SSRIs

Question 1

What are the adverse effects of SSRIs?

Answer 1

• Gastric disturbance (most common)
• Increased risk of GI bleed (if using NSAIDs a PPI should be co-prescribed)
• Mood changes (gets worse before better)
• Prolonged QT interval (Citalopram)
• Fluoxetine and Paroxetine have a higher risk of drug interactions

Question 2

What problems can SSRIs cause in pregnancy?

Answer 2

1st trimester - Congenital heart defects (e.g. Ebstein’s anomaly)

3rd trimester - Persistent pulmonary hypertension

Most risky = PAROXETINE

Question 3

What are the discontinuation symptoms for SSRIs?

Answer 3

• Increased mood changes
• Restlessness
• Difficulty sleeping
• Unsteadiness
• Sweating
• GI symptoms
• Paraesthesia

Question 4

What medications commonly interact with SSRIs?

Answer 4

• NSAIDs
• Warfarin
• Aspirin (like NSAIDs, increased risk of bleeding)
• Triptans (SEROTONIN syndrome)
• MAOIs (SEROTONIN syndrome)

Question 5

What are the symptoms of Serotonin Syndrome?

Answer 5

Caused by too much serotonin due to use of serotonergic medication

• HTN/High HR
• High temperature
• Agitation/increased reflexes
• Tremors/Seizures
• Sweating
• Extensive muscle breakdown

Question 6

How long should an SSRI be stopped for?

Answer 6

Over the course of 4 weeks

Not necessary with Fluoxetine

Question 7

When should a patient be monitored after starting antidepressant therapy?

Answer 7

Reviewed in the first 2 weeks unless:

• Under 30
• High risk of suicide which will be the first week

Should be continued for at least 6 months - if good response to reduce risk of relapse

Question 8

What are the indications and side effects of ECT?

Answer 8

Indications: Catatonia, severe depression

Side Effects (short term):

• Cardiac arrhythmias
• Headaches
• Short term memory loss
• Nausea

Side Effects (long term):
- Impaired memory