SSRIs and FDA Warnings on Antidepressants

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Questions and Answers

What is a primary side effect of mirtazapine?

Insomnia

Sedation (correct)

Decreased appetite

Increased anxiety

Which of the following is NOT an indication for tricyclic antidepressants?

Depression

Acute kidney injury (correct)

Panic disorder

Chronic pain syndrome

For treating sleep onset insomnia, which medication is the most appropriate choice?

Zolpidem extended release

Temazepam

Zaleplon (correct)

Ramelteon

What is the recommended dosing adjustment for anxiolytics in elderly patients with sleep impairment?

Decrease the dose Signup and view all the answers

Which of these medications binds to GABAa receptors?

Zolpidem Signup and view all the answers

Which of the following is a potential adverse effect associated with melatonin receptor agonists?

Abnormal dreams Signup and view all the answers

What is a known side effect of using medications designed to help with sleep?

Suicidal ideation Signup and view all the answers

What mechanism does zolpidem primarily utilize for its effects?

Binding to GABAa receptors Signup and view all the answers

What is the primary mechanism of action of SSRIs?

Inhibit the reuptake of serotonin Signup and view all the answers

Which SSRI was the first to be approved in the USA for treating depression?

Fluoxetine Signup and view all the answers

What is the typical onset of action for SSRIs?

2 weeks to 12 weeks for maximum benefit Signup and view all the answers

Among the following, which is not an indication for SSRIs?

Migraine headaches Signup and view all the answers

Which herb is known to interact with SSRIs and increase the risk of serotonin syndrome?

Gingko Biloba Signup and view all the answers

Which of the following adverse effects is associated with 5-alpha reductase inhibitors?

Decreased libido Signup and view all the answers

What is one of the mechanisms by which GnRH analogs disrupt hormonal function?

Inhibit luteinizing hormone release Signup and view all the answers

During which time frame should patients be closely monitored after initiating SSRI treatment?

First 2-3 weeks Signup and view all the answers

Which of the following SSRIs is only indicated for obsessive-compulsive disorder (OCD) in the USA?

Fluvoxamine Signup and view all the answers

Which contraceptive method is considered safe for use while breastfeeding?

Hormonal IUD Signup and view all the answers

What common side effect may occur at higher dosages of SNRIs, which is not typically associated with SSRIs?

Hypertension Signup and view all the answers

What is the primary action of mifepristone in pregnancy termination?

Inhibits progesterone necessary for pregnancy Signup and view all the answers

What advantage does the use of raloxifene offer for postmenopausal women?

Prevention of osteoporosis Signup and view all the answers

Which of the following is a key effect of PGE₂ on the body?

Sensitizes nerve endings to pain stimuli Signup and view all the answers

Which estrogen is considered to have the best efficacy when taken orally?

Estradiol Signup and view all the answers

Which of the following medications is commonly prescribed for benign prostatic hyperplasia (BPH)?

Dutasteride Signup and view all the answers

Study Notes

FDA Warnings on Antidepressants

All antidepressants carry increased risk of suicidal thoughts and behavior, especially in children, adolescents, and young adults (up to 24 years of age) during the first two months of treatment.
Depression and psychiatric illness are risk factors.

SSRI Medications

Specific Medications: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline
Fluoxetine: First in the USA to be approved for depression; inhibits CYP450
Fluvoxamine: Approved for OCD in the USA; inhibits CYP450
Paroxetine: Inhibits CYP450
Monitoring: Closely monitor patients for the first 2-3 weeks after starting treatment for suicidal ideation.

Herbs Interacting with SSRIs

Ginkgo Biloba
St. John's Wort
Garcinia cambogia (HCA)
L-tryptophan (or 5-HTP)
SAMe (S-adenosyl-methionine) supplements
These can increase the risk of serotonin syndrome.

Onset and Mechanism of Action of SSRIs

Onset: Two weeks to 12 weeks for maximum benefit; half-life of 16-36 hours
Mechanism: Block the reuptake of serotonin, increasing its concentration in the synaptic cleft. This prevents serotonin from being reabsorbed by the presynaptic nerve, increasing availability and potentially improving mood
More serotonin is available to bind with the postsynaptic receptors, which triggers the next action potential.

Indications for SSRI

Depression
Anxiety
Fluvoxamine is not indicated for anxiety.

Other Medications

SNRIs: Desvenlafaxine, Duloxetine, Levomilnacipran, Venlafaxine.
MOA of Desvenlafaxine: Block the reuptake of serotonin and norepinephrine: degree of this block depends on dosage.
Side effects: Common side effects for SNRIs like Venlafaxine and Duloxetine include CNS effects, nausea, constipation, dry mouth and sexual side effects.
Tricyclic antidepressants: Imipramine, Trimipramine, Nortriptyline, Doxepin, Desipramine, Amitriptyline, Clomipramine, Protriptyline, Amoxapine.
Indications: Depression, panic disorder, preventing migraine, treating chronic pain syndrome.
Mirtazapine: An atypical antidepressant: side effects include sedation, increased appetite, and weight gain.

Anxiolytics

Some medications used for anxiety (like Zoloft) also treat depression.

Sleep Aids

Zolpidem, triazolam, ramelteon, temazepam, eszopiclone - short-acting medications for sleep onset insomnia.
Zolpidem extended release, eszopiclone, temazepam, lorazepam, eszopiclone, low dose doxepin, suvorexant - longer-acting medications for sleep maintenance insomnia.

Pain Medications

Gabapentin/Pregabalin: Anticonvulsants used for neuropathic pain,
Carbamazepine: First-line therapy for trigeminal neuralgia; prevents repeated nerve discharges
Ketamine: Can reduce NMDA receptor firing, used to treat chronic opioid use
Lidocaine: Topical anesthetic that blocks nerve impulses in localized neuropathic pain.
Capsaicin cream: Repeated application depletes substance P in neurons for chronic pain relief.

Other Medications and Substances

Lamotrigine, topiramate, valproic acid, ethosuximide: Antiepileptics
COX-2 inhibitors: Used for pain but have potential side effects
Opioids: Used for moderate to severe pain
NSAIDs: For mild to moderate pain, inflammation, strains
Melatonin receptor agonists: Have associated side effects like headache, increased liver function tests and abnormal dreams.
5-alpha reductase inhibitors: Used for BPH, with associated side effects.
Anti-estrogen (like raloxifene): Prevents osteoporosis, primarily for post-menopausal women
Progesterone-based medications: Terminates pregnancy, and are also used in contraceptive methods

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Description

This quiz covers the essential aspects of SSRIs, FDA warnings, and their implications on mental health. It touches on the risks associated with these medications, especially regarding suicidal ideation in younger populations, as well as interactions with herbal supplements. Test your knowledge on these crucial topics related to antidepressant therapy.