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afya
SSRI
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> 1st line Rx for depression Citalopram or Fluoxetine are 1st choice Sertraline is useful post MI Be careful in children and adolescents - and if necessary use Fluoxetine ''SE'' GI most common Inc risk of GI bleed - if also taking NSAID, needs PPI Inc anxiety and agitation in few weeks post starting Fluoxetine and Paroxetine - more drug interactions ''Citalopram and QT interval'' - warning (MHRA) (also escitalopram) asssociated with dose dependant QT interval prolongation avoid if congenital long QT or known long QT or other drugs that prolong QT Max dose 40mg (or 20mg if >65yr or hepatic impairment ''Drug Interactions'' NSAID - avoid or give PPI as well warfarin / heparin - avoid - use Mirtazapine triptans - avoid When starting - review at 2/52 (1/52 if <30yr or inc suicide risk) If good response - continue for at least 6/12 post remission to reduce relapse risk when stopping tail dose over 4/52 (not necessary with fluoxetine) ''Discontinuation Sx (esp Paroxetine)'' Inc mood change restless difficulty sleeping unsteadiness sweating GI - pain, cramps, d&v paraesthesia
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