Precautions of SSRIs?
Reduced seizure threshold.
patients with a high bleeding risk (>80 or previous GI risk) SSRI's increase bleeding risk.
Serotonin toxicity - if an SSRI is taken within 14 days of finishing a MAOI. Or within 2 days of stopping metoclopramide).
Children - only use fluvoxamine or sertraline
CI in treatment with pimozide.
Adverse effects of SSRIs
Nausea, agitation, insomnia, drowsiness, tremor,
extrapyridimal reactions, sedation, confusion, hypotension, hyponaturaemia (as part of SIADH)
Doseage of citalopram??
max dose in elderly??
20mg once daily, increasing after 2-4 weeks to a max of 60mg daily for OCD or eating disorders
40mg max in elderly
For depression maintaince - not usually more than 20mg daily.
Dosage of escitalopram?
10mg once daily in the morning, icrease upto 20mg.
Dosage of fluoxetine?
- major depression?
-Obsessive compulsive disorder
-Premenstural dysphoric disorder
major depression - 20mg once daily, increasing upto 60mg daily if needed.
OCD - 20mg once daily
Panic Disorder - 10mg once daily
Premenstural disorder - 20mg daily (continious) or 20mg daily starting 14 days before menstuaraion until first full day of menstural cycle (cyclic)
Doses of Paroxetine?
Generalised anxiety disorder, social phobia, post-traumatic stress disorder?
Obsessive-compulsive disorder, panic disorder
GAD etc = 10mg once daily, increasing to 20mg daily after a week if required.
20mg once daily
Doses of Sertraline?
Depression - 50mg daily, increasing upto 200mg max.
Obsessive compulsive disorder - 25mg daily
Panic disorder - 25mg daily
Counselling for SSRI's
Take in the morning
Do not drive or operate machinery until you know how this medication affects you.
Do not stop taking this medication unless told to by the doctor
Tell doctors, pharmacists and any other medical team that you are taking this med since it can interact with many other meds
Dose of Mirtazepine?
5 mg at night, increasing gradually as indicated to 30–45 mg at night. Maximum 60 mg.