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References 394 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 with a heightened risk of stroke recurrence for this reason. Stroke can be embolic or haemorrhagic – SSRIs may protect against the former46,47 and provoke the latter,48,49 although the...

Antidepressant prophylaxis

After first episode

Recurrent depression Depression and anxiety disorders CHAPTER 3 Antidepressant prophylaxis After first episode A single episode of depression should be treated for at least 6–9 months after full remission.1 If antidepressant therapy is stopped immediately on r...

Discontinuation of medium- and long-term antidepressants 398 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 (approximately equal to a halving of the absolute risk). A later meta-­analysis of 54 studies suggested that odds of relapse were reduced ...

Dose for prophylaxis

References Depression and anxiety disorders CHAPTER 3 treatment or to have antidepressants slowly stopped.29 After 1 year, relapse occurred in 56% of stoppers and 39% of continuers. There was clear evidence of withdrawal symptoms despite the slow withdrawal (p...

Drug interactions with antidepressants

Pharmacokinetic interactions Depression and anxiety disorders CHAPTER 3 Drug interactions with antidepressants Antidepressants are involved in a number of both pharmacokinetic and pharmacodynamic interactions. Pharmacokinetic interactions Pharmacokinetic inter...

Pharmacodynamic interactions 402 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Pharmacodynamic interactions Pharmacodynamic interactions arise when the effects of one drug are altered by another drug via mechanisms such as direct competition at ...

16. References Depression and anxiety disorders CHAPTER 3 (lumateperone and ziprasidone) and drugs of misuse such as MDMA (3,4-­methylene dioxymethamphetamine). ■ ■prevent the destruction of other monoamine neurotransmitters (e.g. catecholamines). Co-­prescrip...

Cardiac effects of antidepressants – summary

References Depression and anxiety disorders CHAPTER 3 SSRIs are generally recommended in cardiac disease but beware anti-­platelet activity and CYP-­medicated interactions with co-­administered cardiac drugs. Mirtazapine has been suggested as a suitable altern...

Antidepressant-induced arrhythmia Depression and anxiety disorders CHAPTER 3 Antidepressant-­induced arrhythmia Depression confers an increased risk of cardiovascular disease1 and sudden cardiac death.2 Possible factors include platelet activation, decreased h...

Use in at-risk patients

Relative cardiotoxicity 412 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Use in at-­risk patients There is clear evidence for the safety of sertraline46 and mirtazapine47 (and to a lesser extent, citalopram,47 fluoxetine48 and bupropion49) in p...

Summary

References Depression and anxiety disorders CHAPTER 3 Summary ■ ■Tricyclics (but not lofepramine) have an established link to ion channel blockade and cardiac arrhythmia, especially in overdose. ■ ■Non-­tricyclics generally have a very low risk of inducing arr...