Drug Treatments in Psychiatry

• What SSRI is used in under 18s?

  Fluoxetine
• Which SSRI is most likely to lead to QT prolongation & Torsades de pointes?

  Citalopram
• Give 4 examples of tricyclic antidepressants (TCA).

  • Amitriptylline
  • Nortriptylline
  • Clomipramine
  • Lofepramine
• Tricyclic antidepressants are most severe in overdose.
• Give 4 examples of SSRIs.

  • Sertraline
  • Fluoxetine
  • Citalopram
  • Escitalopram
• Give 2 examples of SNRIs.

  • Venlafaxine
  • Duloxetine
• Give an example of noradrenaline and specific serotonin reuptake inhibitors (NASSA).

  Mirtazepine (doesn’t give sexual dysfunction side effects)
• Give an example of a serotonin antagonist and reuptake inhibitor.

  Trazadone
• What is the MOA of temazepam?

  Enhances effect of gamma-aminobutyric acid (GABA)
• How can tardive dyskinesia present?

  Chewing

  Jaw pouting

  Excessive blinking

  Due to late onset abnormal involuntary choreoathetoid movements in pts on conventional antipsychotics
• What kind of drug is mirtazapine?

  Antidepressants
• What kind of drug is venlafaxine?

  SNRI
• What type of drug is risperidone?

  Antipsychotic
• What are the adverse effects of SSRIs?


  Increased risk of GI bleeding
• What are the discontinuation symptoms of SSRIs?

  Increased mood change

  Restlessness

  Difficulty sleeping

  Unsteadiness

  Sweating

  GI symptoms (pain, cramping, diarrhoea, vomiting)

  Parasthesia
• Are SSRIs used in pregnancy?

  have to weigh up the risks & benefits

  1st trimester -> small increased risk of congenital heart defects

  3rd trimester -> can result in persistent pulmonary HTN
• What are the side effects of TCAs?


  Antagonism of histamine receptors

  • Drowsiness

  Antagonism of muscarinic receptors

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention

  Antagonism of adrenergic receptors

  • Postural hypotension
• SSRIs are associated with hyponatraemia.
• What are SNRIs?

  Serotonin and noradrenaline reuptake inhibitor
• What needs to be monitored when taking an SSRI?

  U&Es (Na+)
• SSRIs & monoamine oxidase inhibitors (MAOIs) should never be combined, due to risk of serotonin syndrome.
• What are the side effects of TCAs?

  Drowsiness

  Dry mouth

  Blurred vision

  Constipation

  Urinary retention

  Postural hypotension

  Lengthening of QT interval
• Patients who are 25 & older that have been started on an SSRI, should be reviewed after 1 week.
• What is the best antidepressant choice post-MI?

  Sertraline
• Which antipsychotic medication has the most tolerable side effect profile?

  Aripiprazole