Psychopharmacology

Question 1

What are the indications for antidepressants?

Answer 1

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders
OCD
Panic disorder
Social phobia
PTSD
Prementrual dysphoric disorder
Impulsivity associated with personality disorders

Question 2

What are the 4 main classes of antidepressants?

Answer 2

SSRIs 9selective serotonin reuptake inhibitor)
SNRIs (serotonin/noradrenaline reuptake inhibitors)
MAOIs (monoamine oxidase inhibitors)
TCAs (tricyclics)

Question 3

What is the side effect profile of tricyclics?

Answer 3

Antihistaminic
Anticholinergic
Antiadrenergic

Question 4

What are some of the complications of TCA prescription?

Answer 4

Lethal in overdose (even just a week)

Can cause QT lengthening even at a therapeutic serum level

Question 5

How many doses of a TCA do you need to take in order to overdose?

Answer 5

Even just a week can be lethal

Question 6

What is the side effect profile of MAOIs?

Answer 6

Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance

Question 7

What are some of the complications of MAOI prescription?

Answer 7

Hypertensive crisis can develop when MAOIs are taken with tyramine-rich foods or sympathomimetics (cheese reaction!)

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

Question 8

What are the symptoms of serotonin syndrome?

Answer 8

Abdominal pain
Diarrhoea
Sweats
Tachycardia
Hypertension
Myoclonus
Irritability
Delirium

Can lead to hyperpyrexia, cardiovascular shock and death

Question 9

How long do you need to wait before switching from an SSRI to a MAOI, and what happens if you don’t?

Answer 9

Need to wait 2 weeks before switching from an SSRI to a MAOI to avoid serotonin syndrome - exception in the case of fluoxetine, you need to wait 5 weeks because of its long half life