SSRIs

Question 1

side effects of SSRIs

Answer 1

GI symptoms (N&V, diarrhoea, constipation, stomach cramps, decreased appetite)
Headache
Weight changes
Sexual dysfunction

Question 2

SSRI of choice in children and adolescence

Answer 2

Fluoxetine

Question 3

follow up needed for anti-depressant therapy

Answer 3

patients should normally be reviewed by a doctor after 2 weeks.
For patients under the age of 25 years or at increased risk of suicide should be reviewed after 1 week

Question 4

when could you add an SSRI for OCD

Answer 4

more severe OCD, or if unresponsive to CBT/exposure and response prevention then add an SSRI

Question 5

adverse effects of SSRIs

Answer 5

risk of GI bleeding. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID
Hyponatraemia: thought to be secondary to SIADH

Question 6

mechanism of action of SSRIs

Answer 6

Increase serotonin activity by reducing pre-synaptic reuptake of serotonin, leading to downregulation of the postsynaptic receptors

Question 7

drug interactions of SSRIs

Answer 7

NSAIDs: if given co-prescribe a proton pump inhibitor
Warfarin / heparin: avoid SSRIs and considering mirtazapine
Aspirin: see above
Triptans: avoid SSRIs
Monoamine oxidase inhibitors (MAOIs) - risk of serotonin syndrome

any drugs which increase QTC shouldn’t be given at the same time as

Question 8

symptoms of discontinuation syndrome in SSRIs

Answer 8

Increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
Paraesthesia
Gastrointestinal symptoms

Question 9

SNRIs vs SSRIs

Answer 9

SSRIs tend to be more commonly prescribed than SNRIs because they are effective at improving mood and tend to be less likely than some SNRIs to cause side effects.