SSRIs Flashcards
MoA
Selectively inhibit the reuptake of 5-HT from the synaptic cleft
Commonly used SSRIs
Sertraline
Fluoxetine
Fluoxetine
Which SSRI is safe in stable angina + MI
Sertraline
Which antidepressant in licensed for children?
Fluoxetine
Which SSRIs cause QT prolongation
Citalopram
Escitalopram
Which SSRI has higher risk of withdrawal reactions?
Paroxetine
Other SSRIs
Escitalopram
Fluvoxamine
Paroxetine
Benefit of SSRIs over TCAs
SAC
Less sedating, antimuscarinic and cardiotoxic
Side effects - SSRIs
GASH
GI disturbances (nausea, vomiting, diarrhoea)
Appetite or weight disturbance (gain or loss)
Serotonin syndrome
Hypersensitivity reactions (stop if reactions occur)
Other side effects
Bleeding risk increased
QT interval prolongation (citalopram/escitalopram)
Seizure threshold lowered
Movement disorders + dyskinesia
Overdose
N + V
Agitation
Tremor
Nystagmus
Drowsiness
Sinus tachycardia
Convulsion
Interactions - increased plasma concentrations
Grapefruit juice (enzyme inhibitor)
Interactions - increased risk of bleeding
NSAIDs/Aspirin (GI bleeding)
Anticoagulant
Antiplatelets e.g. warfarin
Interactions - increased risk of QT prolongations
Erythromycin (macrolides)
TCAs
Sotalol
Amiodarone
Chloroquine
Mefloquine
Lithium
Quinine
Antipyschotics
Interactions - increased risk of QT prolongation due to hypokalaemia
These cause hypokalaemia, which in turn can lead to QT prolongation increases risk of torsade de pointes
- Theophylline
- Beta 2 agonists
- Loop/thiazide diuretics
- Corticosteroids
Interactions - increased risk of hyponatraemia
Diuretics - loop/thiazides
Desmopressin
Carbamazepine
NSAIDs
Interactions - increased risk of serotonergic effects/serotonin syndrome
St. Johns wort (serotonergic antidepressant)
Amfetamines
Sumatriptan (5-HT1a agonist)
Selegiline (MAO-B inhibitor)
Tramadol (opioid that also inhibits reuptake of 5-HT + NA)
TCAs/MAOIs (serotonergic drugs)
Ondansetron (5-HT3 antagonists)
Under 18s
Citalopram, escitalopram, paroxetine, sertraline, mirtazapine + venlafaxine are NOT recommended in under 18s.
ONLY fluoxetine effective in children + adolescents.
Monitor carefully for suicidal behaviour, self-harm or hostility esp @ the start.
Cautions
- Epilepsy (poorly controlled/if seizures develop = discontinue)
- Cardiac disease
- Diabetes
- Susceptibility to angle-closure glaucoma
- History of mania
- Bleeding disorders
Overdose (poisoning)
N + V
Agitation
Tremor
Nystagmus
Drowsiness
Sinus tachycardia
Treatment cessation
GI disturbances
Headache
Anxiety
Electric shock sensation in head, neck + spine
Tinnitus
Sleep disturbances
Fatigue
Flu-like symptoms
Sweating
Palpitations + visual disturbances (less common)
