SSRIs Flashcards
Citalopram indication
MDD
Citalopram serious side effects
QTc prolongation, Torsades (these are dose-dependent)
Escitalopram indications
MDD, GAD
Can escitalopram be used in peds patients?
Yes
Is escitalopram labeled with the same QTc warning as citalopram?
No
Fluvoxamine indication
OCD
Fluvoxamine and the elderly
Use with caution because it’s one of the most sedating and can be anticholinergic
Fluoxetine indications
MDD, OCD, panic disorder, PMDD, bulimia, BPD depressive episodes
Fluoxetine side effects
Anorexia, anxiety, insomnia
Can fluoxetine be used in peds patients?
Yes
What enzymes does fluoxetine inhibit?
2D6, 3A4
Paroxetine indications
MDD, GAD, OCD, panic disorder, PTSD, PMDD, SAD
What population should you avoid using paroxetine in?
PREGNANCY
Paroxetine side effects to watch out for in the elderly
Sedating and anticholinergic effects
Other paroxetine side effects
Akathisia, bone fracture
Paroxetine has a ___half-life.
Short
Sertraline indications
MDD, OCD, panic disorder, PTSD, PMDD, SAD
Are SSRIs more likely to be energy-boosting or sedating?
Energy-boosting
What should you watch out for in all SSRIs?
Discontinuation syndrome, abnormal bleeding, SIADH, serotonin syndrome, potential cognitive and motor impairment
Discontinuation syndrome symptoms
FINISH:
flu-like symptoms
insomnia
nausea
imbalance
sensory disturbances
hyperarousal
Exception to discontinuation syndrome
Fluoxetine, because it has a long half-life
What happens when D/C’ing an SSRI
Taper the dose!
Patient education on SSRIs
Treat first depressive episode for 6-12 months minimum, but it takes about 2-4 weeks minimum to see symptom resolution
Insomnia, HA, initial anxiety also possible when starting- use lower doses and titrate slowly
What happens if a patient experiences insomnia or sedation on an SSRI?
have them take the dose in the morning or at night or switch to a med that doesn’t cause as much insomnia
What happens if a patient experience sexual dysfunction on an SSRI?
Switch to bupropion or another agent
Serotonin syndrome symptoms
mental status changes, autonomic instability, neuromuscular abnormality, GI symptoms
How to avoid serotonin syndrome
Avoid serotonergic drugs, triptan migraine agents, pain meds (fentanyl and tramadol), nausea products (Zofran and Reglan), buspirone, linezolid, ritonavir, any drugs that impair serotonin metabolism
Patients on SSRI and NSAID, antiplatelet, and/or anticoagulant
Increased risk of bleeding
SSRIs and hepatic impairment
Use with caution or modify the dose
