adjusted dosing.
  • Could cause potential intolerability due to akathisia/activation.
129
Q

What is aripiprazole not associated with?

A
  • Weight gain

- QT prolongation

130
Q

What type of drug is clozapine (clozaril)?

A

Atypical antipsychotic

131
Q

What form is clozapine available in?

A

Regular tablet only

132
Q

Who is clozapine reserved for?

A

Treatment resistant patients because of side effect profile but this stuff works

133
Q

What are the side effects of clozapine?

A
  • Agranulocytosis
  • Increased risk of seizures
  • Sedation, weight gain abnormal LFTs
  • Increased risk of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, including nonketotic hyperosmolar coma and death with and/or without weight gain
134
Q

Due to its association with agranulocytosis, what should be done monitoring wise for clozapine use?

A

Requires weekly blood draws for 6 months then fortnightly for 6 months

135
Q

What is the commonest psychotic symptom?

A

Lack of insight

136
Q

What problem can psychosis present in terms of medication?

A
  • People with psychotic illnesses relapse most commonly due to non compliance
  • Only 30% of patients take medication as prescribed
137
Q

What should be considered after a 3rd episode of schizophrenia?

A
  • There is a clear link to reduced functioning, lower IQ and negative symptoms
  • Consider long acting IM
138
Q

Give examples of adverse effects of antipsychotics.

A
  • Tardive dyskinesia

- Neuroleptic malignant syndrome

139
Q

What is tardive dyskinesia?

A

-Involuntary muscle movements that may not resolve with drug

140
Q

How does neuroleptic malignant syndrome present?

A

Characterised by:

  • Severe muscle rigidity
  • Fever
  • Altered mental status
  • Autonomic instability
  • Elevated WBC, CPK and LFTs
  • Potentially fatal
141
Q

What extrapyramidal side effects are associated with antipsychotic use?

A
  • Acute dystonia
  • Parkinson syndrome
  • Akathisia
142
Q

What agents can be used for extrapyramidal symptoms?

A
  • Anticholinergics such as benztropine, trihexyphenidyl, diphenhydramine
  • Dopamine facilitators such as Amantadine
  • Beta-blockers such as propranolol
143
Q

What are anxiolytics used to treat?

A
  • Panic disorder
  • GAD
  • Substance-related disorders and their withdrawal
  • Insomnias
  • Parasomnias
144
Q

What treatment regime is common in anxiety disorders?

A

In anxiety disorders often use anxiolytics in combination with SSRIS or SNRIs for treatment.

145
Q

What type of drug is buspirone (buspar)?

A

Non-benzodiazepine anti-anxiety drug

146
Q

What are the advantages of buspirone?

A
  • Good augmentation strategy- Mechanism of action is 5HT1A agonist. It works independent of endogenous release of serotonin.
  • No sedation
147
Q

What are the disadvantages of buspirone?

A
  • Takes around 2 weeks before patients notice results.
  • Will not reduce anxiety in patients that are used to taking BZDs because there is no sedation effect to “take the edge off.
148
Q

What type of drug are benzodiazepines?

A

Anti-anxiety CNS depressants

149
Q

What are benzodiazapines used to treat?

A
  • Insomnia
  • Parasomnias
  • Anxiety disorder
  • Often used for CNS depressant withdrawal protocols ex. ETOH withdrawal
150
Q

What are the side effects of benzodiazapines?

A
  • Somnolence
  • Cognitive deficits
  • Amnesia
  • Disinhibition
  • Tolerance
  • Dependence
151
Q

How do you deal with treatment resistance with antidepressants?

A
  • Start with SSRI
  • Combine SSRI with SNRI
  • Adjunctive treatment with lithium
  • Adjunctive treatment with atypical antipsychotic
  • ECT
152
Q

What are the classes of mood stabiliser?

A
  • Lithium
  • Anticonvulsants
  • Antipsychotics

Systems: Psychiatry AB (18 decks)

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