Any person whose death occurs whilst under the mental health act, regardless of cause, must be reported to the coroner
NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI
Adverse effects of atypical antipsychotics
weight gain
clozapine is associated with agranulocytosis (see below)
hyperprolactinaemia
Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
It is advised that paroxetine be avoided during pregnancy unless the benefits outweigh the risk, as paroxetine can lead to an increased risk of congenital malformations
Acute dystonic reaction. Procyclidine will help to reverse the event. It belongs to a class of medication called anticholinergics that work by blocking acetylcholine. This helps decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson’s disease.
Acute dystonia secondary to antipsychotics is usually managed with procyclidine
Venlafaxine is a serotonin and noradrenaline reuptake inhibitor (SNRI).
Venlafaxine mechanism of action = serotonin and noradrenaline reuptake inhibitor
Mirtazapine is generally more sedating at lower BNF doses (e.g. 15mg) than higher doses (e.g. 45mg)
Tricyclic antidepressants can cause overflow incontinence (anticholinergic effect)
