CNS - Depression & Bipolar - INTRO - SSRIs
44 important questions on CNS - Depression & Bipolar - INTRO - SSRIs
What happens to the response to decreased dose of SSRI in discontinuation syndrome and adverse effects?
- Discontinuation syndrome: Usually worsens.
- Adverse effects: Usually worsens.
What are the clinical features of discontinuation syndrome?
- Dizziness
- Nausea
- Anxiety
- Headache (most common symptoms)
How is depression characterized in response to decreased dose of SSRI?
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What is the daily oral dose range for Citalopram and its effects?
- Citalopram: 20-40 mg
- Insomnia: ++
- Sexual dysfunction: +++
- Agitation: +
- GIT effects: ++
- Weight gain: 0
Describe the context in which adverse effects occur.
- Mostly in the first 1-2 weeks of treatment
- Mostly settle if medication continued
- Check not a drug interaction +TCA, stop TCA
What is the response to decreased dose of SSRI in serotonin syndrome?
What adverse effects may occur in some patients taking SSRIs?
Describe the adverse effects of Fluoxetine.
- Fluoxetine: 20-40 mg
- Insomnia: ++
- Sexual dysfunction: +++
- Agitation: ++
- GIT effects: ++
- Weight gain: 0
What are the clinical features of serotonin syndrome?
- Abdominal cramps
- Agitation
- Myoclonus
- Tremulousness
- Hypo/hypertension
- Confusion
- Disorientation
- Hyperpyrexia
- Sweating
What should be done if symptoms persist despite intervention in discontinuation syndrome and adverse effects?
- Discontinuation syndrome: Seek a psychiatric second opinion.
- Adverse effects: Seek a psychiatric second opinion.
What are some adverse effects of SSRIs?
- Nausea
- Nervousness
- Agitation
- Diarrhoea
- Constipation
- Headache
- Insomnia
What type of sexual dysfunction may occur with SSRIs?
How is the response to discontinuation syndrome usually relieved?
- Usually relieved by increased SSRI dose
What are the adverse effects associated with Fluvoxamine?
- Fluvoxamine: 100-200 mg
- Insomnia: +
- Sexual dysfunction: +++
- Agitation: +
- GIT effects: ++
- Weight gain: 0
What is the recommended action for persistent symptoms in depression and serotonin syndrome?
- Depression: Seek a psychiatric second opinion.
- Serotonin syndrome: Urgent referral to an emergency department.
How do SSRIs interact with alcohol and psychomotor functions?
What are the characteristics of Sertraline as a newer SSRI?
- Undergoes significant first pass metabolism.
- Its metabolite is only weakly pharmacologically active.
- Eliminated by liver metabolism.
- Steady state after 1 week after commencement of treatment.
What is the context for serotonin syndrome?
- Over dosage
- Drug interaction, especially SSRI+MAOI/SSRI+TCA
- Inadequate drug free interval in changing medication
What is a characteristic of Paroxetine regarding metabolism?
What are the cardiovascular effects and lethality in overdose of SSRIs?
What is the daily oral dose range for Sertraline and its effects?
- Sertraline: 50-100 mg
- Insomnia: ++
- Sexual dysfunction: +++
- Agitation: ++
- GIT effects: ++
- Weight gain: 0
What happens in the context of depression regarding treatment?
- Continuation/worsening of initial illness
- Patient relapse with continued TXT
- Some improve with dose increase, some need change of medication
What is the initial dose for major depression in adults and how can it be adjusted?
- Initial dose: 20 mg once daily.
- Increase after 3–4 weeks if necessary.
- Maximum: 60 mg once daily.
- Elderly usual max: 40 mg once daily, 60 mg can be used.
How is Paroxetine eliminated from the body?
What is the response to depression in terms of treatment change?
- No acute change except possible adverse events
What type of drug is Fluoxetine and how is it absorbed?
What is the dosage recommendation for children aged 8-18 with major depression?
- Initial dose: 10 mg once daily.
- Increase after 1–2 weeks if necessary.
- Maximum: 20 mg once daily.
What is the response to serotonin syndrome?
- Worsens - could be dangerous
What is the recommended fluoxetine dose for adults with bulimia nervosa?
- Adults over 18 years: 60 mg once daily.
What is the elimination half-life of Citalopram?
How is Fluoxetine metabolized and what is its half-life?
How can antidepressants be classified based on tolerability and safety margin?
What is a characteristic of Fluvoxamine regarding its metabolites?
What is the dosage for adults with obsessive-compulsive disorder?
- Adults over 18 years: 20 mg once daily.
What is a necessary condition for the antidepressant activity of SSRIs, but not sufficient in itself?
What are the side effects of fluoxetine?
- Sexual dysfunction
- Nausea
- Vomiting
What are some examples of Selective Serotonin Reuptake Inhibitors (SSRIs)?
How do SSRIs differ in terms of their pharmacological profiles?
What kind of affinity do SSRIs have for certain receptors?
What effect does citalopram have that might account for its slightly sedative action?
Why was Zimelidine, the first SSRI in Europe, withdrawn?
What effect does sertraline have that may contribute to its alerting effects?
What is the affinity of SSRIs for the serotonin transporter?
How do SSRIs affect other neurotransmitter systems?
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