SSRI's Flashcards
Give 4 examples of SSRIs
- Citalopram
- Fluoxetine
- Paroxetine
- Sertraline
How do SSRIs work?
Selectively inhibit serotonin re-uptake in the synaptic cleft to increase its action
Why is serotonin action increase helpful in depression?
It is strongly involved in mood regulation and low levels have been seen in depression
How are SSRIs administered?
PO
What are SSRI’s first line treatment for?
Depression
What is another indication of SSRIs?
GAD
What are the specific indications for fluoxetine?
- Childhood depression
- Bulimia nervosa
What is a specific indication for citalopram?
Panic disorder
What is a specific indication for sertraline?
Obsessive-compulsive disorder
What specific risk is fluoxetine associated with?
Increased risk of self-harm and suicidal ideation
When are SSRIs contraindicated?
- Pregnancy
- Poorly controlled epilepsy
- During mania
When should caution be used with SSRIs?
- Epilepsy
- Cardiac disease
- Diabetes
- ECT
- Acute angle-closure glaucoma
- History of bleeding disorders
What can SSRIs interact with?
- Alcohol
- NSAIDs
- Aspirin
- Anti-epileptics
- Theophylline
- Monoamine oxidase inhibitors
- Tramadol
- St Johns Wort
- Grapefruit (sertraline)
How can SSRIs interact with alcohol?
Increase sedation
How can SSRIs interact with NSAIDs and aspirin?
Increased risk of bleeding
How can SSRIs interact with anti-epileptics?
Reduce the seizure threshold
When should MAOIs be started after stopping SSRI?
A week after (5 for fluoxetine)
When should SSRIs be started after stopping a MAOI?
2 weeks after
How can SSRIs interact with tramadol and St John’s Wort?
Increased risk of serotonin discontinuation syndrome
What monitoring should patients on SSRIs receive?
- Improvement of symptoms check every 1-2 weeks for first 6 weeks
- Ask about suicide and self-harm
After how long of no results should SSRI be switched?
1 month (6 weeks in elderly)
How long should patients be left at the same dose following remission?
6-12 months
What should be given to patients after cessation of treatment with anti-depressants?
Follow-up appointment
What are the common side-effects of SSRIs?
- GI upset
- Nausea
- Hyponatraemia
- Dry mouth
- Sexual dysfunction
- Anorexia and weight loss
What are the rarer side-effects of SSRIs?
- Increased bleeding risk
- Suicidal ideation
- Convulsions
- QT interval prolongation
- Serotonin syndrome
- SSRI discontinuation syndrome
What causes serotonin syndrome?
Increased serotonin activity
Which SSRI most commonly causes SSRI discontinuation syndrome?
Paroxetine
What mnemonic can help to remember the side-effects of SSRIs?
SSRIS
What does SSRIS mnemonic stand for?
- Sore tummy
- Sexual dysfunction
- Reduced weight/salivation
- Increased bleeding risk
- Serotonin toxicity
What counselling should a patient starting SSRIs receive?
- Mode of action
- Side-effects
- Lifestyle measures
- Onset and compliance
- Duration
- Withdrawal
- Switching
- Serotonin syndrome
- Signs of SSRI discontinuation syndrome
What is it important to say about side-effects of SSRIs?
They are mostly mild and often transient
What lifestyle measures may help to improve the action of SSRIs?
- Healthy diet
- Regular exercise
- Adequate sleep
What is important to tell patients about the onset and compliance with SSRIs?
Onset may take several weeks so is important to persist with the treatment
What should patients on SSRIs be told about the duration?
They may need to take for some time after episode has resolved
What should patients be told about withdrawal from SSRIs?
Withdrawal must be done slowly to avoid side-effects
What information should be given to patients wishing to switch from an SSRI to another anti-depressant?
May need time in between
What signs of serotonin syndrome should the patient starting an SSRI be told about?
- Agitation
- Confusion
- Nystagmus
- Myoclonus
- Tremor
- Seizures
- Autonomic instability
What advice should patients be given if they experience symptoms of serotonin syndrome?
Seek urgent medical help
What are the symptoms of SSRI discontinuation syndrome?
- Headache
- Paraesthesia
- Shock sensations
- GI upset
- Lethargy
- Insomnia
- Mood changes
