SSRIs and SNRIs Flashcards
What two SSRIs are currently the preferred treatments?
Citalopram
Fluoxetine
Which SSRI is safest post-MI
sertraline
SSRIs should be used with caution in children and adolescents. If an antidepressant is indicated, which SSRI should be used?
Fluoxetine is the drug of choice
Adverse effects of SSRIs
- most common = GI upset
- slight increased risk of GI bleed
- increase in anxiety for first 2 weeks after starting the drug
Which SSRIs interact with the most drugs?
fluoxetine and paroxetine
Which SSRI causes QT prolongation
citalopram
(dose dependent)
What is the maximum daily dose of citalopram?
40 mg for adults
20 mg for patients >65 years
20 mg for hepatic impairment
What drug classes interact with SSRIs?
NSAIDs
warfarin / heparin
aspirin
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
For how long should SSRIs be continued to reduce the risk of relapse?
at least 6 months after remission
> this reduces the risk of relapse
When stopping an SSRI, over how long should the dose be reduced?
- gradually reduced over a 4 week period
(not necessary with fluoxetine).
Discontinuation symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI upset: pain, cramping, diarrhoea, vomiting
paraesthesia
Which SSRI has a higher rate of discontinuation symptoms?
Paroxetine
Use of SSRIs in pregnancy involves a risk/benefit analysis. What complications can occur due to their use?
1st Trimester = small risk of congenital heart defects
3rd Trimester = persistent pulmonary hypertension of the newborn
Which SSRI has a higher risk of congenital malformations?
Paroxetine
Mechanism of action of SNRIs
Inhibits reuptake of serotonin and noradrenaline so these remain in the synaptic cleft
