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Ssri n snri

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Syed Shams
Health & Medicine
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SSRIs and SNRIs:In adults Dr. Syed Faheem Shams Student of MD (Part-II) Psychiatry, BSMMU
Depression ,[object Object],[object Object]
Prevalence in Bangladesh ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antidepressants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Neurotransmitter Receptor Hypothesis of Antidepressant Action Decreased state due to up-regulation of receptors Stahl S M, Essential Psychopharmacology (2000)
Neurotransmitter Receptor Hypothesis of Antidepressant Action Antidepressant blocks the reuptake pump, causing more NT to be in the synapse Increase in NT causes receptors to down-regulate Stahl S M, Essential Psychopharmacology (2000)
SSRIā€™s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fluoxetine Sertraline
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why selective?? ,[object Object],[object Object]
History Of SSRIā€™s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Serotonin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(McGraw-Hill Encyclopedia of Science and Technology, 2005)
Serotonin (contd.) ,[object Object],[object Object],[object Object],[object Object],[object Object]
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Other indications of SSRI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SNRIs ,[object Object],[object Object],[object Object]
Venlafaxine ,[object Object],[object Object],[object Object],Venlafaxine
Recognized minimum effective doses in MDD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recognized minimum effective doses ā€“ antidepressants (except TCAs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Licensed Dosing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Licensed Dosing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Plasma half life Fluvoxamine Paroxetine Sertraline Fluoxetine Escitalopram Citalopram 17-22h 24h 26h 4-6 days 30h 33h
Adverse Effects (A/Es) of SSRIs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse Effects (A/Es) of SSRIs Nausea+ Fluvoxamine Discontinuation sym++ Paroxetine A/E Sertraline Insomnia++ Agitation++ Rash+ Fluoxetine A/E Escitalopram Agitation, Insomnia Citalopram
Major interactions (CP 450 inhibitor) Fluoxetine Sertraline Fluvoxamine Paroxetine Citalopram Escitalopram Avoid - MAOi, St. Johnā€™s wort. Plasma level of some antipsychotics/some benzos/carbamazepine/TCAs plasma level of theophylline (Fluvo) Avoid - MAOi, St. Johnā€™s wort. Caution with alcohol, NSAIDā€™s, Warferin
Serotonin syndrome
Features of Serotonin Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Serotonin syndrome (contd.)
Serotonin syndrome (contd.)
Discontinuation Symptoms ,[object Object],[object Object]
Antidepressant-induced hyponatraemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antidepressant-induced hyponatraemia- monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Special situations ,[object Object],[object Object],[object Object],[object Object]
Special situations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Special situations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Special situations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Special situations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Special situations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key points that patients should know ,[object Object],[object Object],[object Object]
Key points that patients should know ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key points that patients should know ,[object Object],[object Object]
NICE guidelines on the treatment of depression ,[object Object],[object Object]
NICE guidelines on the treatment of depression ,[object Object],[object Object],[object Object],[object Object]
NICE guidelines on the treatment of depression ,[object Object],[object Object]
NICE guidelines on the treatment of anxiety disorders with SSRIs ,[object Object],[object Object],[object Object]
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Thank you allā€¦.
List of people with depression ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Ssri n snri

  • 1. SSRIs and SNRIs:In adults Dr. Syed Faheem Shams Student of MD (Part-II) Psychiatry, BSMMU
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  • 6. Neurotransmitter Receptor Hypothesis of Antidepressant Action Decreased state due to up-regulation of receptors Stahl S M, Essential Psychopharmacology (2000)
  • 7. Neurotransmitter Receptor Hypothesis of Antidepressant Action Antidepressant blocks the reuptake pump, causing more NT to be in the synapse Increase in NT causes receptors to down-regulate Stahl S M, Essential Psychopharmacology (2000)
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  • 23. Plasma half life Fluvoxamine Paroxetine Sertraline Fluoxetine Escitalopram Citalopram 17-22h 24h 26h 4-6 days 30h 33h
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  • 25. Adverse Effects (A/Es) of SSRIs Nausea+ Fluvoxamine Discontinuation sym++ Paroxetine A/E Sertraline Insomnia++ Agitation++ Rash+ Fluoxetine A/E Escitalopram Agitation, Insomnia Citalopram
  • 26. Major interactions (CP 450 inhibitor) Fluoxetine Sertraline Fluvoxamine Paroxetine Citalopram Escitalopram Avoid - MAOi, St. Johnā€™s wort. Plasma level of some antipsychotics/some benzos/carbamazepine/TCAs plasma level of theophylline (Fluvo) Avoid - MAOi, St. Johnā€™s wort. Caution with alcohol, NSAIDā€™s, Warferin
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Editor's Notes

  1. Difference f c nd s??Paroxetine== most A/Esā€¦Fluvoxamine- nausea
  2. antidepressants, which affect other monoamine neurotransmitters as well.
  3. 5-hydroxytryptamine 5-HT.. 14 distinct downstream serotonin receptors (5-HT receptors).
  4. Hypo nd midbrain e beshi
  5. They act upon two neurotransmitters in the brain that are known to play an important part in mood, namely, serotonin and norepinephrine. This can be contrasted with the more widely-used selective serotonin reuptake inhibitors (SSRIs), which act only on serotonin.
  6. Sertraline- 200max. Though >100mg no help. TCA- 75-100
  7. Life threatning
  8. CP450 inhibitors
  9. When SS occurs?
  10. Receptor reboundā€¦..Onset within 5 dayz f stopping treatment. Or during tapper or in missed doseā€¦.treatment??ā€“ mild- no rx others- reintroduce or another f same class with longer half life..
  11. SIADHā€¦ 5Ht regulation f ADHā€¦So SSRI n SNRI moreā€¦..
  12. citalopram
  13. Vascular injury------ platelet---- release f 5HT---- Vaso constricton. 5HT s a weak platelet aggregator. SSRI inhibit the 5HT transporter responsible fr uptake f 5HT n platelet
  14. Fluoxetine--- insulin req reduced, HBA1c improved, wt lossā€¦. Limited data n venla
  15. Citalopram- QT prolongā€¦. Dnt go fr SNRI. Toleranceā€¦bp
  16. 10 mg start n hepatic
  17. ā€“ active monitoring, individual guided self-help, CBT or exercise are preferred in these cases