SSRI Flashcards
SSRI - indications 3
- First-line treatment for moderate-to-severe depression
- Panic disorder
- Obsessive-compulsive disorder
SSRI - MOA
- SSRIs preferentially INHIBIT the re-uptake of serotonin
- This increases the amount of serotonin available for neurotransmission
- This therefore improves symptoms associated with depression, panic disorders and OCD
SSRI - Adverse effects
- GI upset (nausea/vomiting)
- Change in appetite and weight (loss or gain)
- Hyponatraemia
- Sexual dysfunction
- At high dose or in comination with other serotonergic drugs can result in serotonin syndrome
- increased risk of bleeding
SSRI - examples
Citalopram
Fluoxetine
Sertraline
In the treatment of depression - when is sertraline preferentially used?
In patients with chronic health conditions - this is due to sertraline having less drug interactions
SSRIs can result in hyponatraemia:
- Who is this more common in?
- How does it present?
- What should you do in these circumstances?
- Elderly
- Suspect if patient has dizziness, drowsiness, confusion, nausea, muscle cramps, seizures
- If suspected - stop antidepressants and manage hyponatraemia
SSRI - what should you closely monitor when starting patients on SSRIs? And what should you therefore safety net the patient about?
SUICIDAL THOUGHTS
Small risk of suicidal ideation +/- intent but patients at higher risk of suicide should be monitored closely, especially at the beginning of treatment OR if the dose is changed
When starting/changing medications warn patient about worsening symptoms and to seek help immediately if needed
When should you review patients after initating SSRIs?
INITIAL REVIEW
- for most patients review within 2 weeks of starting SSRI
- for patients at an increased risk of suicide OR <30 yrs arrange review within 1 week instead
AFTER INITIAL REVIEW
- review regularly (every 2-4 weeks for a few months) and then adjust reviews based on response to treatment
- if response absent/minimal after 3-4 weeks, consider increasing dose or swapping
What method is usually used when switching SSRIs? And why?
When changing medication cross-tapering is preferred in order to avoid abrupt withdrawal - cross-tapering is when you gradually taper off the first drug while you increase the dose of the second drug over a period of a few weeks (usually 4 weeks)
What are examples of withdrawal symptoms that patients may experience if they abruptly stop their SSRIs? Therefore, what needs to be advised to patients
Withdrawal symptoms may include - flu-like illness, insomnia, imbalance, hyperactivity
Even if you start feeling better do not suddenly stop taking the medication
How long do SSRIs usually take to work to treat depression and how long do patients need to keep taking them?
Once you start taking the medication it usually takes 4-6 weeks to fully work but you should start to feel better after 1-2 weeks
Antidepressants should be continued for at least 6 months after remission of depression – this greatly reduces the risk of relapse of depression
What is serotonin syndrome?
Serotonin syndrome is an uncommon, but potentially serious, set of side effects linked to SSRIs and SNRIs.
Serotonin syndrome occurs when the levels of a chemical called serotonin in your brain become too high. It’s usually triggered when you take an SSRI or SNRI in combination with another medicine (or substance) that also raises serotonin levels, such as another antidepressant or St John’s wort.
Symptoms include:
- confusion
- agitation
- muscle twitching
- sweating
- shivering
- diarrhoea
- arrhythmia, seizures, unconscious (if severe)
DANGEROUS - CALL 999
SSRIs can commonly result in sexual dysfunction - what are some signs or this and what are treatment options?
Decreased libido, erectile dysfunction, delayed orgasm, impaired ejaculations
Tx options include
- Watchful waiting
- reduce dose
- drug holiday
- switching antidepressants
- use of PDEi such as sildenafil for erectile dysfunction
SSRI - who do we need to give these to with cautions
- epilepsy
- peptic ulcer disease
- young people
- hepatic impairment
SSRI - interactions (completely avoid)
- MAO inhibitors and other serotinergic drugs (due to increased risk of serotonin syndrome)
