[ Psychiatric ] Mood disorders 2

Normal bereavement – duration

Usually less than 6 months.

SSRIs – examples

Fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine.

SSRIs – mechanism and onset

Inhibit 5-HT reuptake, take 4 to 8 weeks to work.

SSRIs – most common side effects

GI upset (nausea, vomiting, diarrhea) and headache.

SSRIs – rare dangerous side effects

SIADH (hyponatremia causing lethargy and muscle weakness), QT prolongation, and serotonin syndrome.

SSRIs – common sexual side effects

Decreased libido, anorgasmia, and erectile dysfunction.

SSRIs – use in sexual medicine

Treatment of premature ejaculation.

Paroxetine – pregnancy

Avoid, due to cardiac defects.

Antidepressant discontinuation syndrome – cause and features

Abrupt discontinuation causing nausea, insomnia, and sensory disturbance, can occur with any antidepressant but most common with SSRIs.

Antidepressant discontinuation syndrome – treatment

Retake the drug and taper slowly.

SNRIs – examples

Venlafaxine, desvenlafaxine, duloxetine, and milnacipran.

SNRIs – onset and special use

Take 4 to 8 weeks to work, used for neuropathic pain (DM neuropathy).

SNRIs – distinctive side effect

Increased blood pressure.

Nonselective MAOIs (PIT)

Phenelzine, isocarboxazid, and tranylcypromine.

Selective MAO-B inhibitors – drugs and use

Selegiline and rasagiline, increase dopamine, used for Parkinson disease.

MAOIs – best depression indication

Atypical depression.

MAOIs – side effects

Weight gain, orthostatic hypotension, sexual side effects, and serotonin syndrome.

MAOI cheese effect

Hypertensive crisis after tyramine ingestion (cheese, processed meats, beer or wine), with very high BP, sweating, tachycardia, and tremor.

TCAs – tertiary amine example

Amitriptyline.

Clomipramine – indication

OCD.