This document summarizes various antidepressant medications. It lists 8 classes of antidepressants including SSRIs, SNRIs, NDRIs, TCAs, MAOIs, NASSAs, SARIs and others. For each class, it provides examples of medications, their indications for use, dosing and common side effects. It also describes serotonin syndrome, antidepressant discontinuation syndrome, and tyramine induced hypertensive crisis.
This document summarizes various antidepressant medications. It lists 8 classes of antidepressants including SSRIs, SNRIs, NDRIs, TCAs, MAOIs, NASSAs, SARIs and others. For each class, it provides examples of medications, their indications for use, dosing and common side effects. It also describes serotonin syndrome, antidepressant discontinuation syndrome, and tyramine induced hypertensive crisis.
This document summarizes various antidepressant medications. It lists 8 classes of antidepressants including SSRIs, SNRIs, NDRIs, TCAs, MAOIs, NASSAs, SARIs and others. For each class, it provides examples of medications, their indications for use, dosing and common side effects. It also describes serotonin syndrome, antidepressant discontinuation syndrome, and tyramine induced hypertensive crisis.
This document summarizes various antidepressant medications. It lists 8 classes of antidepressants including SSRIs, SNRIs, NDRIs, TCAs, MAOIs, NASSAs, SARIs and others. For each class, it provides examples of medications, their indications for use, dosing and common side effects. It also describes serotonin syndrome, antidepressant discontinuation syndrome, and tyramine induced hypertensive crisis.
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Antidepressants
class dose indication 1. Selective Serotonin Reuptake inhibitors (SSRIs) Fluoxetine 20-60mg po mane
1st line for MDD
Paroxetine 20-50mg po mane Citalopram 20-40mg po mane Escitalopram 10-20mg po mane Sertraline 50-200mg po mane Fluvoxamine 50-150mg po bd 2. Serotonin and noradrenaline reuptake inhibitors (SNRI) Venlafaxine 75-300mg po mane
to check for imparired liver fx since metabolized. Then 6 monthly to check for fatal hepatotoxicity (paeds) bHCG Pelvic sonar LFT (impaired liver fx, hepatitis) UKE (hypoNa+, SIADH FBC (BM) bHCG
lamotrigine
3. Atypical Olanzapine
tube Interfere with other drug metabolism Dizziness, ataxia Blurred vision, diplopia Headache Sedation N/V SJS ( if rash develops, stop immediately)
Starting: 25mg po nocte titrate: 25mg / 2 weekly (decreased SJS) maintain: 100-200mg po nocte
1st line BP depression
effective Rx depressive ep TOC px depressive ep Effective px manic ep NOT rx manic ep ? rapid cycling & mixed
10-20mg po nocte
Effective:
Manic ep
Px manic ep
Rx depressive NOT effective Px depressive ep Consider cycling/mixed
severe MS, sedation,
dizziness, dry mouth, constipation, dyspepsia, akathasia MS, severe sedation, dizziness, postural hypotension Headache, sedation, akathasia, agitation, anxiety, nausea, dyspepsia, NOT MS
Quetiapine
300-800mg po nocte
Aripiprazole
10-30mg po nocte
fasting glucose + lipogram, BP, waist circumference, weight: baseline 1month 6 monthly more regular for olanzapine if sings of metabolic sd (MS)
SEROTONIN SYNDROME
Medical emergency potentially fatal
Raised plasma serotonin concentrations secondary to co-administration of antidepressants
Usually: SSRI + MAOI/lithium
Sx appear in specific order as condition worsens
o Diarrhoea o Restlessness o Extreme agitation, hyperreflexia, autonomic instability o Myoclonus, seizures, hyperthermia, uncontrollable shivering, rigidity o Delirium, coma, status epilepticus, cardiovascular collapse, death
Rx o Transfer to ICU o Stop causative drug o Supportive care + cooling blanket o Nitroglycerin, cyproheptadine, chlorpromazine, dantrolene, BZ, anticonvulsants o Muscle relaxant + mechanical ventilation ANTIDEPRESSNAT DISCONTINUATION SYNDORME
Can occur following abrupt discontinuation of antidepressants
Commonly SSRIs and medication with short t1/2 (e.g. paroxetine)
Sx o Dizziness, weakness, nausea o Rebound depression, anxiety, insomnia, poor concentration o Headache, migraine like sx, paraesthesias o Upper respiratory sx o Usualy appear about 6 weeks after antidepressant discontinuation o Usually resolve spontaneously after 3 weeks
Prevention o Taper slowly before discontinuation
Rx o Restart medication at appropriate dose > taper > discontinue o If patient was on SSRI, start fluoxetine (because long half life) > taper > stop slowly to minimize chance of sd o Rx symptomatically TYRAMINE INDUCED caused by intake of tyramine containing foods whilst on medication
