Professional Documents
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Depression ST!s
Depression ST!s
A common GP consultation
10% of our pts,
80% managed in primary care
Assessment
Always HAD score/PHQ
Always risk assessment
Suicidal ideation (common to a degree)
What has/would stop you?
Drug/Etoh?
Consider other diagnosis (viral, anaemia,
endocrine)
Arrange review
Presentations
Low mood
Somatic symptoms and signs
Anxiety
Psychotic symptoms
Escitalopram
Citalopram
Fluoxetine
Paroxetine
Sertraline
Depression and what else?
OCD, general anxiety disorder, panic –
paroxetine (seroxat)
OCD, bulimia, PMT – fluoxetine (prozac)
OCD, PTSD – sertraline (lustral)
Panic, social anxiety disorder –
escitalopram/citalopram (cipralex)
(cipramil)
SSRI side effects
anxiety, panic attacks, nervousness
tremor, insomnia, hypersomnia
postural hypotension
palpitations
sexual dysfunction
pruritus, rash, sweating, yawning
nausea, vomiting, diarrhoea, dry mouth,
anorexia
increase in risk of gastrointestinal bleeding
Major Side effects
The 'Serotonin syndrome' consists of
confusion, agitation, hyperreflexia,
myoclonus, shivering, sweating, tremor,
fever, diarrhoea and inco-ordination.
This has been described as a possible
adverse effect common to all selective
serotonin reuptake inhibitors
Suicide risk
A systematic review has examined the
association between suicide attempts and
selective reuptake inhibitors (SSRIs). The
authors concluded that:
there was a documented association
between suicide attempts and the use of
SSRIs.
However several major methodological
limitations in the published trials
My favourites
1st line- usually citalopram/fluoxetine
(pct pref)
Cardiac pts – sertraline
Under 18, only fluoxetine (prob only spec
px)
Elderly, citalopram
If SSRI fails, consider ?compliance ?
duration ?dose increase to max, ?2nd line
2 line agents
nd